***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Background The Trastuzumab for Gastric Cancer ( ToGA ) study is the first international trial to include Japanese patients with human epidermal growth factor 2 ( HER2 ) positive advanced/metastatic gastric or gastroesophageal junction cancer . ToGA showed that trastuzumab plus chemotherapy ( capecitabine/cisplatin or 5-fluorouracil/cisplatin ) improved overall survival in the overall population ( hazard ratio 0.74 ) . Regional differences in outcome in favor of Japanese population s were observed in other studies ; therefore , subgroup analyses of ToGA may contribute to the evaluation of the potential benefits of this regimen in Japanese patients . Methods We performed subgroup analyses on 101 Japanese patients enrolled into ToGA ( trastuzumab plus chemotherapy , n = 51 ; chemotherapy , n = 50 ) . Results Median overall survival in the Japanese subgroup was 15.9 months ( 95 % confidence interval 12–25 ) for trastuzumab plus chemotherapy and 17.7 months ( 95 % confidence interval 12–24 ) for chemotherapy ( hazard ratio 1.00 ; 95 % confidence interval 0.59–1.69 ) . After adjusting for prespecified covariates , the estimated hazard ratio for overall survival was 0.68 ( 95 % confidence interval 0.36–1.27 ) . Further post hoc and exploratory examinations supported the robustness of the adjusted hazard ratios . Conclusions After adjusting for imbalanced patient background s between arms , overall survival of Japanese patients with human epidermal growth factor 2 positive advanced/metastatic gastric or gastroesophageal junction cancer who received trastuzumab plus chemotherapy was improved compared with patients who received chemotherapy alone Background In the Trastuzumab for GAstric cancer ( ToGA ) study , trastuzumab plus chemotherapy improved median overall survival by 2.7 months in patients with human epidermal growth factor receptor 2 (HER2)-positive [ immunohistochemistry ( IHC ) 3+/fluorescence in situ hybridization-positive ] gastric/gastroesophageal junction cancer compared with chemotherapy alone ( hazard ratio 0.74 ) . Post hoc exploratory analyses in patients expressing higher HER2 levels ( IHC 2+/fluorescence in situ hybridization-positive or IHC 3 + ) demonstrated a 4.2-month improvement in median overall survival with trastuzumab ( hazard ratio 0.65 ) . The ToGA study provides the largest screening data set available on HER2 overexpression/amplification in this indication . We further analyzed correlation(s ) of HER2 overexpression/amplification with clinical and epidemiological factors . Methods HER2-positivity was analyzed by histological subtype , tumor location , geographic region , and specimen type . Exploratory efficacy analyses were performed . Results The HER2-positivity rate was 22.1 % across analyzed tumor sample s. Rates were similar between European and Asian patients ( 23.6 % vs. 23.9 % ) , but higher in intestinal- vs. diffuse-type ( 31.8 % vs. 6.1 % ) , and gastroesophageal junction cancer versus gastric tumors ( 32.2 % vs. 21.4 % ) . Across all IHC scores , variability in HER2 staining ( ≤30 % stained cells ) was observed in almost 50 % of cases , with increasing rates in lower IHC categories , and did not affect treatment outcome . The polysomy rate was 4 % . Conclusions HER2 expression varies by tumor location and type . All patients with advanced gastric or gastroesophageal junction cancer should be tested for HER2 status , preferably using IHC initially . Due to the unique characteristics of gastric cancer , specific testing/scoring guidelines should be adhered to Background Neoadjuvant chemotherapy ( NAC ) has been attempted as a means of improving survival of potentially resectable advanced gastric cancer ( AGC ) . In the course of exploring the most promising NAC regimen , a superior surrogate marker reflecting overall survival ( OS ) is necessary . We investigated prognostic factors in AGC patients who underwent NAC followed by gastric resection  and evaluated whether histologic response to NAC was predictive of survival . Methods Seventy consecutive patients with gastric cancer treated with NAC followed by surgical resection between Jan 1 , 2000 , and Dec 31 , 2009 , at Osaka National Hospital were identified from a prospect i ve data base . Prognostic factors for OS were investigated