Cancer of the Pancreas: Clinical Outcome in 76 Cases

1986 ◽  
Vol 72 (6) ◽  
pp. 601-607 ◽  
Author(s):  
Vittorio Pugliese ◽  
Sebastiano Saccomanno ◽  
Luigina Bonelli ◽  
Daniela Barone ◽  
Massimo Conio ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Clinical Outcome ◽  
Clinical Presentation ◽  
High Sensitivity ◽  
Radical Resection ◽  
Final Diagnosis ◽  
Diagnostic Techniques ◽  
Tissue Diagnosis ◽  
Cancer Of The Pancreas

A final diagnosis of pancreatic cancer was established in 76 consecutive patients during 4 years. The clinical outcome was evaluated retrospectively, as well as clinical presentation and its impact on the rate of resectability. Even though the diagnostic techniques showed a high sensitivity, only 18.4% of patients had a radical resection performed. In 77.6% of the cases a tissue diagnosis had been obtained. However, in only 1/5 of them was the tissue proof obtained preoperatively. This review confirms that the survival of patients with pancreatic cancer is poor, with slight advantages in the few resectable cases. Therefore, an earlier diagnosis should be attempted in high-risk symptomatic patients, selected by means of nonaggressive tests and evaluated by means of more accurate diagnostic techniques, when suitable.

Possibility of detecting intraductal papillary mucinous neoplasms using metabolite biomarkers for pancreatic cancer

2020 ◽  
Vol 14 (11) ◽  
pp. 1009-1020
Author(s):  
Ryota Nakano ◽  
Shin Nishiumi ◽  
Takashi Kobayashi ◽  
Takuya Ikegawa ◽  
Yuzo Kodama ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Multiple Logistic Regression Analysis ◽  
High Sensitivity ◽  
Plasma Samples ◽  
Multiple Logistic Regression ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Detection Model ◽  
High Risk Factors ◽  
Mucinous Neoplasms

Aim: The aim of this study was to identify whether metabolite biomarker candidates for pancreatic cancer (PC) could aid detection of intraductal papillary mucinous neoplasms (IPMN), recognized as high-risk factors for PC. Materials & methods: The 12 metabolite biomarker candidates, which were found to be useful to detect PC in our previous study, were evaluated for plasma samples from patients with PC (n = 44) or IPMN (n = 24) or healthy volunteers (n = 46). Results: Regarding the performance of individual biomarkers of PC and PC high-risk IPMN, lysine exhibited the best performance (sensitivity: 67.8%; specificity: 86.9%). The multiple logistic regression analysis-based detection model displayed high sensitivity and specificity values of 92.5 and 90.6%, respectively. Conclusion: Metabolite biomarker candidates for PC are useful for detecting high-risk IPMN, which can progress to PC.

Predictors of Neoplastic Progression in High-Risk Individuals Undergoing Surveillance for Pancreatic Cancer: Lessons from the First 16 Years of the Cancer of the Pancreas Screening (CAPS) Program

2017 ◽  
Vol 152 (5) ◽  
pp. S274 ◽  
Author(s):  
Jose Alejandro N. Almario ◽  
Marcia I. Canto ◽  
Anne Marie Lennon ◽  
Eun J. Shin ◽  
Christopher L. Wolfgang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Neoplastic Progression ◽  
Cancer Of The Pancreas

scholarly journals 229 - Surgical and Patient-Centered Outcomes after Pancreatic Resection in High-Risk Individuals for Pancreatic Cancer: A 20-Year Prospective Cancer of the Pancreas Screening (CAPS) Cohort Study

2018 ◽  
Vol 154 (6) ◽  
pp. S-1263-S-1264
Author(s):  
Tossapol Kerdsirichairat ◽  
Marcia I. Canto ◽  
Madeline Ford ◽  
Michael G. Goggins ◽  
Amanda Blackford ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
High Risk ◽  
Pancreatic Resection ◽  
Patient Centered ◽  
Cancer Of The Pancreas

scholarly journals Management of patients with increased risk for familial pancreatic cancer: updated recommendations from the International Cancer of the Pancreas Screening (CAPS) Consortium

Gut ◽  
2019 ◽  
Vol 69 (1) ◽  
pp. 7-17 ◽  
Author(s):  
Michael Goggins ◽  
Kasper Alexander Overbeek ◽  
Randall Brand ◽  
Sapna Syngal ◽  
Marco Del Chiaro ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Multidisciplinary Teams ◽  
Familial Pancreatic Cancer ◽  
High Grade ◽  
Degree Relative ◽  
Delphi Approach ◽  
Cancer Of The Pancreas ◽  
Increased Risk ◽  
Consensus Statements

