scholarly journals Use of endoscopic ultrasound for pancreatic cancer from 2000 to 2016

2022 ◽  
Vol 10 (01) ◽  
pp. E19-E29
Author(s):  
Sheila D. Rustgi ◽  
Haley M. Zylberberg ◽  
Sunil Amin ◽  
Anne Aronson ◽  
Satish Nagula ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Endoscopic Ultrasound ◽  
Survival Benefit ◽  
The United States ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Time Period ◽  
Chi Squared ◽  
Impact On Survival ◽  
Comorbidity Scores

Abstract Background and study aims Pancreatic cancer (PC) is the fourth most common cause of cancer death in the United States. Previous studies have suggested a survival benefit for endoscopic ultrasound (EUS), an important tool for diagnosis and staging of PC. This study aims to describe EUS use over time and identify factors associated with EUS use and its impact on survival. Patients and methods This was a retrospective review of the Surveillance, Epidemiology and End Results (SEER) database linked with Medicare claims. EUS use, clinical and demographic characteristics were evaluated. Chi-squared analysis, Cochran-Armitage test for trend, and logistic regression were used to identify associations between sociodemographic and clinical factors and EUS. Kaplan-Meier and Cox proportional hazard ratios were used for survival analysis. Results EUS use rose during the time period, from 7.4 % of patients in 2000 to 32.4 % in 2015. Patient diversity increased, with a rising share of older, non-White patients with higher Charlson comorbidity scores. Both clinical (receipt of other therapies, PC stage) and nonclinical factors (region of country, year of diagnosis) were associated with receipt of EUS. While EUS was associated with a survival improvement early in the study period, this effect did not persist for PC patients diagnosed in 2012 to 2015 (median survival 3 month ± standard deviation [SD] 9.8 months without vs. 4 months ± SD 8 months with EUS). Conclusions Our data support previous studies, which suggest a survival benefit for EUS when it was infrequently used, but finds that benefit was attenuated as EUS became more widely available.

Traveling for Pancreatic Cancer Care Is Worth the Trip

2020 ◽  
pp. 000313482095148
Author(s):  
Marcus A. Alvarez ◽  
Kiyah Anderson ◽  
Jeremiah L. Deneve ◽  
Paxton V. Dickson ◽  
Danny Yakoub ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Clinical Factors ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
User File ◽  
Real Phenomenon ◽  
Centralized Care ◽  
Zip Code

Background Centralized care for patients with pancreatic cancer is associated with longer survival. We hypothesized that increased travel distance from home is associated with increased survival for pancreatic cancer patients. Methods The National Cancer Database user file for all pancreatic cancer patients was investigated from 2004 through 2015. Distance from the patients’ zip code to the treating facility was determined. Survival was investigated using the Kaplan-Meier method. Cox hazard ratios (CoxHRs) were determined based on stage of disease, distance traveled for care, and clinical factors. Results 340 780 patients were identified. In the average age of 68 ± 12 years, 51% were male and 83% were Caucasian. For all stages of cancer, longer survival was associated with traveling farther ( P < .001). The survival advantage was longer for Caucasians than African Americans (3.7 months vs. 2.6 months, P < .001) Travel was associated with a 13% decrease in risk of death ( P < .001). Even controlling for the pathologic stage, traveling farther was associated with decreased risk of death (CoxHR = .91, P < .001). Discussion Traveling for care is associated with improved survival for pancreatic cancer patients. While a selection bias may exist, the fact that all stages of patients investigated benefited suggests that this is a real phenomenon.

Incidence and characterization of venous thromboembolic events (VTE) in patients with pancreatic cancer: Effect of timing of VTE on survival.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4037-4037
Author(s):  
Maithili A Shethia ◽  
Aparna Hegde ◽  
Xiao Zhou ◽  
Michael J. Overman ◽  
Saroj Vadhan-Raj
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Survival Analysis ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
One Year ◽  
The Impact

