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T1 Date 3 20 December 28, 2014 E1 Date:T1 T2 Age 24 35 70-year-old T3 Sex 36 39 man T4 Sign_symptom 65 69 pain E2 Sign_symptom:T4 T5 Biological_structure 55 64 abdominal R1 MODIFY Arg1:T5 Arg2:E2 T6 Sign_symptom 71 80 dizziness E3 Sign_symptom:T6 T7 Sign_symptom 86 92 nausea E4 Sign_symptom:T7 T8 Nonbiological_location 113 149 Hebei General Hospital, Hebei, China T9 Diagnostic_procedure 151 162 Gastroscopy E5 Diagnostic_procedure:T9 T10 Disease_disorder 192 210 ulcerative lesions E6 Disease_disorder:T10 T11 Shape 170 179 irregular T12 Detailed_description 180 191 hemorrhagic R2 MODIFY Arg1:T12 Arg2:E6 R3 MODIFY Arg1:T11 Arg2:E6 T13 Biological_structure 230 242 gastric body T14 Biological_structure 250 266 lesser curvature R4 MODIFY Arg1:T13 Arg2:E6 R5 MODIFY Arg1:T14 Arg2:E6 T15 Disease_disorder 271 287 pyloric stenosis E7 Disease_disorder:T15 T16 Biological_structure 295 302 stomach R6 MODIFY Arg1:T16 Arg2:E7 T17 Diagnostic_procedure 312 318 biopsy E8 Diagnostic_procedure:T17 T18 Biological_structure 304 311 Gastric R7 MODIFY Arg1:T18 Arg2:E8 T19 Disease_disorder 328 342 adenocarcinoma E9 Disease_disorder:T19 T20 Date 347 362 January 7, 2015 E10 Date:T20 T21 Therapeutic_procedure 375 386 gastrectomy E11 Therapeutic_procedure:T21 T22 Detailed_description 364 374 palliative R8 MODIFY Arg1:T22 Arg2:E11 T23 Therapeutic_procedure 392 401 Roux-en-Y E12 Therapeutic_procedure:T23 T24 Therapeutic_procedure 407 426 esophagojejunostomy E13 Therapeutic_procedure:T24 R9 MODIFY Arg1:E12 Arg2:E13 T25 Biological_structure 494 516 pancreatic lymph nodes T26 Biological_structure 476 484 anterior T27 Biological_structure 485 493 superior T28 Biological_structure 460 471 para-aortic R10 MODIFY Arg1:T27 Arg2:T25 R11 MODIFY Arg1:T26 Arg2:T25 R12 MODIFY Arg1:T28 Arg2:T25 T29 Therapeutic_procedure 588 596 resected E14 Therapeutic_procedure:T29 A1 POLARITY E14 NEG R13 MODIFY Arg1:T25 Arg2:E14 T30 Biological_structure 529 540 lymph nodes T31 Qualitative_concept 443 450 Diffuse T32 Qualitative_concept 451 459 enlarged R14 MODIFY Arg1:T32 Arg2:T25 R15 MODIFY Arg1:T31 Arg2:T25 T33 Biological_structure 552 573 common hepatic artery R16 MODIFY Arg1:T33 Arg2:T30 R17 MODIFY Arg1:T30 Arg2:E14 T34 Diagnostic_procedure 612 621 pathology E15 Diagnostic_procedure:T34 T35 Disease_disorder 661 683 gastric adenocarcinoma E16 Disease_disorder:T35 T36 Severity 635 660 moderately differentiated R18 MODIFY Arg1:T36 Arg2:E16 T37 Diagnostic_procedure 694 714 Immunohistochemistry E17 Diagnostic_procedure:T37 T38 Diagnostic_procedure 737 777 human epidermal growth factor receptor 2 E18 Diagnostic_procedure:T38 T39 Diagnostic_procedure 779 784 HER-2 E19 Diagnostic_procedure:T39 