crossing96/oncoscreening huggingface dataset:
The clinical and economic costs of delirium after surgical resection for esophageal malignancy.	OBJECTIVE: The aim of this study was to identify preoperative risk factors and postoperative consequences that are associated with the occurrence of delirium after esophagectomy for malignancy. BACKGROUND: Delirium is an underdiagnosed, serious complication after major surgery, particularly in the elderly population. METHODS: All patients undergoing esophagectomy for cancer (1991-2011) were included. Patients with and without delirium were compared with respect to medical comorbidities, use of neoadjuvant therapy, operative outcomes, postoperative complications, overall cost, and survival. RESULTS: Of the 500 patients included in this analysis, 46 (9.2%) patients developed postoperative delirium. Patients with delirium had higher ASA and Charlson comorbidity index scores. Delirium was associated with a longer hospital (14 ± 7.5 vs 10.9 ± 5.7; P < 0.05) and intensive care unit stay (3.6 ± 3.8 vs 2.7 ± 16.9; P < 0.05) and an increased incidence of pulmonary complications and increased hospital costs. Delirium was preceded by another complication in 32.6% of cases but by a septic complication in only 19.6% of cases. Age was the only preoperative predictor of postoperative delirium in multivariate modeling (P < 0.05). No differences were noted in the use of neoadjuvant chemoradiotherapy or survival. CONCLUSIONS: This study demonstrates that postoperative delirium is associated with a more complicated and costly recovery after esophagectomy and that age is independently predictive of its development. Delirium has often been thought to be the sequela of other complications; however, this study demonstrates that it presents in isolation or precedes other complications in 67.4% of cases. Focused screening will likely allow targeted preventative strategies to be used in the perioperative period to reduce complications and costs associated with delirium.	esophagus
Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett's esophagus.	PURPOSE: Diet is a potentially modifiable risk factor for Barrett's esophagus (BE). We investigated the associations between intakes of fruits and vegetables and risk of BE. METHODS: We identified study subjects from 1,859 participants who underwent the endoscopy in a single VA Medical Center in the US between 2008 and 2011. Dietary intake in the previous year was elicited using a self-administered Block food frequency questionnaire (FFQ). Logistic regression model was used to estimate odds ratio (OR) and its 95 % confidence interval (CI) for BE. RESULTS: A total of 151 cases with definite BE and 777 controls completed the FFQ. When highest tertile of intake was compared with the lowest, the OR (95 % CI) was 0.46 (0.26-0.81) for dark green vegetables, 0.52 (0.30-0.90) for legumes, 0.50 (0.28-0.90) for total fiber, 0.45 (0.25-0.81) for isoflavones, 0.52 (0.30-0.67) for total folate, and 0.45 (0.26-0.79) for lutein, adjusting for multiple confounding factors including use of aspirin or proton pump inhibitor, gastro-esophageal reflux symptoms, and physical activity. The association for dark green vegetables was attenuated after adjustment for lutein, total fiber, and total folate (OR = 0.82; 95 % CI 0.30-2.22). CONCLUSION: Higher intake of dark green vegetables was associated with a decreased risk of BE in a veteran population. Such an inverse association may be partially mediated by lutein, fiber, and folate. The novel findings on the association between intake of lutein, total folate, or isoflavones and risk of BE need further confirmation.	esophagus
Expression status of fatty acid synthase (FAS) but not HER2 is correlated with the differentiation grade and prognosis of esophageal carcinoma.	BACKGROUND/AIMS: Fatty acid synthase (FAS) and human epidermal growth factor receptor 2 (HER2) are overexpressed in a series of cancers. However, few studies have investigated the potential role of FAS and HER2 in esophageal carcinoma. The aim of this study was to evaluate the expression of FAS and HER2 and the possible link between FAS/HER2 expression and the pathological prognostic variables. METHODOLOGY: The frequency of FAS and HER2 expression was determined immunohistochemically. The overall survival rate was analysed by the Kaplan-Meier method and the log-rank test using SPSS 17.0 software. RESULTS: The majority of the cases were esophageal squamous cell carcinomas (n=142). FAS and HER2 overexpression in the studied cases are 73.2% and 14.1%, respectively. There was a significant difference in FAS expression regarding tumor differentiation and FAS overexpression showed its prognostic value for patients with different tumor differentiation. Meanwhile, HER2 overexpression did not significantly relate to the clinicopathological characteristics of the tumors, with the only exception of the surgical margins. CONCLUSIONS: FAS and HER2 overexpression are common in esophageal carcinomas. FAS overexpression showed its prognostic value for esophageal carcinoma patients with different tumor differentiation, which lead us to consider FAS-inhibitors as potential candidates for target-based adjuvant therapies.	