Background and aimThe International Cancer of the Pancreas Screening Consortium met in 2018 to update its consensus recommendations for the management of individuals with increased risk of pancreatic cancer based on family history or germline mutation status (high-risk individuals).MethodsA modified Delphi approach was employed to reach consensus among a multidisciplinary group of experts who voted on consensus statements. Consensus was considered reached if ≥75% agreed or disagreed.ResultsConsensus was reached on 55 statements. The main goals of surveillance (to identify high-grade dysplastic precursor lesions and T1N0M0 pancreatic cancer) remained unchanged. Experts agreed that for those with familial risk, surveillance should start no earlier than age 50 or 10 years earlier than the youngest relative with pancreatic cancer, but were split on whether to start at age 50 or 55. Germline ATM mutation carriers with one affected first-degree relative are now considered eligible for surveillance. Experts agreed that preferred surveillance tests are endoscopic ultrasound and MRI/magnetic retrograde cholangiopancreatography, but no consensus was reached on how to alternate these modalities. Annual surveillance is recommended in the absence of concerning lesions. Main areas of disagreement included if and how surveillance should be performed for hereditary pancreatitis, and the management of indeterminate lesions.ConclusionsPancreatic surveillance is recommended for selected high-risk individuals to detect early pancreatic cancer and its high-grade precursors, but should be performed in a research setting by multidisciplinary teams in centres with appropriate expertise. Until more evidence supporting these recommendations is available, the benefits, risks and costs of surveillance of pancreatic surveillance need additional evaluation.

2-OR: Impact of N Terminal Pro B-Type Natriuretic Peptide and High Sensitivity Cardiac Troponin on the Prediction of Death and Cardiovascular Events in High-Risk Patients with Type 2 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2-OR
Author(s):  
MARCUS V.B. MALACHIAS ◽  
PARDEEP JHUND ◽  
BRIAN CLAGGETT ◽  
MAGNUS O. WIJKMAN ◽  
RHONDA BENTLEY-LEWIS ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
High Risk ◽  
Natriuretic Peptide ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
High Sensitivity ◽  
High Risk Patients ◽  
Risk Patients

A Critical Overview of Systematic Reviews of Chemotherapy for Advanced and Locally Advanced Pancreatic Cancer using both AMSTAR2 and ROBIS as Quality Assessment Tools

2020 ◽  
Vol 15 ◽  
Author(s):  
Amit Dang ◽  
Surendar Chidirala ◽  
Prashanth Veeranki ◽  
BN Vallish
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Systematic Reviews ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Risk Of Bias ◽  
Low Risk ◽  
Locally Advanced Pancreatic Cancer ◽  
Grade 3 ◽  
Critical Overview

Background: We performed a critical overview of published systematic reviews (SRs) of chemotherapy for advanced and locally advanced pancreatic cancer, and evaluated their quality using AMSTAR2 and ROBIS tools. Materials and Methods: PubMed and Cochrane Central Library were searched for SRs on 13th June 2020. SRs with metaanalysis which included only randomized controlled trials and that had assessed chemotherapy as one of the treatment arms were included. The outcome measures, which were looked into, were progression-free survival (PFS), overall survival (OS), and adverse events (AEs) of grade 3 or above. Two reviewers independently assessed all the SRs with both ROBIS and AMSTAR2. Results: Out of the 1,879 identified records, 26 SRs were included for the overview. Most SRs had concluded that gemcitabine-based combination regimes, prolonged OS and PFS, but increased the incidence of grade 3-4 toxicities, when compared to gemcitabine monotherapy, but survival benefits were not consistent when gemcitabine was combined with molecular targeted agents. As per ROBIS, 24/26 SRs had high risk of bias, with only 1/26 SR having low risk of bias. As per AMSTAR2, 25/26 SRs had critically low, and 1/26 SR had low, confidence in the results. The study which scored ‘low’ risk of bias in ROBIS scored ‘low confidence in results’ in AMSTAR2. The inter-rater reliability for scoring the overall confidence in the SRs with AMSTAR2 and the overall domain in ROBIS was substantial; ROBIS: kappa=0.785, SEM=0.207, p<0.001; AMSTAR2: kappa=0.649, SEM=0.323, p<0.001. Conclusion: Gemcitabine-based combination regimens can prolong OS and PFS but also worsen AEs when compared to gemcitabine monotherapy. The included SRs have an overall low methodological quality and high risk of bias as per AMSTAR2 and ROBIS respectively.