R19 IDENTICAL Arg1:E19 Arg2:E18 R20 SUB_PROCEDURE Arg1:E18 Arg2:E17 T40 Lab_value 787 788 + E20 Lab_value:T40 R21 MODIFY Arg1:E20 Arg2:E18 T41 Diagnostic_procedure 791 825 vascular endothelial growth factor E21 Diagnostic_procedure:T41 T42 Diagnostic_procedure 827 831 VEGF E22 Diagnostic_procedure:T42 T43 Lab_value 834 835 + E23 Lab_value:T43 R22 BEFORE Arg1:E23 Arg2:E21 R23 IDENTICAL Arg1:E22 Arg2:E21 R24 SUB_PROCEDURE Arg1:E21 Arg2:E17 T44 Diagnostic_procedure 838 842 CD31 E24 Diagnostic_procedure:T44 T45 Lab_value 844 845 + E25 Lab_value:T45 T46 Diagnostic_procedure 848 853 CD105 E26 Diagnostic_procedure:T46 T47 Lab_value 855 856 + E27 Lab_value:T47 R25 MODIFY Arg1:E27 Arg2:E26 R26 SUB_PROCEDURE Arg1:E26 Arg2:E17 R27 MODIFY Arg1:E25 Arg2:E24 R28 SUB_PROCEDURE Arg1:E24 Arg2:E17 T48 Diagnostic_procedure 870 885 triple positive E28 Diagnostic_procedure:T48 T49 Diagnostic_procedure 887 889 TP E29 Diagnostic_procedure:T49 T50 Lab_value 892 893 + E30 Lab_value:T50 R29 IDENTICAL Arg1:E29 Arg2:E28 R30 MODIFY Arg1:E30 Arg2:E28 R31 SUB_PROCEDURE Arg1:E28 Arg2:E17 T51 Diagnostic_procedure 896 923 glutathione S-transferase π E31 Diagnostic_procedure:T51 T52 Diagnostic_procedure 925 930 GST-π E32 Diagnostic_procedure:T52 T53 Lab_value 933 936 +++ E33 Lab_value:T53 R32 MODIFY Arg1:E33 Arg2:E31 R33 IDENTICAL Arg1:E32 Arg2:E31 R34 SUB_PROCEDURE Arg1:E31 Arg2:E17 T54 Diagnostic_procedure 939 964 topoisomerase enzyme II α E34 Diagnostic_procedure:T54 T55 Diagnostic_procedure 966 974 TOPOII α E35 Diagnostic_procedure:T55 R35 IDENTICAL Arg1:E35 Arg2:E34 T56 Diagnostic_procedure 977 980 P53 E36 Diagnostic_procedure:T56 T57 Lab_value 982 983 – E37 Lab_value:T57 T58 Diagnostic_procedure 990 995 Ki-67 E38 Diagnostic_procedure:T58 T59 Lab_value 997 1000 70% E39 Lab_value:T59 R36 MODIFY Arg1:E37 Arg2:E36 R37 MODIFY Arg1:E39 Arg2:E38 R38 SUB_PROCEDURE Arg1:E34 Arg2:E17 R39 SUB_PROCEDURE Arg1:E36 Arg2:E17 R40 SUB_PROCEDURE Arg1:E38 Arg2:E17 T60 Disease_disorder 1030 1052 gastric adenocarcinoma E40 Disease_disorder:T60 T61 Severity 1021 1029 stage IV R41 MODIFY Arg1:T61 Arg2:E40 T62 Qualitative_concept 1058 1066 multiple T63 Biological_structure 1067 1077 lymphnodes T64 Disease_disorder 1078 1088 metastases E41 Disease_disorder:T64 T65 Severity 1090 1096 T4N2M1 R42 MODIFY Arg1:T65 Arg2:E40 R43 MODIFY Arg1:T63 Arg2:E41 R44 MODIFY Arg1:T62 Arg2:E41 T66 Therapeutic_procedure 1130 1151 cycle of chemotherapy E42 Therapeutic_procedure:T66 T67 Dosage 1128 1129 1 R45 MODIFY Arg1:T67 Arg2:E42 T68 Medication 1157 1168 oxaliplatin E43 Medication:T68 T69 Medication 1173 1176 S-1 E44 Medication:T69 R46 MODIFY Arg1:E43 Arg2:E42 R47 MODIFY Arg1:E44 Arg2:E42 T70 Sign_symptom 1266 1295 gastrointestinal disturbances E45 