bluuebunny/crossref_metadata_2025_split huggingface dataset:
173. POSTOPERATIVE CHEMORADIATION FOR LOCAL ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA WITH LOW MEAN PLATELET VOLUME
Authors: Wang Qifeng , Wu Lei , Zhu Jie , Ni Wenjie , Chang Xiao , Xiao Zefen , Han Yongtao 
Published: September 2022

Abstract
To develop mean platelet volume (MPV) as a biomarker to predict prognosis and guide postoperative chemoradiation (POCRT) in patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC).
We proposed a blood biomarker, MPV, for predicting disease-free survival (DFS) and overall survival (OS) in LA-ESCC patients who underwent surgery (S) alone or S + POCRT. The median cut-off value of MPV was 11.4 fl. We further evaluated whether MPV could guide POCRT in the study and external validation groups. We used multivariable Cox proportional hazard regression analysis, Kaplan–Meier curves, and log-rank tests to ensure the robustness of our findings.
In the develop group, MVP was associated with OS and DFS defined by clinicopathological variables and remained an independent prognostic factor in the multivariate analysis (p = 0.001 and p = 0.002, respectively). For high MVP, 5-year OS and DFS were significantly improved compared to those with low MPV (p = 0.0011 and p = 0.0018, respectively). Subgroup analysis revealed that POCRT was associated with improved 5-year OS and DFS compared with S alone in the low-MVP group (p &lt; 0.0001 and p = 0.0002, respectively). External validation group analysis (n = 112) showed that POCRT significantly increased 5-year OS and DFS (p = 0.0035 and p = 0.0062, respectively) in patients with low MPV.
MPV as a novel biomarker can improve prognostic prediction and help identify patients most likely to benefit from POCRT for LA-ESCC.
178. NEOADJUVANT CHEMORADIOTHERAPY VERSUS CHEMOTHERAPY FOR GASTROESOPHAGEAL JUNCTION ADENOCARCINOMA; WHICH IS THE OPTIMAL TREATMENT OPTION?
Authors: Farinha Hugo Teixeira , Zandirad Eric , Barberà-Carbonell Beatriz , Demartines Nicolas , Schäfer Markus , Mantziari Styliani 
Published: September 2022

Abstract
Patients with locally advanced gastroesophageal junction (GEJ) adenocarcinoma are treated either with either perioperative chemotherapy (CT) or preoperative radiochemotherapy (RCT) followed by surgery. However, specific selection criteria of one modality over the other still lack, as comparative data for their efficacy remain scarce. The aim of this study was to compare pathologic response and long-term outcomes in GEJ adenocarcinoma patients treated with neoadjuvant RCT versus CT.
All patients with locally advanced GEJ adenocarcinoma treated with neoadjuvant treatment (NAT) followed by surgery between 2009 and 2018 in our tertiary referral center were retrospectively analyzed. The x2 or Fisher test were used to compare categorical, and the Mann–Whitney-U test continuous variables. Survival and tumor recurrence were compared with the Kaplan Meier method and log-rank test. Multivariate logistic and Cox regression were performed to identify independent predictors of complete pathological response and long-term survival.
Among the 94 included patients, 67 (71.2%) received RCT and 27 CT. Complete pathologic response was more frequent in RCT patients (13.4% vs 7.4%, p = 0.009), who had a trend to better lymph node control (ypN0) (55.2% vs 33.3%; p = 0.057), but similar rates of R0 resection (66.7% vs 72.1% CT, p = 0.628). RCT patients had more postoperative cardiovascular complications (35.8% vs 11.1%; p = 0.017). Long-term overall and disease-free survival were similar in the two groups (5-year OS 61.1% RCT vs 75.7% CT, p = 0.259; 5-year DFS 33.5% RCT vs 22.8% CT; p = 0.763). NAT type was not independently associated with pathologic response nor long-term survival.
Patients with locally advanced GEJ adenocarcinoma demonstrated higher rates of complete pathologic response after neoadjuvant RCT than CT and a trend to superior locoregional lymph node sterilization, although this did not translate in a significant survival or recurrence benefit.
184. THE PROGNOSTIC VALUE AND MOLECULAR PROPERTIES OF TERTIARY LYMPHOID STRUCTURES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Wen Jing , Ling Yihong , Zhong Jian , Weng Zelin , Lin Guangrong 
Published: September 2022

