tbuckley/cabot-search huggingface dataset:
Real-world validation of the Khorana risk score in gastric cancer patients receiving immune checkpoint inhibitors.
Authors: Junmin Song, Wing Fai Li, Chaeseong Yim, Changlin Gong, Yu-Cheng Chang, Yu Chang, Jaeun Ahn, Kuan-Yu Chi, Muhammad Fahimuddin, Cho Han Chiang
Journal: Journal of Clinical Oncology (2025)

363 Background: Thrombosis is a common cancer-related complication, particularly in gastric cancer. Studies show that immune checkpoint inhibitors (ICIs) increase the risk of venous thromboembolism (VTE) and arterial thrombosis. The Khorana risk score is widely used to assess thrombosis risk before starting chemotherapy. This study aimed to validate the Khorana score in gastric cancer patients receiving ICIs using a large global database. Methods: We used the TriNetX Global Collaborative Network, which contains de-identified data from over 120 million patients. We included patients diagnosed with gastric cancer who received ICIs between January 2014 and July 2023. The Khorana risk score was calculated based on lab values and BMI within two weeks before ICI initiation. Patients were divided into two cohorts: elevated risk (score 3-6) and intermediate risk (score 2). Cox-proportional hazard analyses were conducted over a one-year follow-up. The primary outcome was VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]). Secondary outcomes were arterial thrombosis, including myocardial infarction (AMI) and ischemic stroke, and all-cause mortality. Results: The study included 551 patients, with 362 in the intermediate risk and 189 in the elevated risk cohorts. The mean age was 64 in both cohorts, with the elevated group consisting of more males (76% vs. 63%) and a higher proportion of Black patients (11% vs. 6%). Pembrolizumab (49%) and nivolumab (47%) were the most used ICIs. Patients with elevated risk had a significantly higher risk of VTE (HR 1.74, 95% CI 1.18-2.58), DVT (HR 1.82, 95% CI 1.07-3.10), and PE (HR 1.74, 95% CI 1.07-2.84). However, no significant associations were found with arterial thrombosis (HR 1.28, 95% CI 0.74-2.20), including cerebral infarction (HR 1.05, 95% CI 0.51-2.16), or AMI (HR 1.46, 95% CI 0.70-3.05). The elevated risk cohort also had significantly higher mortality (HR 1.44, 95% CI 1.11-1.87). Conclusions: An elevated Khorana risk score is associated with a higher risk of VTE, but not arterial thrombosis, in gastric cancer patients treated with ICIs. Further studies are needed to determine how the Khorana score can be applied to predict ICI-related thrombosis and guide prophylactic anticoagulation. Outcomes Khorana risk score 3-6 Khorana risk score 2 Hazard ratio(95% CI) P-value(Log-rank) At risk patients Cases At risk patients Cases Venous thromboembolism 189 45 362 58 1.74 (1.18-2.58) 0.005 Deep vein thrombosis 189 25 362 30 1.82 (1.07-3.10) 0.025 Pulmonary embolism 189 29 362 36 1.74 (1.07-2.84) 0.025 Arterial thrombosis 189 21 362 34 1.28 (0.74-2.20) 0.375 Cerebral infarction 189 11 362 22 1.05 (0.51-2.16) 0.901 Acute myocardial infarction 189 12 362 17 1.46 (0.70-3.05) 0.317 All-cause mortality 189 93 362 145 1.44 (1.11-1.87) 0.006
Real-world survival comparison of second-line treatment strategies for patients with RAS/RAF wild-type, right-sided metastatic colorectal cancer.