Sign_symptom:T70 T71 Detailed_description 1205 1215 terminated R48 MODIFY Arg1:E45 Arg2:T71 R49 MODIFY Arg1:T71 Arg2:E42 T72 Date 1300 1316 February 2, 2015 E46 Date:T72 T73 Therapeutic_procedure 1318 1339 adjuvant radiotherapy E47 Therapeutic_procedure:T73 T74 Diagnostic_procedure 1379 1427 positron-emission tomography computed tomography E48 Diagnostic_procedure:T74 T75 Diagnostic_procedure 1429 1435 PET-CT E49 Diagnostic_procedure:T75 R50 IDENTICAL Arg1:E49 Arg2:E48 T76 Severity 1444 1453 extensive T77 Detailed_description 1454 1461 distant T78 Disease_disorder 1462 1472 metastasis E50 Disease_disorder:T78 R51 MODIFY Arg1:T77 Arg2:E50 R52 MODIFY Arg1:T76 Arg2:E50 T79 Biological_structure 1511 1522 lymph nodes T80 Biological_structure 1474 1494 left supraclavicular T81 Biological_structure 1499 1510 mediastinal R53 MODIFY Arg1:T81 Arg2:T79 R54 MODIFY Arg1:T80 Arg2:T79 T82 Biological_structure 1528 1539 lymph nodes T83 Biological_structure 1555 1571 abdominal cavity R55 MODIFY Arg1:T83 Arg2:T82 R56 MODIFY Arg1:T79 Arg2:E50 R57 MODIFY Arg1:T82 Arg2:E50 T84 Diagnostic_procedure 1588 1622 Eastern Cooperative Oncology Group E51 Diagnostic_procedure:T84 T85 Diagnostic_procedure 1624 1628 ECOG E52 Diagnostic_procedure:T85 R58 IDENTICAL Arg1:E52 Arg2:E51 T86 Lab_value 1653 1654 2 E53 Lab_value:T86 R59 MODIFY Arg1:E53 Arg2:E51 T87 Diagnostic_procedure 1664 1679 body mass index E54 Diagnostic_procedure:T87 T88 Diagnostic_procedure 1681 1684 BMI E55 Diagnostic_procedure:T88 R60 IDENTICAL Arg1:E55 Arg2:E54 T89 Lab_value 1690 1692 19 E56 Lab_value:T89 R61 MODIFY Arg1:E56 Arg2:E54 T90 Sign_symptom 1740 1752 malnutrition E57 Sign_symptom:T90 A2 POLARITY E57 UNCERTAIN T91 Administration 1754 1758 Oral T92 Medication 1759 1767 apatinib E58 Medication:T92 T93 Dosage 1768 1774 850 mg T94 Frequency 1775 1785 once a day T95 Therapeutic_procedure 1814 1826 radiotherapy E59 Therapeutic_procedure:T95 R62 MODIFY Arg1:T91 Arg2:E58 R63 MODIFY Arg1:T93 Arg2:E58 R64 MODIFY Arg1:T94 Arg2:E58 T96 Therapeutic_procedure 1970 2007 intensity modulated radiation therapy E60 Therapeutic_procedure:T96 T97 Therapeutic_procedure 2009 2013 IMRT E61 Therapeutic_procedure:T97 R65 IDENTICAL Arg1:E61 Arg2:E60 T98 Detailed_description 1959 1969 palliative R66 MODIFY Arg1:T98 Arg2:E60 T99 Clinical_event 1831 1841 prescribed E62 Clinical_event:T99 R67 MODIFY Arg1:E58 Arg2:E62 R68 MODIFY Arg1:E59 Arg2:E62 T100 Dosage 2056 2077 64 Gy in 30 fractions T101 Biological_structure 2085 2096 mediastinum T102 Dosage 2110 2131 52 Gy in 26 fractions T103 Disease_disorder 2155 2173 metastatic lesions E63 Disease_disorder:T103 T104 Biological_structure 2145 2154 abdominal R69 MODIFY Arg1:T104 Arg2:E63 R70 MODIFY Arg1:T100 Arg2:T101 R71 