Factors affecting the administration of adjuvant therapy in patients with pancreatic adenocarcinoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15087-e15087
Author(s):  
Pablo Emilio Serrano Aybar ◽  
Peter Tae Wan Kim ◽  
Kenneth Leung ◽  
Sean P. Cleary ◽  
Steven Gallinger ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Multivariate Logistic Regression Analysis ◽  
Major Complication ◽  
High Volume ◽  
Lower Probability ◽  
Node Negative ◽  
Factors Affecting ◽  
Major Complications ◽  
The Impact

e15087 Background: Adjuvant therapy for pancreatic adenocarcinoma is now considered standard of care. The proportion of patients receiving adjuvant therapy (ADT) following pancreatic resection is a good quality indicator of cancer care. The aim of this study was to evaluate factors associated with receiving ADT in patients with pancreatic cancer. Methods: Between years 2000-2010, all patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma at a single high-volume hepatotopancreatobiliary center were evaluated. The impact of demographic, peri-operative and pathological risk factors affecting the administration of ADT were analyzed using univariate and multivariate logistic regression analysis. Results: There were 258 patients identified. Median age was 65 (37-84) years, 54% were females. There was a 15% margin positivity rate, 14% pancreatic leak rate, 14.7% major complication rate, and 1.2% 90 day/in-hospital mortality rate. Overall, 160/258 (70%) of patients received adjuvant therapy. On multivariate analysis; age, presence of major complications, node-negative disease and earlier era (2000-2004) were significantly associated with a lower probability of receiving ADT. Reasons for not receiving ADT were; patient preference: 20/67 (32%), not recommended: 14/67 (23%), disease recurrence: 12/67 (9.5%) and being medically unfit for ADT: 18/67 (11.5%). None of these reasons were different between time-periods except for fewer patients being offered ADT from 2000-2005 (15.4% vs. 2.5%, p <0.001). Conclusions: Thirty percent of patients do not receive ADT following pancreatectomy. Those with advanced age; node-negative disease and those who had major complications after pancreaticoduodenectomy were less likely to receive ADT. The impact of these factors should be taken into account when considering the administration of ADT.

The natural history and effect of adjuvant therapy on resected AJCC stage I-II lymph node-negative pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 264-264
Author(s):  
Shaun McKenzie ◽  
Bin Huang ◽  
Thomas Tucker ◽  
Patrick McGrath ◽  
Dennie V. Jones ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
Early Stage ◽  
Stage I ◽  
Lymph Node Status ◽  
Node Negative ◽  
The Impact

264 Background: Previous investigation has suggested that early stage, lymph node negative pancreatic adenocarcinoma (PAC) has a relatively good prognosis and adjuvant therapy provides little benefit over surgery alone. The purpose of our trial was to evaluate patients with stage I-II PAC receiving surgical resection to determine their clinical characteristics, overall outcome, and the impact of adjuvant therapy on survival. Methods: Utilizing the population-based registry data from the Kentucky Cancer Registry (KCR) we identified patients with lymph node negative, AJCC I-II, PAC who underwent pancreatic resection during the years of 1995-2008. Patients were further stratified by receipt of surgery alone versus surgery with adjuvant chemotherapy or chemoradiation. Clinical and pathologic data included patient demographics, tumor characteristics, and lymph node status. Kaplan-Meier and Cox-regression survival analyses were performed. Results: During the study period, 203 patients meeting criteria were identified from the KCR. Median survival (MS) for the entire cohort was 21.7 months. The majority of patients were >70 years old, Caucasian, had well or moderately differentiated tumors and tumors <5cm. 46% (n=94) and 54% (n=109) of patients had stage I and II disease respectively. When stratified by surgery only (n=119, 59%) versus adjuvant therapy (n=84, 41%), only younger age predicted receipt of adjuvant therapy (p=0.002). Adjuvant therapy provided no benefit over surgery alone regardless of stage (stage I MS: 21.5 vs. 24.7 months, p=0.97 and stage II MS: 24.2 vs. 18.0, p=0.13, respectively). By multivariate analysis, only tumor size >5cm predicted worse survival (HR 2.32, CI 1.21-4.45, p=0.012). Age, stage, adjuvant therapy, differentiation, and lymph node retrieval had no impact on survival. Conclusions: Our data indicate that the survival for surgically resected early stage, lymph node negative pancreatic adenocarcinoma remains poor and is not improved by the addition of adjuvant chemotherapy. These findings should be considered when designing future adjuvant therapy trials for this deadly disease.