Authors: Nishwant Swami, Wei-Ting Hwang, Ronac Mamtani, Mark H. O'Hara, William Joseph Chapin
Journal: Journal of Clinical Oncology (2025)

73 Background: For patients with RAS/RAF wild type metastatic colorectal cancer (mCRC), systemic therapy usually includes fluoropyrimidine-based chemo + anti-VEGF or anti-EGFR targeted therapy. The PARADIGM trial established tumor sidedness as an important predictive biomarker for patients with RAS/RAF wild-type disease; in right-sided tumors, there was no survival difference between first-line chemo + anti-EGFR vs. chemo + anti-VEGF. However, there is no comparative data to guide second-line treatment decisions in this population. We aim to compare the effectiveness of second-line chemo + anti-EGFR versus chemo + anti-VEGF therapy for patients with RAS/RAF wild-type, right-sided mCRC who received first-line chemo + anti-VEGF. Methods: We used the nationwide Flatiron Health electronic health record-derived database, comprising de-identified patient-level structured and unstructured data obtained from ~280 cancer clinics and curated via technology-enabled abstraction. Patients ≥18 years old with RAS/RAF wild-type, right-sided mCRC who received first-line therapy consisting of chemotherapy ((FOLFIRI or FOLFOX or CAPEOX) + anti-VEGF and initiated second-line chemotherapy with either anti-EGFR or anti-VEGF targeted therapy between January 2013-May 2024 were included. Multiple imputation with chained equations imputed missing values for sidedness, RAS/RAF status, and propensity score covariates (age, gender, year of diagnosis, synchronous/metachronous disease, MMR/MSI status, ECOG score, CEA level, and first-line therapy duration). Cox proportional hazards modeling with stabilized inverse probability of treatment weighting (IPTW) assessed the association of anti-EGFR vs anti-VEGF treatment with overall survival. Results: 4,444 patients received appropriate first-line treatment and received chemo + anti-EGFR or chemo + anti-VEGF in the second line. Across 25 imputations, an average of 444 patients met inclusion criteria: 175 patients received chemo + anti-EGFR and 269 patients received chemo + anti-VEGF. Following IPTW, baseline characteristics were balanced between treatment groups. Patients who received chemotherapy + anti-EGFR had a 24% increased hazard of death when compared with patients who received chemotherapy + anti-VEGF, though this was not statistically significant (HR 1.24, 95% CI 0.96 – 1.61, p=0.097). Conclusions: Among patients with RAS/RAF wild-type, right-sided mCRC who received first-line chemotherapy + anti-VEGF, there is some evidence to support continuing anti-VEGF therapy vs. switching to anti-EGFR therapy in the second line, though the result was not statistically significant. Future studies should explore predictive biomarkers for EGFR vs VEGF-directed treatment for this population to determine the patients most likely to benefit from anti-EGFR therapy during their disease course.
Tumor lysis syndrome in colorectal cancer: A systematic review of clinical characteristics.
Authors: Wan Ying Tan, Ursula M. A. Medeiros Araujo de Matos, Victoria Forbes
Journal: Journal of Clinical Oncology (2025)

122 Background: Tumor lysis syndrome (TLS) is an oncologic emergency resulting from the release of potassium, phosphorus, and nucleic acids from tumor cells. While rare in colorectal cancer (CRC), TLS is linked with high mortality, and literature is limited. This study aims to summarize the clinical characteristics of patients with TLS in CRC. Methods: We conducted a systematic review of TLS in CRC through a comprehensive literature search in PubMed and manual searches from January 1st, 1993, up to September 13th, 2024. Keywords included "Tumor Lysis Syndrome," "Colorectal Cancer," and "Colon Cancer." 32 studies were found, identifying 11 spontaneous and 22 therapy-related TLS cases. Quantitative and qualitative data were extracted for descriptive analysis. Results: A total of 33 patients (16 males and 15 females) had a mean age of 56.5 ± 17.8 years at TLS diagnosis. The mean ages for males and females were 58.3 ± 7.1 and 55.8 ± 13.7 years, respectively (p=0.59). The primary histology was adenocarcinoma (92%) followed by neuroendocrine (8%) (data unavailable for 9 patients). Among 15 patients with grading information, Grade 2 tumors were most common (53%), followed by Grade 3 (40%) and Grade 1 (7%). Staging data was available for 32 patients. Most patients had Stage IV disease (94%), with frequent metastases to the liver (93%), lungs (30%), and bones (10%). Hyperuricemia is present in all patients (1 patient without data). Acute kidney injury (AKI) was present in all patients (4 patients without data). Hyperphosphatemia was found in 82% of patients (5 patients without data). Hypocalcemia was noted in 52% (10 patients without data), and hyperkalemia was found in 74% (6 patients without data). Out of the 33 patients, 11 experienced spontaneous TLS (33%) and 22 had therapy-related TLS (67%). Duration of TLS onset following therapy was available for 17 patients, including one outlier at 30 days on Capecitabine. The mean duration for therapy-related TLS, excluding the outlier, was 3.8 ± 2.5 days. Among the 22 patients on therapy, 59% received 5-Fluorouracil (5-FU)-based treatment. 31% of those receiving 5-FU had combination therapy with Bevacizumab. Death occurred in 59% of patients, with data missing for 4 patients. Conclusions: TLS in colorectal cancer (CRC) is associated with a mortality rate of up to 59% and shows no gender preference. Identifying predictive factors is crucial for TLS prophylaxis. Patients with TLS in CRC often present with Stage IV disease, liver metastasis, hyperuricemia, and acute kidney injury (AKI).