MODIFY Arg1:T102 Arg2:T104 T105 Biological_structure 2208 2218 lymph node T106 Biological_structure 2187 2207 left supraclavicular R72 MODIFY Arg1:T106 Arg2:T105 T107 Medication 2236 2244 apatinib E64 Medication:T107 R73 MODIFY Arg1:E64 Arg2:T105 R74 MODIFY Arg1:E60 Arg2:T100 R75 MODIFY Arg1:E60 Arg2:T102 T108 Diagnostic_procedure 2272 2278 PET-CT E65 Diagnostic_procedure:T108 T109 Date 2294 2320 2 weeks after radiotherapy E66 Date:T109 T110 Lab_value 2331 2344 80% reduction E67 Lab_value:T110 T111 Diagnostic_procedure 2352 2385 maximum standardized uptake value E68 Diagnostic_procedure:T111 T112 Diagnostic_procedure 2387 2393 SUVmax E69 Diagnostic_procedure:T112 R76 IDENTICAL Arg1:E69 Arg2:E68 T113 Diagnostic_procedure 2398 2431 2-deoxy-2-[[18]F]fluoro-d-glucose E70 Diagnostic_procedure:T113 T114 Diagnostic_procedure 2433 2436 FDG E71 Diagnostic_procedure:T114 R77 IDENTICAL Arg1:E71 Arg2:E70 R78 MODIFY Arg1:E70 Arg2:E68 R79 MODIFY Arg1:E67 Arg2:E68 T115 Diagnostic_procedure 2439 2449 FDG uptake E72 Diagnostic_procedure:T115 T116 Lab_value 2454 2460 higher E73 Lab_value:T116 T117 Biological_structure 2489 2499 lymph node T118 Biological_structure 2468 2488 left supraclavicular R80 MODIFY Arg1:T118 Arg2:T117 R81 MODIFY Arg1:E73 Arg2:E72 R82 MODIFY Arg1:T117 Arg2:E72 T119 Biological_structure 2516 2534 metastatic regions T120 Medication 2559 2567 apatinib E74 Medication:T120 T121 Therapeutic_procedure 2572 2589 radiation therapy E75 Therapeutic_procedure:T121 T122 Diagnostic_procedure 2604 2648 Response Evaluation Criteria in Solid Tumors E76 Diagnostic_procedure:T122 R83 MODIFY Arg1:E74 Arg2:T119 R84 MODIFY Arg1:E75 Arg2:T119 T123 Diagnostic_procedure 2650 2656 RECIST E77 Diagnostic_procedure:T123 R85 IDENTICAL Arg1:E77 Arg2:E76 T124 Lab_value 2683 2699 partial response E78 Lab_value:T124 R86 MODIFY Arg1:E78 Arg2:E76 T125 Therapeutic_procedure 2738 2750 radiotherapy E79 Therapeutic_procedure:T125 T126 Dosage 2752 2773 66 Gy in 28 fractions R87 MODIFY Arg1:T126 Arg2:E79 T127 Biological_structure 2803 2813 lymph node T128 Biological_structure 2782 2802 left supraclavicular R88 MODIFY Arg1:T128 Arg2:T127 T129 Disease_disorder 2821 2840 residual metastasis E80 Disease_disorder:T129 R89 CAUSE Arg1:E80 Arg2:E79 R90 MODIFY Arg1:T127 Arg2:E79 T130 Diagnostic_procedure 2842 2855 Tumor markers E81 Diagnostic_procedure:T130 T131 Diagnostic_procedure 2860 2880 biochemical analyses E82 Diagnostic_procedure:T131 T132 Frequency 2896 2910 every 2 months R91 MODIFY Arg1:T132 Arg2:E82 R92 MODIFY Arg1:T132 Arg2:E81 T133 Date 2912 2936 Two months after therapy E83 Date:T133 T134 Diagnostic_procedure 2959 2967 CT scans E84 Diagnostic_procedure:T134 T135 Biological_structure 2938 2943 chest T136 