by univariate and multivariate analyses . Results Median survival time for all patients was 668 days after surgical resection . Age less than 65 years ( hazard ratio 0.463 , 95 % confidence interval 0.244–0.879 ) and pathologic nodal stage of N0–1 ( hazard ratio 0.318 , 95 % confidence interval 0.160–0.635 ) were identified as significant independent prognostic factors for longer OS , whereas grade d histologic response of primary tumor to NAC was statistically significant on univariate analysis , but not on multivariate analysis , as a prognostic factor . Conclusions Posttherapy nodal status , not grade d histologic response , predicts survival after NAC for AGC and could serve as a reliable surrogate marker for OS in the course of exploring the most promising regimen for NAC BACKGROUND The survival benefit and morbidity after nodal dissection for gastric cancer remains controversial . We aim ed to do a single-institution r and omised trial to compare D1 ( ie , level 1 ) lymphadenectomy with that of D3 ( ie , levels 1 , 2 , and 3 ) dissection for gastric cancer in terms of overall survival and disease-free survival . METHODS From Oct 7 , 1993 , to Aug 12 , 1999 , 335 patients were registered . 221 patients were eligible , 110 of whom were r and omly assigned D1 surgery and 111 of whom were r and omly assigned D3 surgery , both with curative intent . Three participating surgeons had done at least 25 independent D3 dissections before the start of the trial , and every procedure was verified by pathological analyses . The primary endpoints were 5-year overall survival and 5-year disease-free survival . We also analysed risk of recurrence . Main analyses were done by intention to treat . This trial is registered at the US National Institute of Health website . FINDINGS Median follow-up for the 110 ( 50 % ) survivors was 94.5 months ( range 62.9 - 135.1 ) . Overall 5-year survival was significantly higher in patients assigned D3 surgery than in those assigned D1 surgery ( 59.5 % [ 95 % CI 50.3 - 68.7 ] vs 53.6 % [ 44.2 - 63.0 ] ; difference beteween groups 5.9 % [ -7.3 to 19.1 ] , log-rank p=0.041 ) . 215 patients who had R0 resection ( ie , no microscopic evidence of residual disease ) had recurrence at 5 years of 50.6 % [ 41.1 - 60.2 ] for D1 surgery and 40.3 % [ 30.9 - 49.7 ] for D3 surgery ( difference between groups 10.3 % [ -3.2 to 23.7 ] , log-rank p=0.197 ) . INTERPRETATION D3 nodal dissection , compared with that of D1 , offers a survival benefit for patients with gastric cancer when done by well trained , experienced surgeons A correlation between osteopontin , E-cadherin , β-catenin , and cyclooxygenase 2 overexpression and poor clinicopathological features and prognosis has been previously suggested in gastric cancer . This translational study was aim ed at assessing the correlation of these immunohistochemical biomarkers with outcome in patients with radically resected gastric cancer . We analyzed osteopontin , E-cadherin , β-catenin , and cyclooxygenase 2 expression by immunohistochemistry in 346 primary gastric tumor tissue sample s from patients enrolled in the ITACA-S trial . This phase III study r and omized patients with radically resected gastric cancer to receive adjuvant chemotherapy with either 5-fluorouracil and leucovorin or a sequential regimen of infusional 5-fluorouracil and leucovorin plus irinotecan followed by cisplatin and docetaxel .  High expression of osteopontin was correlated with high histological grade , diffuse histotype , and peritoneal relapse , but not with TNM stage . Moreover , osteopontin overexpression was associated with higher risk of tumor recurrence and metastases , and was an independent prognostic factor for both relapse-free and overall survival of gastric cancer patients following adjuvant chemotherapy .  Abnormal E-cadherin expression and abnormal β-catenin expression were correlated with more advanced disease stage , and as a consequence , with poor outcome . Our results suggest that osteopontin overexpression is a valuable independent predictor of tumor recurrence and survival in patients with radically resected gastric cancer 
    Output:
    
Our results indicated that histology might be a useful prognostic marker for both early and advanced GC patients , with intestinal-type associated with a better outcome .