Analysis of gut and mucosal microbiomes in patients with extrahepatic cholangiocarcinoma.
Authors: Hyewon Ryu
Journal: Journal of Clinical Oncology (2025)

620 Background: Cholangiocarcinoma is an aggressive malignancy with a poor prognosis. While gut microbial dysbiosis is linked to various diseases, including biliary disorders and cancer, its association with cholangiocarcinoma remains unclear. Methods: This study compared the mucosal and gut microbiomes of patients with extrahepatic cholangiocarcinoma (n = 21) to those with cholecystitis (n = 21) and healthy individuals (n = 28). Mucosal microbiomes were collected from cancer lesions and gallbladders, with fecal samples obtained from 31 participants. The 16S rRNA gene (V3 and V4 region) was sequenced using the Illumina MiSeq platform and analyzed with QIIME 2. Results: 16S rRNA sequencing revealed Proteobacteria as the dominant taxon in the cancer cohort, with Klebsiella, Aeromonas, Staphylococcus, Fusobacterium, and Haemophilus also enriched. In contrast, Firmicutes dominated in the cholecystitis and control cohorts. β-diversity analysis highlighted significant differences between cohorts. Elevated levels of bile acids, particularly chenodeoxycholic acid and ursodeoxycholic acid, were observed in the cancer cohort and positively correlated with Proteobacteria, Aeromonas, Enterobacter, and Enterococcus. Conclusions: These findings suggest that microbiome dysbiosis contributes to cholangiocarcinoma development.
Impact of unplanned readmission to the same facility within 30 days following robot-assisted and laparoscopic hemicolectomy for early-onset non-metastatic colon cancer.
Authors: Rahul Thusay, Max Koss, Jothsna Sabbasani, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2025)

111 Background: Colon cancer in younger populations has risen in recent years, prompting changes in screening guidelines. Hemicolectomy remains integral for standard treatment for non-metastatic early-onset colon cancer, and many institutions have adopted robot-assisted approaches for this procedure. However, high costs associated with this technology along with mixed data regarding survival benefits and post-surgical complications warrant further investigations on the specific advantages of robot-assisted surgery. This study aims to examine the impact of unplanned readmission to the same facility within 30 days following surgery for patients receiving robot-assisted and laparoscopic hemicolectomy on long-term survival for early-onset non-metastatic colon cancer to see how current paradigms of colon cancer treatment extend to early-onset patients. Methods: The National Cancer Database was used to identify patients under the age of 50 receiving a minimally invasive hemicolectomy for primary non-metastatic colon cancer diagnosed between 2016-2020. Patients were stratified based on surgical approach and whether they underwent an unplanned readmission to the same facility within 30 days following surgery, and survival differences were calculated log-rank test and Cox regression analysis that included co-variates related to tumor characteristics, patient demographics, and facility characteristics. Results: 5,076 patients were identified, with 577 receiving a robot-assisted approach and 4,499 receiving a laparoscopic approach. Multivariate analysis found no significant difference in long-term survival between patients receiving a laparoscopic versus robot-assisted approach (HR: 0.893, 95% CI: 0.687-1.161, p=0.398). Additionally, multivariate analysis found that unplanned readmission within 30 days did not have a significant impact on long-term survival outcomes for patients receiving a robot-assisted approach (HR: 0.856, 95% CI: 0.257-2.848, p=0.800), but it did find worsened survival outcomes for the laparoscopic approach (HR: 1.535, 95% CI: 1.070-2.203, p=0.020). Conclusions: Patients receiving laparoscopic hemicolectomy for early-onset non-metastatic colon cancer appear to have worsened overall long-term survival outcomes when undergoing an unplanned readmission to the same facility within 30 days of surgery when compared to patients receiving a robot-assisted surgical approach. However, it also appears that overall, both surgical approaches have similar overall long-term survival. Further research on how robot-assisted surgery impacts survival and post-surgical complications in patients with early-onset non-metastatic colon cancer is warranted to examine how this advancing technology could improve cancer care.