4037 Background: Patients (pts) with pancreatic cancer are at high risk for VTE, and the occurrence of VTE can affect pts’ prognosis. The purpose of this study was to evaluate the incidence of VTE and the impact of timing of VTE (early vs. late) on survival. Methods: Medical record of 260 pts with pancreatic cancer, newly referred to UT MDACC during one year period from 1/1/2006 to 12/31/2006, were reviewed for the incidence of VTE during a 2-year follow-up period from the date of diagnosis. All VTE episodes were confirmed by radiologic studies. Survival analysis was conducted using Kaplan-Meier analysis and Cox proportional hazard models. Results: Of the 260 pts, 47 pts (18%) had 51 episodes of VTE during the 2-year follow-up. The median age of the pts with VTE was 61 years (range: 28-86) and 53% were males. Of the 47 pts with VTE, 27 (57%) had PE, 19 (40%) had DVT and 1 had concurrent PE/DVT. Three pts had recurrent VTE during the study period. Median follow-up time for OS was 192 days (range: 1-1652 days). Kaplan-Meier Survival analysis showed that those who developed VTE earlier (within 30 or 90 days) had shorter median overall survival (OS) compared with those who had VTE beyond these time points. The hazard ratios, 95% CI, and median OS at 1 year are summarized in the table below. Conclusions: The incidence of VTE is high in pts with pancreatic cancer. The timing of VTE had a significant impact on OS; pts who had an early development of VTE had a shorter overall survival. [Table: see text]

Secondary sarcomas after radiation in patients with breast cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10072-10072
Author(s):  
C. M. Mery ◽  
S. George ◽  
C. P. Raut
Keyword(s):  
Breast Cancer ◽  
Proportional Hazard ◽  
Seer Database ◽  
Chi Square ◽  
Incidence Trends ◽  
Proportional Hazard Models ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Time Period ◽  
Different Types

10072 Background: Studies have shown that radiation (RT) predisposes patients with breast cancer (BCa) to develop a secondary sarcoma (SS). Few have analyzed recent incidence trends or have been powered to assess specific histologies. The goal of this study was to quantify the risk of developing different types of SS after RT in BCa and assess time trends using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Females with microscopically-confirmed non-metastatic BCa reported to SEER between 1973 and 2003 were included. Development of SS was analyzed with Kaplan-Meier curves and proportional hazard models, and reported as hazard ratios (HR) with 95% confidence intervals. Descriptive variables were analyzed with chi square. Results: The cohort of 482,469 BCa patients (age 60.1±13.4yrs) was divided in 2 groups: RT (37%) and no RT, based on treatment. RT patients were younger (p<0.0001) and had more partial mastectomies (p<0.0001). RT usage increased with time (from 23% in 1973–1977 to 48% in 2001–2003, p<0.0001). 874 patients developed SS 12–343 months after BCa diagnosis. RT patients had a higher incidence of all SS (30 vs 21 cases/100,000 person-years, HR: 1.57 [1.4–1.8]), angiosarcomas (HR: 7.8 [4.9–12.2]) and malignant fibrous histiocytomas (MFH) (HR: 2.5 [1.6–3.9]). Risk was increased in sites close to the RT field (chest and ipsilateral arm) (HR: 4.17 [3.2–5.5]) but not in others (HR: 1.07 [0.91–1.3]). Risk increased with age and time period at BCa diagnosis (p<0.0001). RT remained a significant predictor of SS development after adjustment for these variables (HR: 1.5 [1.3–1.7]). The hazard of developing SS after RT increased over the first several years after diagnosis of BCa, peaked at 10–14 years, and then decreased again, reaching the non-RT hazard at ∼22 years. 5-yr survival after SS diagnosis was 38%. Conclusions: Administration of RT for BCa increases the risk for development of SS, in particular angiosarcomas and MFH in sites associated with the RT field. Risk of SS has increased with time, independently of RT usage. Patients receiving RT for BCa should be followed closely for more than 20 years. No significant financial relationships to disclose.

Single institutional analysis of pancreatic cancer survival trends based on BMI.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 234-234
Author(s):  
Jeff Wiisanen ◽  
Robert R. McWilliams ◽  
William R Bamlet
Keyword(s):  
Pancreatic Cancer ◽  
Detrimental Effect ◽  
Cancer Survival ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Time Period ◽  
Association Table ◽  
Stage 1