esophagus
[A case of far advanced-esophageal squamous cell carcinoma successfully treated with docetaxel].	A 65-year-old man with dysphagia and hoarseness was admitted to our hospital. The upper gastrointestinal examinations revealed a tumor in the lower esophagus while the biopsy specimens revealed squamous cell carcinoma. The clinical diagnosis was esophageal cancer(Lt, type 2, cT3N4M0, cStage IVa). The patient underwent neoadjuvant-chemotherapy(5-fluorouracil/cisplatin). After one course, computed tomography(CT)showed rapid growth of the tumor and lymph nodes, resulting in a progressive disease. It was considered unresectable because of the direct invasion of the No. 1 lymph node to the liver. Then, three courses of docetaxel were administered as second-line chemotherapy, and CT revealed the markedly reduced size of the tumor and lymph nodes, resulting in a partial response. The tumor was now thought to be resectable. Subtotal esophagectomy could be performed and the postoperative course was uneventful. Histopathological findings showed no evidence of malignancy at the primary tumor(grade 3), although there were residual atypical keratinocytes in some lymph nodes. The patient is doing well without any signs of recurrence 21 months after the surgery.	esophagus
Small cell neuroendocrine carcinoma of the esophagus: report of 6 cases with immunohistochemical and molecular genetic analysis of KIT and PDGFRA.	Small cell neuroendocrine carcinoma of the esophagus (SCNECE) is a very rare, but a highly aggressive tumor. Six cases of SCNECE (0.25%) were found in the 2,438 archival pathologic specimens of esophagus in the last 20 years in our pathology laboratory. The ages ranged from 62 years to 81 years with a mean of 73 years. All cases were male. The presenting symptoms were dysphagia in 5 cases and vomiting in 1 case. The locations were lower esophagus in 4 cases and middle esophagus in 2 cases. Endoscopically, the tumor was ulcerated in 3 cases and polypoid in 3 cases. All the 6 patients were treated by chemoradiation therapy, and the survival ranged from 6 months to 25 months with a mean of 13 months. Histologically, 5 cases were pure SCNECE, 1 case showed triplicate differentiation into small cell carcinoma, adenocarcinoma and squamous cell carcinoma. Immunohistochemically, each SCNECE showed at least one of the neurocrine antigens. Cytokeratins were positive in 6/6, vimentin 0/6, synaptophysin in 4/6, CD56 4/6, neuron-specific enolase 3/6, chromogranin 0/6, p53 protein in 6/6, KIT in 6/6, and platelet-derived growth factor receptor-α (PDGFRA) in 6/6. Ki-67 labeling ranged from 56% to 100% with a mean of 79%. A retrospective genetic analysis using PCR-direct sequencing method in paraffin sections identified no mutations of KIT (exons 9, 11, 13 and 17) and PDGFRA (exons 12 and 18) genes in all the 6 cases.	esophagus
Substance use (alcohol, areca nut and cigarette) is associated with poor prognosis of esophageal squamous cell carcinoma.	BACKGROUND: Few studies have reported the association between lifestyle factors and prognosis of esophageal squamous cell carcinoma (ESCC) and among these, the effects of habitual areca nut chewing have never been examined. METHODOLOGY/PRINCIPAL FINDINGS: Data from 718 pathology-proven ESCC patients recruited in a multicenter hospital-based case-control study between 2000 and 2008 in Taiwan were analyzed. Clinical and lifestyle information were obtained by chart review and questionnaire survey. Death was confirmed using the National Death Index. The mean age at diagnosis was 59.8 years and 506 (70.5%) patients presented with stage III or IV diseases. The overall 1- and 5-year survival rates were 41.8% and 9.75% respectively. In addition to clinical stage, habitual alcohol drinking was found to be the strongest predictor for ESCC survival, followed by areca chewing and smoking. Compared with non-users, patients who regularly used all three substances (alcohol, areca nut, and cigarette) had 1.52 times the risk of early death (adjusted hazard ratio = 1.52, 95% CI = 1.02-2.27, p = 0.04). In addition, the more the number of substances used, the worse the prognosis of ESCC (adjusted p for trend = 0.01). CONCLUSIONS/SIGNIFICANCE: Our study found that indulgence in more substances is a significant predictor of ESCC survival. Further mechanistic studies are necessary to elucidate how these substances lead to an adverse outcome.	esophagus