Comparison of demographics, mortality outcomes and resource utilization in early-onset versus later-onset pancreatic cancer: An analysis of the US National Inpatient Sample (NIS).
Authors: Sneha Singh, Bugra Zengin, Shobha Mandal, Sangam Sangam, Sushmita Khadka
Journal: Journal of Clinical Oncology (2025)

700 Background: Pancreatic cancer is associated with higher mortality, with 5-year relative survival of 12%. Early-onset pancreatic cancer (EOPC) is relatively uncommon and is seen in 5-12% of the cases. Recent studies indicate a rising trend in the incidence of EOPC. In this study, we categorized EOPC for ages less than 50 and later-onset pancreatic cancer (LOPC) for ages above or equal to 50 years. The aim of the study is to understand difference in demographics, mortality, and resource utilization between the two sub-categories of patients admitted to acute care hospitals in the United States. Methods: This is a retrospective cohort study of adult patients hospitalized with pancreatic cancer as the primary diagnosis at acute care hospitals across the United States in 2021, using the National Inpatient Sample (NIS) database. International Classification of Diseases, 10th Revision (ICD-10) codes were utilized to identify patients with a primary diagnosis of pancreatic cancer. The primary outcome is comparing demographics and in-hospital mortality between EOPC and LOPC. The secondary outcomes are length of stay (LOS) and total hospitalization charges. We performed multivariate logistic regression analysis to assess in-hospital mortality, LOS, and total hospitalization charges after adjusting for potential confounders such as sex, race, Charlson comorbidity index, hospital teaching status, and hospital region. Results: Our study included 38,654 patients with pancreatic cancer, of which 2,242 were EOPC and 36,412 were LOPC. The majority of the baseline characteristics were similar in both groups, except that EOPC has a higher Hispanic population (16.06% versus 8.77 %, p &lt; 0.001), higher Medicaid as the payer source (28.28 % versus 7.32%, p &lt; 0.001), and a more significant number of patients admitted to an urban teaching hospital (89.2 % versus 85.2%, p &lt; 0.05) compared to LOPC subpopulation. No statistically significant difference in mortality was found between the two sub-categories (odds ratio 0.97, 95 % CI 0.60-1.5). Charlson index, hospital location, hospital bed size, and hospital region are independent predictors of mortality. There was no statistically significant difference between the two sub-categories for mean length of stay and total hospitalization charges. Conclusions: No significant difference was observed between EOPC and LOPC regarding in-hospital mortality, total length of stay, and total hospitalization charges. Our study highlights that EOPC disproportionately affects the Hispanic population and also a greater number of EOPC patients being admitted to urban teaching hospitals. Future research is needed to understand the disproportionate effect on the Hispanic population in the EOPC group and continued research in the domain, as the incidence of early-onset pancreatic cancer is expected to rise.
Exclusive liver invasion as prognostic indicator in T3 gallbladder cancer.