Abstract
Tertiary lymphoid structures (TLSs) play key roles in tumor adaptive immunity. However, the prognostic value and molecular properties of TLSs in esophageal squamous cell carcinoma (ESCC) patients have not been studied.
The prognostic values of the presence and maturation status of tumor-associated TLSs were determined in 394 and 256 ESCCs with hematoxylin and eosin (H&E)-stained slides from Sun Yat-sen University Cancer Center (SYSUCC) and Cancer Hospital of Shantou University Medical College (SUMCCH), respectively. A deep-learning TLS classifier was established with H&E-stained slides using inception-resnet-v2 neural network. Digital spatial profiling (DSP) was performed to determine the cellular and molecular characteristics of TLSs in ESCCs.
Immature and mature TLSs were observed in 30.2% and 42.9% ESCCs from SYSUCC by pathological examination. The deep-learning TLSs classifier yielded an area under curve value of 0.975 for patients’ mature TLS detection in the external test set, by which 55.1% ESCCs from SUMCCH were identified with mature TLSs. The presence of mature TLSs associated with an earlier pT-stage and improved survival. Mature TLSs were characterized by increased proportions of proliferating B, plasma, and CD4+ Th cells, and increased B memory, CD4+ T activated and effector memory, and Th17 signatures. TLS-mature ESCCs were with increased intratumoral CD8+ T infiltration.
Mature TLSs provide a privileged microniche for B and T cell differentiation and maturation, thereby generating an effective anti-tumor humoral and cellular immunity to improve ESCC prognosis.
187. ADENOCARCINOMA OF DISTAL ESOPHAGUS AND ESOPHAGO-GASTRIC JUNCTION: CROSS VERSUS FLOT PROPENSITY SCORE MATCHING ANALYSIS OF SURVIVAL IN A SINGLE-CENTER INSTITUTION
Authors: Lombardi Pietro Maria , Marano Salvatore , Basato Silvia , Pansa Andrea , Giorgi Lorenzo , Perano Vittoria , Castoro Carlo 
Published: September 2022

Abstract
Multimodal treatments are the gold standard for advanced resectable gastroesophageal cancer. The exclusive neoadjuvant, chemoradiation-based CROSS regimen and the perioperative chemotherapy-based FLOT regimen are commonly adopted for adenocarcinoma of distal esophagus and esophago-gastric junction (EGJ). At present, there is no clear evidence of the superiority of either of these two approaches on survival.
An intention-to-treat analysis was performed on a cohort of consecutive patients who underwent neoadjuvant CROSS or FLOT regimen and subsequently confirmed to curative-intent surgery for adenocarcinoma of distal oesophagus and EGJ between August 2017 and October 2021. Propensity Score Matching (PSM) was performed in order to balance baseline characteristics of patients undergoing CROSS and FLOT neoadjuvant regimen. The primary endpoint was Overall Survival (OS). Secondary endpoints included Disease-Free Survival (DFS), 90-day morbidity rate, margin status, incidence and pattern of recurrence. Subgroup analyses were performed according to the specific neoadjuvant regimen adopted.
Of the 111 patients included, 84 were correctly matched after PSM, 42 in each group. CROSS and FLOT patients showed similar 1-year OS rate (85.3% and 85.4% respectively, p = 0.189) and 1-year DFS rate (73.3% and 81.3% respectively, p = 0.267). When compared to FLOT patients, CROSS patients reported lower but not significant rates of post-operative severe complications (4.8% vs 11.9%, p = 0.433) and negative margins of resection (95.2% vs 97.6%, p = 1.000). In the CROSS group, 89% of recurrences occurred outside the radiation field. In FLOT group, 69% of patients completed all the 8 expected perioperative cycles.
FLOT and CROSS offer similar OS and DFS, together with comparable 90-day morbidity/mortality rates and pathological findings. Both regimens are affected by specific limitations that have to be kept in mind during treatment assessment. The results of ongoing Randomized Controlled Trials are urgently awaited.
200. SAFETY AND EFFICACY OF CONVERSION SURGERY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Tsuji Takayuki 
Published: September 2022