234 Background: Body mass index (BMI) has been reported to determine risk for pancreatic cancer in addition to outcome, as those with higher BMI have decreased survival. Since May 2011, therapy for pancreatic cancer has improved with the addition of FOLFIRINOX. This study looks at overall survival in relation to BMI since the advent of the FOLFIRINOX. Methods: 2,277 patients with pancreatic adenocarcinoma were identified through the Mayo Clinic SPORE pancreatic cancer registry from 2000-14. Usual adult and BMI at time of enrollment were utilized as a binary variable ( < 30, ≥30 kg/m2). These were analyzed for association with survival using Kaplan-Meier curves and Cox proportional hazards regression. Results: For the 2000-11 and 2011-14 groups, stage distribution was 4.4%, 34.7%, 21.6%, 39.2% and 1.2%, 39%, 22.2%, 37.6%, respectively for stage 1-4. Since pancreatic cancer commonly causes weight loss, more patients were in the higher usual adult BMI (34.6%) compared to enrollment (17.1%). For the period 2000-11, 33.8% of patients had a usual adult BMI of 30+ vs 37.8% for the 2011-14 patients. As previously reported, there was a difference in survival by BMI for the period 2000-May 2011, however, this was not seen for the period June 2011-14. Conclusions: Based on this cohort of patients, the previously reported detrimental effect of elevated BMI on survival in pancreatic cancer patients is no longer seen. This corresponds with the time period of improvement in pancreatic cancer treatment with FOLFIRINOX. Further studies should be performed to confirm our findings and to identify the causality of this association. [Table: see text]

Impact of no treatment vs other nonsurgical treatments in Pancreatic Adenocarcinoma National Cancer Database: 2004-2014.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15795-e15795
Author(s):  
Sukamal Saha ◽  
Mohamed Elgamal ◽  
Meghan Cherry ◽  
Robin Buttar ◽  
Kiran Devisetty ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Survival Data ◽  
Radiation Treatment ◽  
Chemoradiation Therapy ◽  
National Cancer Database ◽  
Chi Squared ◽  
Impact On Survival ◽  
Very High

e15795 Background: Surgery remains the only curative treatment option in pancreatic adenocarcinoma, yet in more than 50% of the patients (pts) the disease is too advanced or at very high risk and considered inoperable. They are either managed with no treatment or other nonsurgical methods. Hence, we analyzed a large cohort of pancreatic adenocarcinoma pts undergoing No Treatment vs Chemotherapy, Radiation or Chemoradiation to determine their impact on survival. Methods: Only pancreatic adenocarcinoma pts who had no surgery in the National Cancer Database (NCDB) from 2004–2014 were included. Of that group, patients with unknown or missing data about chemotherapy or radiation treatment or less than 3 years of survival data were excluded. Pts were stratified into 4 groups: Chemotherapy, Radiation Therapy, Chemoradiation and No Treatment. Overall 1-, 2- and 3-year survival was calculated and the groups were compared using Pearson’s chi-squared. Results: Of the total 309,709 pancreatic cancer pts in the NCDB 2004–2014, 111,421 (36.0%) remained after application of the study criteria. Of these, 43,203 (38.8%) received chemotherapy only, 2,453 (2.2%) received radiation only, 15,764 (14.1%) received chemoradiation and 50,001 (40.0%) had no treatment. Overall survival for 1, 2, and 3 years was best in the chemoradiation group with a 1 year survival of (40.0%) compared to chemotherapy only (22.4%), radiation only (14.9%) and no treatment (9.6%). Overall, only (19.0%) of pts survived for 1 year, (5.4%) survived for 2 years and (2.3%) survived for 3 years. (Table) Conclusions: Survival in pancreatic adenocarcinoma pts remains dismal without surgery. Best survival in nonsurgical pts was seen after combination Chemoradiation therapy and worst survival in No Treatment group. Hence, whenever possible, a combination Chemoradiation should be offered even as palliation in non-surgical pancreatic adenocarcinoma pts.[Table: see text]

scholarly journals Factors Affecting Adjuvant Therapy in Stage III Pancreatic Cancer—Analysis of the National Cancer Database

2017 ◽  
Vol 11 ◽  
pp. 117955491772804 ◽  
Author(s):  
Mridula Krishnan ◽  
Aabra Ahmed ◽  
Ryan W Walters ◽  
Peter T Silberstein
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Therapy ◽  
Survival Benefit ◽  
Cox Regression ◽  
Stage Iii ◽  
National Cancer Database ◽  
Factors Affecting ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Charlson Comorbidity Score