Authors: Woohyung Lee, Arum Shin, Ki Byung Song, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim
Journal: Journal of Clinical Oncology (2025)

631 Background: T3 gallbladder cancer (GBC) contains a diverse range of invasive tumors. However, distinct prognostic outcomes may be observed among T3GBC confined to localized range despite sharing the same T3GBC. There is uncertainty regarding whether there are noticeable prognostic variances between tumors that invade the liver, or serosa only and those that extend to adjacent organs. This study aims to investigate prognostic differences according to the extent of invasion in patient with T3GBC. Methods: The patients with T3GBC who underwent curative intent surgery from February 2002 to December 2021 were analyzed. The patients were divided into those who had tumor invaded liver only, serosa only, or extended beyond. Their clinicopathologic characteristics, perioperative details and prognostic data were compared. Survival analyses were carried out using the log-rand test including subgroups considering nodal metastasis, and other T stages. Cox-proportional hazard model including other factors were used to identify the independent risk factors for survival. Results: We identified 194 patients with T3GBC. The patients with tumor invaded liver only, serosa only, and adjacent organs were 86, 33, and 35, respectively. The median survival was 23 months. The patients with invasion limited to the liver showed better survival than those who involve adjacent structures (26 months vs 9 months, p &lt; 0.001). In multivariate analysis, it was demonstrated that the concomitant presence of invasion in structures other than the liver serves as independent prognostic factors for survival. (hazard ratio [HR], 6.8, 95% confidence interval [CI] 1.746 – 26.803, p = 0.006) as well as lymphovascular invasion (HR 2.5, 95% CI 1.093 – 4.193, p= 0.026 ). Conclusions: In the T3 gallbladder cancer, exclusive liver invasion is a better prognostic indicator compared to concurrent invasion around adjacent structure. It is crucial to recognize that the extent of invasion in T3GBC patients before surgery. Multicenter studies are needed for the definite results.
Gastric cancer patient insights: Patient-reported outcomes and real-world perspectives from the gastric cancer patient community.
Authors: Martha Raymond, Margaret-Ann Simonetta
Journal: Journal of Clinical Oncology (2025)

362 Background: According to the National Cancer Institute Surveillance, Epidemiology, and End Results Program, an estimated 26,890 patients in the United States will be diagnosed with gastric (stomach) cancer in 2024. Estimated deaths from the disease in 2024 will reach 10,880, with a five-year relative survival rate of 36%. Understanding the need for increased gastric cancer education and awareness, the GI Cancers Alliance created a 12-month series of engagement opportunities to better understand and listen to the gastric cancer patient voice and perspectives. Methods: Our 12-month patient-reported outcomes (PRO) research (September 2023 – August 2024) included an online survey, in person and virtual focus groups, and personalized follow-up interviews. 651 gastric cancer patients and survivors participated in these engagement opportunities, with 89% of participants asking for follow-up personalized interviews. One of our program goals was to reach and interact with patients who often experience barriers in receiving quality cancer care. Our PRO research provided an opportunity to amplify the patient voice and lived experience by engaging patients in medically underserved communities, rural and urban populations, diverse ethnic communities, and patients receiving care in community-based and federally funded oncology centers, and charity (indigent) care. Results: Overarching results from our study suggest that while advances have been made, health equity, racial disparities and barriers in cancer care remain a challenge. 651 patient participants (43% male, 54% female, 3% non-binary) identified their race/ethnicity as: 24% Black/African American, 22% Hispanic, 21% Multiracial, Non-Hispanic/White 19%, Asian/Pacific Islander 7%, Native American 2%, and 5% Other. 69% of patients reported that their clinician did not suggest biomarker testing, nor discuss the role of biomarkers to help make informed treatment decisions. 68% of patients were concerned that they lacked knowledge and options to make informed decisions regarding their treatment. 64% of patients reported they suffered from mental health concerns ranging from severe depression, feelings of hopelessness and anxiety; 63% of patients struggled to afford nutritious food to meet their changing dietary needs, especially post-surgery. Conclusions: Our PRO research underscores the need for increased education and outreach for gastric cancer patient communities experiencing barriers to high quality cancer prevention, early detection, and treatment. By partnering with our 100+ advocacy partner organizations, we will continue to amplify the gastric cancer patient voice by establishing new programming, initiatives, and enhanced outreach addressing the challenges and barriers to quality cancer care for all patients.