scholarly journals Factors affecting aerosol size distribution during various dental procedures

2021 ◽  
Author(s):  
Shruti Choudhary ◽  
Michael J Durkin ◽  
Daniel C Stoeckel ◽  
Heidi M Steinkamp ◽  
Martin H Thornhill ◽  
...  
Keyword(s):  
Particulate Matter ◽  
High Speed ◽  
High Volume ◽  
Routine Care ◽  
Mitigation Strategies ◽  
Aerosol Size Distribution ◽  
Dental Clinic ◽  
Factors Affecting ◽  
Dental Procedures ◽  
The Impact

Objectives: To determine the impact of various aerosol mitigation interventions and establish duration of aerosol persistence in a variety of dental clinic configurations. Methods: We performed aerosol measurement studies in endodontic, orthodontic, periodontic, pediatric, and general dentistry clinics. We used an optical aerosol spectrometer and wearable particulate matter sensors to measure real-time aerosol concentration from the vantage point of the dentist during routine care in a variety of clinic configurations (e.g, open bay, single room, partitioned operatories). We compared the impact of aerosol mitigation strategies [ventilation and high-volume evacuation (HVE)] and prevalence of particulate matter in the dental clinic environment before, during and after high-speed drilling, slow speed drilling and ultrasonic scaling procedures. Results: Conical and ISOVAC HVE were superior to standard tip evacuation for aerosol-generating procedures. When aerosols were detected in the environment, they were rapidly dispersed within minutes of completing the aerosol-generating procedure. Few aerosols were detected in dental clinics, regardless of configuration, when conical and ISOVAC HVE were used. Conclusions: Dentists should consider using conical or ISOVAC HVE rather than standard tip evacuators to reduce aerosols generated during routine clinical practice. Furthermore, when such effective aerosol mitigation strategies are employed, dentists need not leave dental chairs fallow between patients as aerosols are rapidly dispersed. Clinical Significance: ISOVAC HVE is highly effective in reducing aerosol emissions. With adequate ventilation and HVE use, dental fallow time can be reduced to 5 minutes.

scholarly journals The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center

2019 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Benjamin D. Powers ◽  
William Fulp ◽  
Amina Dhahri ◽  
Danielle K. DePeralta ◽  
Takuya Ogami ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pancreatic Adenocarcinoma ◽  
High Volume ◽  
Socioeconomic Deprivation ◽  
Cancer Center ◽  
The Impact

Cost Analysis of TSV Process and Scaling Options

2014 ◽  
Vol 2014 (1) ◽  
pp. 000001-000007
Author(s):  
Victor Vartanian ◽  
Larry Smith ◽  
Klaus Hummler ◽  
Steve Olson ◽  
Brian Sapp ◽  
...  
Keyword(s):  
High Volume ◽  
Film Structure ◽  
Manufacturing Cost ◽  
Wafer Level ◽  
Factors Affecting ◽  
Multiple Process ◽  
Cost Of Materials ◽  
The Cost ◽  
The Impact ◽  
Cost Differences

SEMATECH evaluated the impact of various process options on the overall manufacturing cost of a TSV module, from TSV lithography and etch through post-plate CMP. The purpose of this work was to understand the cost differences of these options in order to identify opportunities to significantly reduce cost. Included in this study were multiple process and materials options for TSV etch, liner, and barrier/seed (B/S). For each of these options, recipes were adjusted for post-etch clean, ECD Cu fill and CMP overburden, and the resulting cost impacts were evaluated. The TSV dimensions used in this study are 5x50 μm and 2x40 μm. These cost comparisons included a sensitivity analysis, highlighting the main factors responsible for the differences. Cost of materials, tool cost, and throughput were the primary factors affecting cost differences, especially in barrier/seed deposition. In some cases the contributions from both these sources were comparable. We explain the assumptions used and some of the uncertainties inherent in this work. For example, where materials costs were significant, we extrapolated the cost of new materials from research quantities to those needed to support high volume manufacturing. We had to estimate throughputs and materials costs using our best engineering judgment, because the recipes have not yet been optimized. We also considered that the tools used on some non-critical steps might be fully depreciated, or a lower cost tool such as is used in wafer level packaging. Despite these uncertainties and assumptions, we were able to extract some fairly clear conclusions. The process options include the following B/S variations: For 5x50 μm TSVs, the B/S film structure is TaN/Ta/Ru/Cu, and the options are with and without the Ru and/or Cu layers. For 2x40 μm TSVs, the B/S structure is TaN/Ru/Cu, with different thicknesses of Ru, and the Cu is an optional seed layer for the field. We also discuss the impact of scaling the TSV dimensions on manufacturing costs. This work is continuing to look at different process options and to apply this methodology to MEOL modules such as temporary bond and debond, wafer thinning, and TSV reveal.