Scalp metastasis from esophageal adenocarcinoma: comparative histopathology dictates surgical approach.	Cutaneous metastasis of esophageal cancer, in particular esophageal adenocarcinoma, is rare and metastasis to the scalp is extremely rare. We describe such a case that was originally diagnosed as an adnexal carcinoma. A 77-year-old male with a history of esophageal adenocarcinoma status after esophagectomy at our institution 4.5 years prior, presented to our plastic surgery clinic with a 2-month history of 2 temporoparietal scalp lesions. He was referred to our clinic by a community dermatologist who had performed a shave biopsy of the lesions. The clinical diagnosis was adnexal cyst. The history of esophageal carcinoma was not provided to the pathologist. The dermatopathology report came back as malignant adnexal neoplasm and considerations included apocrine carcinoma. We reexamined the pathologist's slides from the outside facility, comparing them to the histopathology from his esophagectomy. Histopathologic changes were identical. Thus, our surgical and postoperative approach changed significantly. Clinical suspicion should be high for cutaneous metastases in patients with a history of solid organ cancers. It is important for clinicians to illicit a history of malignancy. A biopsy should be performed on any suspicious lesions, and clinical data along with histopathology of the prior cancer resection(s) should be provided to the pathologist for comparison. Diagnosis of the suspicious lesion should be made before definitive excision, as this may change the approach, with the potential for postoperative chemotherapy and radiation. The definitive operative approach consists of surgical debulking with the evidence of negative margins. On the scalp, we feel that 5-mm margins are appropriate to obtain clear margins. One should appreciate the subdermal extent of metastases and adjust the margins accordingly. We recommend excising the galea with the skin as an en bloc resection. This will both assure clear deep margins of resection and assist in a tension-free closure of the scalp.	esophagus
A randomized phase II study of PEP02 (MM-398), irinotecan or docetaxel as a second-line therapy in patients with locally advanced or metastatic gastric or gastro-oesophageal junction adenocarcinoma.	BACKGROUND: PEP02 is a novel highly stable liposomal nanocarrier formulation of irinotecan. This randomized phase II study evaluated the efficacy and safety of single agent PEP02 compared with irinotecan or docetaxel in the second-line treatment of advanced oesophago-gastric (OG) cancer. PATIENTS AND METHODS: Patients with locally advanced/metastatic disease who had failed one prior chemotherapy regimen were randomly assigned to PEP02 120 mg/m(2), irinotecan 300 mg/m(2) or docetaxel (Taxotere) 75 mg/m(2) every 3 weeks. The primary end point was objective response rate (ORR). Simon's two-stage design was used and the ORR of interest was 20% (α = 0.05, type II error β = 0.10, null hypothesis of ORR was 5%). RESULTS: Forty-four patients per arm received treatment, and 124 were assessable for response. The ORR statistical threshold for the first stage was reached in all arms. In the intent-to-treat (ITT) population, ORRs were 13.6% (6/44), 6.8% (3/44) and 15.9% (7/44) in the PEP02, irinotecan and docetaxel arms, respectively. The median progression-free survival (PFS) and overall survival were similar between the trial arms. Commonest grade 3-4 adverse event reported was diarrhoea in the PEP02 and irinotecan groups (27.3% versus 18.2%). CONCLUSION: The ORR associated with PEP02 was comparable with docetaxel and numerically greater than that of irinotecan. PEP02 warrants further evaluation in the advanced gastric cancer setting.	esophagus