Abstract
Recently, cases of conversion surgery for unresectable esophageal cancer are increasing. Last year, in Japan, Cisplatin +5-FU (CF) + Pembrolizumab is recommended as 1st line therapy for unresectable esophageal squamous cell carcinoma (ESCC), based on the results of the KEYNOTE 590 trial. With improvement of response rate, conversion surgery is expected to become a main option for treatment strategy for unresectable ESCC.
【Methods】&lt;100.
In our institute, conversion surgery is considered for patients with para-aortic lymph node-positive advanced ESCC who have no other distant metastases, if the para-aortic lymph node metastases have disappeared after systemic chemotherapy. There were 30 patients of unresectable esophageal cancer with positive para-aortic lymph node metastasis from 2011 to 2020. Seven of these patients showed disappearance of para-aortic lymph node metastasis and underwent conversion surgery. Characteristics, short-term and long-term results of these seven cases are studied.
All of the seven patients who had para-aortic lymph node metastases were treated with induction DCF (Docetaxel + CF) as initial treatment. After disappearance of para-aortic lymph node metastases, thoracoscopic or open esophagectomy was performed. Four patients (57%) had Clavien-Dindo grade 2 or 3 complications, but no perioperative death was observed. Three patients (43%) had recurrence, within mediastinum lymph node, abdominal lymph node or adrenal gland. 3-year DFS was 57% and 3-year OS was 83%.
Conversion surgery is safe and feasible in cases that responded to systemic chemotherapy. Some cases showed good prognosis. Long-term survival is expected with conversion surgery.
201. PREDICTION OF LYMPH NODE METASTASIS IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA USING GENETIC SIGNATURES FROM LARGE-SCALE GENOMIC REPERTOIRES
Authors: Kang Xiaozheng , Wan Zhiyi , Zhang Ruixiang , Zhang Enli , Zhao Yahui , Qi Shu , Chen Xiankai , Qin Jianjun , Li Yin 
Published: September 2022

Abstract
The presence of lymph node metastasis puts patients with resectable esophageal squamous cell carcinoma (ESCC) at a high risk of disease recurrence, and these patients would benefit from neoadjuvant treatment. However, current clinical staging is not enough to capture all patients with high-risk disease, and novel diagnostic tools are required to improve the accuracy of treatment planning. We tried to explore a better prediction using genomic features from large-scale gene mutation data.
The major public data repositories of whole-exome sequencing for ESCC were involved in this study. The absolute differences in gene mutation frequency were calculated using Fisher’s exact test in nodal negative versus nodal positive patients. The classification of gene mutation status was dichotomized as wild-type and mutant type. To find a reliable gene panel that could provide sufficient population coverage, we set the cut-off level above 85% in both nodal phenotypes. The genomic classifier for nodal metastasis risk prediction was further generated by LASSO logistic regression analysis with 10-fold cross-validation based on the topmost significantly different genes.
Above the threshold values, a total of 120 differentially mutated genes were identified in the 561 ESCC genomic sequencing data. The population coverage rates were 85.97% in the nodal positive group (n = 335) and 88.05% in the nodal negative group (n = 226), respectively. According to the LASSO logistic regression approach, a panel of 112 topmost relevant genes (termed LNM112) was selected. The receiver operating characteristic curve of the LNM112 predictive model was plotted with an area under the curve value of 0.95 (95% CI: 0.93–0.96). The sensitivity and specificity of the LNM112 model were 96.72% (324/335) and 71.24% (161/226), respectively.
We identified a genomic signature (112 genes) from the large-scale genomic repertoires capable of predicting lymph node metastasis in ESCC. It can be incorporated into the current staging modalities to help inform treatment decisions, and external validation is warranted in different populations.
205. PREDICTORS OF THE DIFFICULTY OF TRANSCERVICAL SUBCARINAL LYMPH NODE DISSECTION IN ESOPHAGEAL CANCER
Authors: Furuke Hirotaka , Fujiwara Hitoshi , Konishi Hirotaka , Shiozaki Atsushi , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Morimura Ryo , Ikoma Hisashi , Kuriu Yoshiaki , Kubota Takeshi , Okamoto Kazuma , Otsuji Eigo 
Published: September 2022