Biological_structure 2949 2958 abdominal R93 MODIFY Arg1:T136 Arg2:E84 R94 MODIFY Arg1:T135 Arg2:E84 T137 Disease_disorder 2985 2992 disease E85 Disease_disorder:T137 T138 Detailed_description 2978 2984 stable R95 MODIFY Arg1:T138 Arg2:E85 T139 Sign_symptom 2994 3000 anemia E86 Sign_symptom:T139 T140 Sign_symptom 3005 3030 gastrointestinal symptoms E87 Sign_symptom:T140 T141 Qualitative_concept 3035 3043 improved R96 MODIFY Arg1:T141 Arg2:E87 R97 MODIFY Arg1:T141 Arg2:E86 T142 Diagnostic_procedure 3045 3049 ECOG E88 Diagnostic_procedure:T142 T143 Diagnostic_procedure 3080 3083 BMI E89 Diagnostic_procedure:T143 T144 Lab_value 3073 3074 0 E90 Lab_value:T144 T145 Lab_value 3088 3090 22 E91 Lab_value:T145 R98 MODIFY Arg1:E90 Arg2:E88 R99 MODIFY Arg1:E91 Arg2:E89 T146 Sign_symptom 3092 3112 Hematologic toxicity E92 Sign_symptom:T146 A3 POLARITY E92 NEG T147 Sign_symptom 3114 3126 hypertension E93 Sign_symptom:T147 A4 POLARITY E93 NEG T148 Sign_symptom 3128 3145 renal dysfunction E94 Sign_symptom:T148 A5 POLARITY E94 NEG T149 Sign_symptom 3147 3158 proteinuria E95 Sign_symptom:T149 A6 POLARITY E95 NEG T150 Sign_symptom 3164 3182 hand–foot syndrome E96 Sign_symptom:T150 A7 POLARITY E96 NEG T151 Medication 3208 3216 apatinib E97 Medication:T151 T152 Date 3229 3243 September 2015 E98 Date:T152 T153 Diagnostic_procedure 3247 3268 follow-up examination E99 Diagnostic_procedure:T153 T154 Lab_value 3276 3285 increased E100 Lab_value:T154 T155 Diagnostic_procedure 3286 3315 carbohydrate antigen (CA) 125 E101 Diagnostic_procedure:T155 T156 Diagnostic_procedure 3320 3328 ferritin E102 Diagnostic_procedure:T156 T157 Diagnostic_procedure 3339 3350 gastroscopy E103 Diagnostic_procedure:T157 T158 Diagnostic_procedure 3365 3367 CT E104 Diagnostic_procedure:T158 T159 Biological_structure 3355 3364 abdominal R100 MODIFY Arg1:E100 Arg2:E101 R101 MODIFY Arg1:E100 Arg2:E102 R102 MODIFY Arg1:T159 Arg2:E104 T160 Sign_symptom 3380 3393 abnormalities E105 Sign_symptom:T160 A8 POLARITY E105 NEG R103 MODIFY Arg1:E105 Arg2:E104 R104 MODIFY Arg1:E105 Arg2:E103 T161 Date 3398 3411 November 2015 E106 Date:T161 T162 Sign_symptom 3429 3450 difficulty swallowing E107 Sign_symptom:T162 T163 Sign_symptom 3480 3492 hematochezia E108 Sign_symptom:T163 T164 Detailed_description 3467 3479 intermittent R105 MODIFY Arg1:T164 Arg2:E108 T165 Diagnostic_procedure 3552 3563 Gastroscopy E109 Diagnostic_procedure:T165 T166 Medication 3494 3502 Apatinib E110 Medication:T166 T167 Sign_symptom 3525 3550 gastrointestinal bleeding E111 Sign_symptom:T167 T168 Detailed_description 3507 3517 terminated R106 MODIFY Arg1:T168 Arg2:E110 R107 CAUSE Arg1:E111 Arg2:T168 T169 Sign_symptom 3573 3593 anastomotic stenosis E112 Sign_symptom:T169 T170 Disease_disorder 