Background: Adjuvant therapy after curative resection is associated with survival benefit in stage III pancreatic cancer. We analyzed the factors affecting the outcome of adjuvant therapy in stage III pancreatic cancer and compared overall survival with different modalities of adjuvant treatment. Methods: This is a retrospective study of patients with stage III pancreatic cancer listed in the National Cancer Database (NCDB) who were diagnosed between 2004 and 2012. Patients were stratified based on adjuvant therapy they received. Unadjusted Kaplan-Meier and multivariable Cox regression analysis were performed. Results: We analyzed a cohort included 1731 patients who were recipients of adjuvant therapy for stage III pancreatic cancer within the limits of our database. Patients who received adjuvant chemoradiation had the longest postdiagnosis survival time, followed by patients who received adjuvant chemotherapy, and finally patients who received no adjuvant therapy. On multivariate analysis, advancing age and patients with Medicaid had worse survival, whereas Spanish origin and lower Charlson comorbidity score had better survival. Conclusions: Our study is the largest trial using the NCDB addressing the effects of adjuvant therapy specifically in stage III pancreatic cancer. Within the limits of our study, survival benefit with adjuvant therapy was more apparent with longer duration from date of diagnosis.

scholarly journals Preoperative Comorbidity Correlates Inversely with Survival after Intestinal and Multivisceral Transplantation in Adults

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Rajesh Sivaprakasam ◽  
Takahashi Hidenori ◽  
Charlotte Pither ◽  
Seigo Nishida ◽  
Andrew J. Butler ◽  
...  
Keyword(s):  
Intestinal Transplantation ◽  
Postoperative Survival ◽  
Inverse Association ◽  
Function Score ◽  
Logrank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Comorbidity Scores ◽  
The Relationship ◽  
Score Range

We investigated the relationship between preoperative comorbidity and postoperative survival after intestinal transplantation. Each patient received a score for preoperative comorbidity. Each comorbidity was given a score based on the degree it impaired function (score range 0–3). A total score was derived from the summation of individual comorbidity scores. Patients (72 adults (M : F, 33 : 39)) received an isolated intestinal graft (27) or a cluster graft (45). Mean (standard deviation) survival was 1501 (1444) days. The Kaplan-Meier analysis revealed a significant inverse association between survival and comorbidity score (logrank test for trend, ). Patients grouped into comorbidity scores of 0 and 1, 2 and 3, 4 and 5, 6, and above had hazard ratios (95% confidence intervals) for death (compared to group 0 + 1), which increased with comorbidity scores: 1.945 (0.7622–5.816), 5.075 (3.314–36.17), and 13.77 (463.3–120100), respectively, (). Receiver-operator curves at 1, 3, 5, and 10 years postoperative had “C” statistics of 0.88, 0.85, 0.88, and 0.92, respectively. When evaluating patients for transplantation, the degree of comorbidity should be considered as a major factor influencing postoperative survival.

Clinical outcomes of first-line FOLFIRINOX versus gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer at the Yale Smilow Healthcare System.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 769-769
Author(s):  
Timil Patel ◽  
Thejal Srikumar ◽  
Joseph Anthony Miccio ◽  
Jill Lacy ◽  
Stacey Stein ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Metastatic Pancreatic Cancer ◽  
Continuous Variables ◽  
First Line ◽  
Real World Data ◽  
Prior Therapy ◽  
Kaplan Meier ◽  
Chi Squared ◽  
Treatment Data ◽  
Prior Surgery

769 Background: FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GN) are established first line (1L) therapies for metastatic pancreatic cancer (MPC) but real-world data on their comparative effectiveness is limited. Methods: All cases of MPC treated with 1L FFX or GN at Yale Smilow Cancer Hospital and the affiliated community care centers (CCC) from January 2011 – April 2019 were reviewed. Patient (pt) demographics, prior therapy, initial and subsequent dose reductions (DR), time to treatment discontinuation (TTD), overall survival (OS), and second line (2L) treatment data were manually abstracted from the electronic medical record. Categorical and continuous variables were compared between 1L FFX and GN cohorts via the Chi-squared and Wilcoxon rank-sum tests. Median OS was calculated by the Kaplan-Meier method. Results: We identified 363 MPC pts treated with 1L FFX or GN; 269 (74%) pts were treated with FFX and 94 (26%) with GN as 1L therapy. 204 (56%) pts were treated at the main campus and 159 (44%) at a CCC. Demographics and baseline characteristics (FFX/GN) were as follows: gender (male) 55% / 41%; race (white) 82% / 77%; age < 76 90% / 71% ( P < 0.001). 332 (91%) of pts received no prior therapy; 21 (6%) had prior surgery plus adjuvant gemcitabine and 10 (3%) had surgery alone. 98% of FFX-treated pts were treated with upfront DR, compared to 78% of GN-treated pts ( P= 0.003). 78% and 53% of FFX-treated and GN-treated pts, respectively, had subsequent DR ( P< 0.001). Median TTD was 4.8 months with FFX and 3.4 months with GN ( P= 0.0029) and the median OS was 11.3 months with FFX versus 7.2 months with GN ( P < 0.0001). After 1L, 33% and 61% of FFX- and GN-treated pts, respectively, received no further chemotherapy ( P< 0.001). Conclusions: In the largest manually abstracted retrospective analysis to date, MPC pts treated with 1L FFX were younger, more likely to receive 2L therapy, and had increased survival compared to pts treated with GN. The OS of pts treated with FFX was similar to the OS reported by Conroy et al despite upfront dose attenuations in 98% of pts. A randomized trial is needed to confirm optimal sequencing of chemotherapy in MPC.