Endoscopic diagnostic strategy of superficial esophageal squamous cell carcinoma.	The prognosis of the esophageal squamous cell carcinoma is still poor. Early detection is ideal to improve patient survival. In particular, superficial cancer limited within the mucosal layer is a good candidate for minimally invasive treatment by endoscopic resection with curative intent. However, an effective endoscopic diagnostic strategy is not established worldwide. Herein, we review the published papers on this subject.	esophagus
President's address of the 65th annual scientific meeting of the Japanese Association for Thoracic Surgery: challenges for advanced esophageal cancer.	"Advanced esophageal tumors have been a challenge for surgery since the very beginning, and these challenges continue still today. In the early period of three-field lymphadenectomy (late 1980s), there was no special attention paid to tracheal necrosis after such an extended operation. In 1988, we reported functional mediastinal dissection preserving the right bronchial artery to prevent such complications. In 1993, we reported that the survival after three-field lymphadenectomy was better than that after en-bloc esophagectomy, and then the lymph node compartment classification based on the metastatic rate and the survival rate. This concept was introduced into the 9th edition of the Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus published in 1999. In early 1980s, combined resection of the neighboring organs was initiated for a locally advanced esophageal cancer. Almost all patients who underwent such an operation, however, died of metastasis in the short-term after surgery without any additional treatment. In 1987, we reported several types of tracheal repair using the latissimus dorsi muscle flap, as a less-invasive surgery that enabled adjuvant or additive therapy, after resection of the trachea involved by cancer. Then in 2004, we demonstrated that the canine aorta could be resected even immediately after aortic stenting. This suggests that an esophageal cancer involving the aorta can be resected using a new technique. To meet the challenges posed by advanced esophageal cancer, the help of other specialized fields besides esophageal surgery is needed: ""The specialist must know everything of something, something of everything."""	esophagus
Primary esophageal and gastro-esophageal junction cancer xenograft models: clinicopathological features and engraftment.	There are very few xenograft models available for the study of esophageal (E) and gastro-esophageal junction (GEJ) cancer. Using a NOD/SCID model, we implanted 90 primary E and GEJ tumors resected from patients and six endoscopic biopsy specimens. Of 69 resected tumors with histologically confirmed viable adenocarcinoma or squamous cell carcinoma, 22 (32%) was engrafted. One of 11 tumors, considered to have had a complete pathological response to neo-adjuvant chemo-radiation, also engrafted. Of the 23 patients whose tumors were engrafted, 65% were male; 30% were early stage while 70% were late stage; 22% received neo-adjuvant chemo-radiation; 61% were GEJ cancers. Engraftment occurred in 18/54 (33%) adenocarcinomas and 5/16 (31%) squamous cell carcinomas. Small endoscopic biopsy tissue had a 50% (3/6) engraftment rate. Of the factors analyzed, pretreatment with chemo-radiation and well/moderate differentiation showed significantly lower correlation with engraftment (P<0.05). In the subset of patients who did not receive neo-adjuvant chemo-radiation, 18/41 (44%) engrafted compared with those with pretreatment where 5/29 (17%, P=0.02) engrafted. Primary xenograft lines may be continued through 4-12 passages. Xenografts maintained similar histology and morphological characteristics with only minor variations even after multiple passaging in most instances.	esophagus
Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma.	OBJECTIVES: Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma. METHODS: From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2). RESULTS: The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001). CONCLUSIONS: The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.	esophagus