3601 3615 gastric cancer E113 Disease_disorder:T170 T171 Disease_disorder 3620 3642 intragastric hemorrhag E114 Disease_disorder:T171 R108 CAUSE Arg1:E113 Arg2:E112 R109 CAUSE Arg1:E114 Arg2:E112 T172 Therapeutic_procedure 3691 3708 chemoradiotherapy E115 Therapeutic_procedure:T172 A9 POLARITY E115 NEG T173 Medication 3739 3754 hemostatic drug E116 Medication:T173 T174 Therapeutic_procedure 3764 3779 supportive care E117 Therapeutic_procedure:T174 T175 Date 3797 3809 After 1 week E118 Date:T175 T176 Disease_disorder 3822 3834 hemorrhaging E119 Disease_disorder:T176 A10 POLARITY E119 NEG T177 Date 3849 3865 One month later, E120 Date:T177 T178 Detailed_description 3896 3908 intermittent T179 Sign_symptom 3909 3921 hematochezia E121 Sign_symptom:T179 R110 MODIFY Arg1:T178 Arg2:E121 T180 Date 3926 3943 December 20, 2015 E122 Date:T180 T181 Diagnostic_procedure 3945 3951 PET-CT E123 Diagnostic_procedure:T181 T182 Disease_disorder 3975 3985 metastasis E124 Disease_disorder:T182 T183 Severity 3965 3974 extensive R111 MODIFY Arg1:T183 Arg2:E124 T184 Therapeutic_procedure 4029 4044 supportive care E125 Therapeutic_procedure:T184 T185 Date 4049 4063 April 16, 2016 E126 Date:T185 T186 Outcome 4077 4081 died E127 Outcome:T186 T187 Disease_disorder 4099 4108 infection E128 Disease_disorder:T187 T188 Biological_structure 4089 4098 pulmonary R112 MODIFY Arg1:T188 Arg2:E128 * OVERLAP E1 E2 E3 E4 E129 T189 Clinical_event 97 105 referred E129 Clinical_event:T189 R113 MODIFY Arg1:T8 Arg2:E129 R114 BEFORE Arg1:E129 Arg2:E5 * OVERLAP E5 E6 E7 E8 E9 R115 BEFORE Arg1:E9 Arg2:E10 * OVERLAP E10 E11 E13 E14 R116 BEFORE Arg1:E14 Arg2:E15 * OVERLAP E15 E16 E17 E40 E41 R117 BEFORE Arg1:E41 Arg2:E42 R118 BEFORE Arg1:E42 Arg2:E46 * OVERLAP E46 E47 E48 E50 R119 BEFORE Arg1:E50 Arg2:E51 * OVERLAP E51 E54 E57 E62 R120 BEFORE Arg1:E62 Arg2:E60 * OVERLAP E60 E64 R121 BEFORE Arg1:E64 Arg2:E65 * OVERLAP E65 E66 E68 E72 E74 E76 R122 BEFORE Arg1:E76 Arg2:E79 R123 BEFORE Arg1:E79 Arg2:E81 * OVERLAP E81 E82 R124 BEFORE Arg1:E82 Arg2:E83 * OVERLAP E83 E84 E85 E86 E87 E88 E89 E97 R125 CAUSE Arg1:E97 Arg2:E96 R126 CAUSE Arg1:E97 Arg2:E95 R127 CAUSE Arg1:E97 Arg2:E94 R128 CAUSE Arg1:E97 Arg2:E93 R129 CAUSE Arg1:E97 Arg2:E92 R130 BEFORE Arg1:E97 Arg2:E98 * OVERLAP E98 E99 E101 E102 E103 E104 R131 BEFORE Arg1:E104 Arg2:E106 * OVERLAP E106 E107 E108 E110 E109 E112 E115 E130 T190 Clinical_event 3785 3795 prescribed E130 Clinical_event:T190 R132 MODIFY Arg1:E130 Arg2:E117 R133 MODIFY Arg1:E130 Arg2:E116 R134 BEFORE Arg1:E130 Arg2:E118 * OVERLAP E118 E119 R135 BEFORE Arg1:E119 Arg2:E120 * OVERLAP E120 E121 R136 BEFORE Arg1:E121 Arg2:E122 * OVERLAP E122 E123 E124 E125 R137 BEFORE Arg1:E125 Arg2:E126 * OVERLAP E126 E127 E128