scholarly journals On the Court: A Comprehensive Analysis of Basketball Facial Trauma

2019 ◽  
Vol 12 (4) ◽  
pp. 266-270 ◽  
Author(s):  
Sammy Othman ◽  
Jason E. Cohn ◽  
Brian McKinnon
Keyword(s):  
Health Care Providers ◽  
The United States ◽  
Emergency Department Visits ◽  
Categorical Variables ◽  
Facial Trauma ◽  
Care Providers ◽  
Injury Surveillance System ◽  
Time Period ◽  
Chi Squared ◽  
The Face

With basketball gradually becoming increasingly popular across the United States, it is necessary for health care providers to understand injuries associated with the sport. We aim to determine the incidence of basketball-related facial injuries and further describe their patterns with regard to age, mechanism of injury, and degree of injury. An analysis of emergency department visits under the National Electronic Injury Surveillance System was conducted from 2015 through 2017. Chi-squared testing (χ2) was performed to compare categorical variables. After a review of results, a total of 4,578 patients were included for analysis spanning a 3-year time period (2015-2017). Lacerations were the most common injury overall (57.9%). Nasal fractures were by far the most common fracture (76.1%), and elbows to the face and collisions with other players were the most common types of injury mechanisms (31 and 28.7%, respectively). Adolescents (aged 12-18 years) were the most frequently injured group (42.5%), although young adults (aged 19-34 years) were also frequently affected (30.1%). Basketball facial trauma remains a prominent issue. Our research, in correlation with previous research, shows that current precautions to injury are not widely observed or are ineffective to the extent of need for further reform. It thus becomes necessary to provide patient education and develop more practical methods for decreasing player injury.

scholarly journals Modern UNOS Data Reveals Septuagenarians have Inferior Heart Transplant Survival

2021 ◽  
Author(s):  
Manish Suryapalam ◽  
Jay Kanaparthi ◽  
Mohammed Abul Kashem ◽  
Huaqing Zhao ◽  
Yoshiya Toyoda
Keyword(s):  
Demographic Data ◽  
The United States ◽  
Survival Outcomes ◽  
Transplant Survival ◽  
Post Transplant ◽  
Kaplan Meier ◽  
Chi Squared ◽  
Older Recipients ◽  
Long Term Studies

Background: While heart transplantation is increasingly performed in the United States for elderly patients, survival outcomes have primarily been analyzed in single-center studies. The few existing long-term studies have indicated no difference in HTx outcomes between patients ≥70 years and 60-69 years age, but these studies only assessed to 5-years post-transplant and included data from the 1980-90s, introducing significant variance due to poorer outcomes in that era. We analyzed the UNOS database from 1987-2020, stratified by timeframe at 2000, to derive a more representative comparison of modern HTx survival outcomes. Methods: All UNOS HTx recipients over 18 years of age (n=66,186) were divided into 3 cohorts: 18-59, 60-69 and ≥70 years old. Demographic data as well as perioperative factors were evaluated for significance using Chi-Squared and H-Tests as appropriate. Kaplan-Meier Curve and cox regressions with log-rank tests were used to assess 5 through 10 year survival outcomes. Results: 45,748 were 18-59 years old, 19,129 were 60-69 years old and 1,309 were ≥70 year old. The distribution of most demographic and perioperative factors significantly differed between cohorts. Pairwise survival analysis involving the 18-59 cohort always indicated significance. While there was no significance between the two older cohorts in the earlier timeframe, there was significance in the later timeframe from 6-10 years post-HTx (p<0.05). Cox regressions confirmed results. Conclusions: The results indicate that since 2000, recipients 60-69 years of age have better 6 through 10-year post-transplant survival than older recipients, a relationship previously obscured by worse outcomes in early data.

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