T2 Gallbladder Cancer—Aggressive Therapy is Warranted

2016 ◽  
Vol 82 (6) ◽  
pp. 518-521 ◽  
Author(s):  
Mohd Raashid Sheikh ◽  
Houssam Osman ◽  
Susannah Cheek ◽  
Shenee Hunter ◽  
Dhiresh Rohan Jeyarajah
Keyword(s):  
Clinical Presentation ◽  
Radical Surgery ◽  
Radical Resection ◽  
Gall Bladder Cancer ◽  
Incidental Diagnosis ◽  
Radical Cholecystectomy ◽  
Node Positive ◽  
Operative Findings ◽  
Worse Prognosis

Treatment of gall bladder cancer (GBC) has traditionally been viewed with pessimism and lymph node positivity has been associated with worse prognosis. The aim of this study is to analyze the role of radical cholecystectomy in T2 tumors. All patients who underwent surgery for GBC between September 2005 and June 2014 were identified retrospectively. Data collected included clinical presentation, operative findings, and histopathological data. Twenty-five patients had incidental GBC diagnosis after cholecystectomy. Ten patients were T2 on initial cholecystectomy pathology and all underwent radical resection. Two patients were N1 on initial cholecystectomy pathology. Four were upstaged to N1 and two patients were upstaged to T3 after further surgery. Overall, 60 per cent patients with T2 disease had node positivity and 60 per cent were upstaged by further surgery. Eleven patients were diagnosed on imaging. Four of these patients were unresectable and six were either stage T3 or higher or node positive. Sixty per cent of T2 GBC was node positive and 60 per cent were upstaged with radical cholecystectomy. This finding supports the call for radical resection in patients with incidental diagnosis of T2 tumor on cholecystectomy. This study also emphasizes the role of radical surgery in accurate T staging.

scholarly journals 688 Pediatric Obstructive Sleep Apnea (OSA) and COVID-19-Related Adverse Clinical Outcomes

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A269-A269
Author(s):  
Vaishal Shah ◽  
Nancy Foldvary-Schaefer ◽  
Lu Wang ◽  
Lara Jehi ◽  
Cynthia Pena Obrea ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Control Design ◽  
Supplemental Oxygen ◽  
Case Control ◽  
World Health ◽  
Invasive Ventilation ◽  
High Flow Oxygen

Abstract Introduction The relationship of OSA and human coronavirus (COVID-19) in the pediatric population is unknown. We postulate that OSA is associated with SARS-CoV-2 positivity and with adverse COVID-19 outcomes in children. Methods A retrospective review of 120 consecutive patients (&lt;18 years) with prior polysomnogram (PSG) and COVID-19 testing from the Cleveland Clinic COVID-19 registry was conducted. Using a case control design of SARS-CoV-2 positive and negative pediatric patients, we examined COVID-19 and pre-existing OSA (dichotomized AHI≥1) using logistic (OR,95%CI) regression and as continuous measures: AHI, oxygen(SpO2) nadir, %time SpO2&lt;90%) using linear regression(beta+/-SE). In those positive for SARS-CoV-2(cases only), we assessed the association of OSA and World Health Organization(WHO) COVID-19 clinical outcome composite score (hospitalization, requiring supplemental oxygen, non-invasive ventilation/high-flow oxygen, invasive ventilation/ECMO or death) using Wilcoxon rank sum test for ordinal data. Results Cases (n=36) were 11.8±4.4 years, 61% male, 27.8% black and 88.9% with OSA, while 85.7% of controls (n=84) had OSA. OSA was not associated with increased SARS-CoV-2 positivity: OR=1.33(0.40, 4.45,p=0.64). No significant difference between cases and controls for mean AHI 3.7(1.5,6.0) vs 3.5(1.5,7.1),p=0.91,SpO2 nadir 88.6±5.4 vs 89.1±4.4,p=0.58,%time SpO2&lt;90% 0.05[0.00,1.00) vs 0.10 (0.00,1.00, p=0.65) respectively was noted. WHO-7 COVID-19 clinical outcome did not meet statistical significance in relation to OSA due to the low event frequency (p=0.49). Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 12.5 vs 0% respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included: 75% obesity, 50% asthma, 25% sickle cell disease and 25% hypoplastic left heart. Conclusion In this first report of which we are aware focused on COVID-19 in pediatric OSA, we use a case control design leveraging COVID-19 and sleep laboratory registries. Albeit not statistically significant, pediatric patients with OSA had a higher percentage of worse clinical outcomes. Larger network studies are needed to clarify whether poorer COVID-19 outcomes may be attributable to OSA or modulated via high risk health conditions. Support (if any):

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