Abstract
Transmediastinal radical esophagectomy (TME) is a new minimally invasive approach without thoracotomy. However, transcervical dissection of subcarinal lymph nodes (SCLN) is challenging. The shape or narrowness of the mediastinal space, especially around the aortic arch to tracheal bifurcation, may affect the difficulty. The present study aimed to clarify predictors for the difficulty of transcervical SCLN dissection.
Patients who underwent TME between 2016 and 2019 were included (n = 126). Four indicators, the cervical angle, carina distance, aorta distance, and sternum distance, were defined as indicators of the mediastinal narrowness by 3D-CT. The relationship between the difficulty of the transcervical SCLN dissection and clinicopathological features, including the above indicators, were investigated.
In a univariate analysis, the cervical angle (p = 0.023), aorta distance (p = 0.002), and middle thoracic tumor (p = 0.040) correlated with the difficulty. The median cervical angle (degree) and aorta distance (mm) were 15 and 33 in difficult cases, and 19 and 43 in easy cases, respectively. In a multivariate analysis, middle thoracic tumor (odds ratio: 3.28, p = 0.050) and a short aorta distance (odds ratio: 5, p = 0.036) were independent predictive factors.
The cervical angle, aorta distance, and middle thoracic tumor may predict the difficulty of transcervical SCLN dissection. In difficult cases, transhiatal approach is essential for safe lymphadenectomy.
209. THE EFFECT OF ENHANCED RECOVERY AFTER MINIMALLY INVASIVE ESOPHAGECTOMY: A RANDOMIZED CONTROLLED TRIAL
Authors: Shen Yaxing , Wang Hao , Fang Yong , Yin Jun , Tan Lijie 
Published: September 2022

Abstract
The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes in patients undergoing minimally invasive esophagectomy (MIE) for esophageal cancer.
Patients with esophageal cancer undergoing MIE between March 2016 and August 2018 were enrolled. Patients were randomly divided into 2 groups: ERAS+ group that received a guideline-based ERAS protocol, and ERAS- group that received standard care. The primary endpoint was morbidity after MIE. The secondary endpoints were the length of hospital stay and time to ambulation after the surgery. The perioperative results were also collected and compared.
A total of 60 patients in the ERAS+ group and 58 patients in the ERAS- group were included. Demographic and clinical features were similar between the groups. Postoperatively, the overall morbidity rate was lower in the ERAS+ group (33.3% vs. 51.7%; p = 0.04), as was the pulmonary complication rate (16.7% vs. 32.8%; p = 0.04). The ERAS+ group began ambulation at a mean of 2.8 days, as compared to 3.3 days for the ERAS- group (P = 0.001). The length of hospital stay was similar between the groups (9 days vs. 9 days; p = 0.70).
Implementation of an ERAS protocol for patients undergoing MIE resulted in earlier ambulation and lower complications, without a further change in overall length of hospital stay.
217. LAPAROSCOPIC FUNDOPLICATION EFFECTIVE IN TREATING REFLUX MICRO-ASPIRATION
Authors: Khoma Oleksandr , Van der Wall Hans , Falk Gregory L 
Published: September 2022