Prospective, open, multi-centre phase I/II trial to assess safety and efficacy of neoadjuvant radiochemotherapy with docetaxel and oxaliplatin in patients with adenocarcinoma of the oesophagogastric junction.	BACKGROUND: This phase I/II-trial assessed the dose-limiting toxicities (DLT) and maximum tolerated dose (MTD) of neoadjuvant radiochemotherapy (RCT) with docetaxel and oxaliplatin in patients with locally advanced adenocarcinoma of the oesophagogastric junction. METHODS: Patients received neoadjuvant radiotherapy (50.4 Gy) together with weekly docetaxel (20 mg/m(2) at dose level (DL) 1 and 2, 25 mg/m(2) at DL 3) and oxaliplatin (40 mg/m(2) at DL 1, 50 mg/m(2) at DL 2 and 3) over 5 weeks. The primary endpoint was the DLT and the MTD of the RCT regimen. Secondary endpoints included overall response rate (ORR) and progression-free survival (PFS). RESULTS: A total of 24 patients were included. Four patients were treated at DL 1, 13 patients at DL 2 and 7 patients at DL 3. The MTD of the RCT was considered DL 2 with docetaxel 20 mg/m(2) and oxaliplatin 50 mg/m(2). Objective response (CR/PR) was observed in 32% (7/22) of patients. Eighteen patients (75%) underwent surgery after RCT. The median PFS for all patients (n = 24) was 6.5 months. The median overall survival for all patients (n = 24) was 16.3 months. Patients treated at DL 2 had a median overall survival of 29.5 months. CONCLUSION: Neoadjuvant RCT with docetaxel 20 mg/m2 and oxaliplatin 50 mg/m(2) was effective and showed a good toxicity profile. Future studies should consider the addition of targeted therapies to current neoadjuvant therapy regimens to further improve the outcome of patients with advanced cancer of the oesophagogastric junction. TRIAL REGISTRATION: NCT00374985.	esophagus
Long-term survival of advanced small cell carcinoma of the esophagus after resection: a case report.	BACKGROUND: Small cell carcinoma of the esophagus is a rare and rapidly lethal disease. The mean survival for patients with advanced disease is 5.3 months, and only 10% live longer than one year. CASE REPORT: We report a very unusual case in which a patient diagnosed with advanced disease is still alive 96 months after being treated by surgery-alone. This patient is a 61-year-old woman who was referred to our hospital with the chief complaints of dysphagia and vomiting. Endoscopy revealed a huge type-3 tumor on the abdominal esophagus invading the gastric cardia. Histopathology established the diagnosis of small cell carcinoma; computed tomography did not detect metastatic cells in the lymph nodes or other distant sites. We therefore performed radical resection, involving a lower esophagectomy, total gastrectomy, and splenectomy with regional lymph node dissection. The initial diagnosis of small cell carcinoma was confirmed, and classified as type-3 (13.8×7.5 cm), T3N1M0, stage III with invasion to the adventitia (T3) and lymph node metastases along the lesser curvature of the stomach (N1). Postoperative adjuvant chemotherapy using tegafur, gimestat, and otastat was discontinued due to poor tolerance, and the patient developed severe anorexia. The patient remains alive at the time of writing eight years and four months post-surgery, with no evidence of tumor. CONCLUSION: To our knowledge, this is the longest survival reported for a case of advanced small cell carcinoma of the esophagus treated by surgery-alone.	esophagus
Chemoradiotherapy in the management of locally advanced squamous cell carcinoma esophagus: is surgical resection required?	PURPOSE: The present study aims to evaluate benefit of adding surgery to chemoradiotherapy alone in management of carcinoma esophagus. METHODS: We retrospectively analyzed 45 eligible patients of squamous cell esophageal carcinoma which were enrolled from February 2008 to April 2009. All patients were treated with chemoradiotherapy (50.40 Gy with 40 mg/m(2) of weekly cisplatin). Tumor response was assessed after 6 weeks of treatment. Patients with resectable disease were subjected to surgical resection (arm A) and remaining was kept on regular clinical follow-up (arm B). Overall survival (OS) was selected as the primary endpoint. The secondary end points were disease-free survival (DFS) and clinical toxicities. RESULTS: Median follow-up was 13.6 months. Pathological complete response was seen in 60.9 % patients in arm A. In arm B, 77.3 % patients attained radiological complete response (p = 0.194). The median OS was 16.4 and 19.1 months (p = 0.388) and median DFS was 5.8 and 4.1 months (p = 0.347) in arm A and B, respectively. The 2-year survival probability was 39.1 and 36.4 % (p = 0.387) in arm A and B, respectively. The recurrence probability was 56.5 % (SE = 5.6 %) and 45.5 % (SE = 4.2 %) (p = 0.328) in arm A and B, respectively. The probability of loco regional recurrence was more in arm B than in arm A (p = 0.002). CONCLUSIONS: The study suggests that there is no difference in clinical toxicity profiles or survival outcomes with either definitive chemoradiotherapy or chemoradiation followed by surgery in management of locally advanced esophageal cancer.	esophagus