Abstract
Pulmonary micro-aspiration has become increasingly recognised subtype of severe gastro-oesophageal reflux disease (GORD). Acid suppression can help with symptoms in proportion of patients, however, does not reduce pulmonary contamination with gastric content. Laparoscopic fundoplication was found to be effective in reducing rates of reflux micro-aspiration.
The aim of this study was to examine outcomes of surgical treatment of GORD in patients with confirmed reflux micro-aspiration on novel reflux scintigraphy.
Data was extracted from prospectively populated single centre database. Patients with confirmed reflux aspiration by validated novel protocol scintigraphy and treated with laparoscopic 360-degree Nissen fundoplication between 2006–2018 were included. Primary outcome was resolution of reflux micro-aspiration on post-operative scintigraphy. Secondary outcomes included manometry and scintigraphy findings associated with ongoing aspiration, surgical complications, and patient-reported quality of life outcomes.
Inclusion criteria were met by 159 patients (66% female); average age 58 (SD 14, range 18–88). Most common presenting symptoms were regurgitation and cough.
Laparoscopic fundoplication was associated with resolution of reflux micro-aspiration in 138 (86.8%) of patients. Strongest predictors of persistent aspiration following surgery were severe ineffective oesophageal motility (p = 0.001) and reduced oesophageal clearance (p = 0.003).
Complications (Clavien-Dindo grade III and above) occurred in 4 patients (2.5%). There was no perioperative death in this cohort.
Patient satisfaction rate with surgery was 94%.
Laparoscopic fundoplication is effective in treating reflux micro-aspiration with best outcomes observed in patients with normal oesophageal motility and good oesophageal clearance.
219. DIFFERENT CLINICAL SYMPTOM PATTERNS IN PATIENTS WITH REFLUX MICRO-ASPIRATION CONFIRMED BY NEW PULMONARY ASPIRATION SCINTIGRAPHY TECHNIQUE
Authors: Khoma Oleksandr , Park Jin-soo , Lee Felix , Van der Wall Hans , Falk Gregory L 
Published: September 2022

Abstract
Little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.
Data was extracted from a prospectively populated database of patients referred to a tertiary centre with severe refractory, or atypical reflux (laryngopharyngeal reflux). Patients with reflux micro-aspiration on new technique scintigraphy were included. A comparator group of patients with proven proximal reflux to the level of pharynx when supine and/or upright was also included.
Inclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59, range 17–88).
Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing.
Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).
Combination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration. Atypical reflux symptoms may result from IBS-type abnormality.
223. INTRAOPERATIVE PYLOROPLASTY DURING OESOPHAGECTOMY: A 12 YEAR TERTIARY CENTRE EXPERIENCE
Authors: Chaudhury Madhu , Shetty Vinutha Daya , Ball Chris , Ward Jeremy , Turner Paul , Pursnani Kish , Singh Mohan 
Published: September 2022

Abstract
Delayed gastric emptying (DGE) is a known complication following oesophagectomy with gastric conduit reconstruction. Pyloroplasty is often performed to mitigate the consequences of DGE. It remains contentious whether performing a pyloroplasty has a significant role in reducing DGE. We discuss our twelve-year experience at a single centre routinely performing Heineke-Mikulicz pyloroplasty for all oesophagectomies.
This retrospective study employed an electronic database containing information on all patients who underwent elective Ivor Lewis oesophagectomies from April 2009 to December 2021 in a tertiary upper gastrointestinal cancer centre. Across six surgeons in the centre, a standardised pyloroplasty technique was performed. DGE was defined as patients who had high nasogastric output (&gt; 1.5 litres per day) after ten post-operative days or required endoscopic pyloric balloon dilatation within one year following oesophagectomy.
578 patients underwent Ivor Lewis oesophagectomy during the study period. The mean age was sixty years and the male to female ratio was 1.8:1. The median length of stay was 13 days (3–148). DGE was seen in 9.9% (n = 57) patients. Of these patients, 39.7% (n = 29) cases required oesophageal dilatation within 12 months after their oesophagectomy. 50.8% (n = 21) required in-patient endoscopic dilatation, 14.0% (n = 8) required out-patient endoscopic dilatation. From those who developed DGE, the 30- and 90-day mortality was nil. There were 1.2% (n = 7) leaks specifically from the pyloroplasty which were all managed conservatively.
The rate of delayed gastric emptying is reported to be approximately 15% (Zhang & Zhang, 2018). Our study demonstrates that performing a pyloroplasty reduces this risk to 9.9% and is worthwhile as the complication rate from pyloroplasty is low. Although there are various methods employed in overcoming pyloric sphincter denervation following oesophagectomy (pyloroplasty, pyloromyotomy, digital or instrumental pyloric stretching or intra-operative balloon dilatation), the most effective method of reducing DGE warrants a randomised control trial.