scholarly journals Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions

2017 ◽  
Vol 27 (4) ◽  
pp. 397-402 ◽  
Author(s):  
Borys V. Gvozdyev ◽  
Leah Y. Carreon ◽  
Christopher M. Graves ◽  
Stephanie A. Riley ◽  
Katlyn E. McGraw ◽  
...  
Keyword(s):  
Health Status ◽  
Spine Surgery ◽  
General Health ◽  
Major Complication ◽  
Adverse Outcomes ◽  
General Health Status ◽  
Major Complications ◽  
Significant Difference ◽  
Patient Reported ◽  
The Impact

OBJECTIVEPatient-reported outcomes (PROs) such as the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) are widely used to evaluate treatment outcomes following spine surgery for degenerative conditions. The goal of this study was to use the Charlson Comorbidity Index (CCMI) as a measure of general health status, for comparison with standard PROs.METHODSThe authors examined serial CCMI scores, complications, and PROs in 371 patients treated surgically for degenerative lumbar spine conditions who were enrolled in the Quality and Outcomes Database from a single center. The cohort included 152 males (41%) with a mean age of 58.7 years. Patients with no, minor, or major complications were compared at baseline and at 1 year postoperatively.RESULTSMinor complications were observed in 177 patients (48%), and major complications in 34 (9%). There were no significant differences in preoperative ODI, EQ-5D, or CCMI among the 3 groups. At 1 year, there was a significantly greater deterioration in CCMI in the major complication group (1.03) compared with the minor (0.66) and no complication groups (0.44, p < 0.006), but no significant difference in ODI or EQ-5D.CONCLUSIONSDespite equivalent improvements in PROs, patients with major complications actually had greater deterioration in their general health status, as evidenced by worse CCMI scores. Because CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including subsequent spine surgery. Although PRO scores are a key metric, they fail to adequately reflect the potential long-term impact of major perioperative complications.

scholarly journals Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

2015 ◽  
Vol 9 (1-2) ◽  
pp. 83 ◽  
Author(s):  
Siavash Falahatkar ◽  
Keivan Gholamjani Moghaddam ◽  
Ehsan Kazemnezhad ◽  
Alireza Farzan ◽  
Hamidreza Baghani Aval ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Renal Dysfunction ◽  
Percutaneous Nephrolithotomy ◽  
Multivariate Logistic Regression Analysis ◽  
Urinary Tract Abnormality ◽  
Factors Affecting ◽  
Preoperative Hemoglobin ◽  
Clavien Classification ◽  
The Impact ◽  
Hemoglobin Drop

Introduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC).Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate–severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results.Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper’s limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference.Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC.

The Impact of Adjuvant Therapy Delay on Survival Following Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

2017 ◽  
Vol 152 (5) ◽  
pp. S1235
Author(s):  
Onur Kutlu ◽  
Jeffrey E. Lee ◽  
Nestor de La Cruz ◽  
Claudius Conrad
Keyword(s):  
Adjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
The Impact

685 THE IMPACT OF ADJUVANT THERAPY ON SURVIVAL FOR NODE-NEGATIVE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A PROPENSITY SCORE MATCHED ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xue-feng Leng ◽  
Wenwu He ◽  
Yingchun Jiang ◽  
Xuefeng Leng ◽  
Qiyu Luo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Propensity Score ◽  
Adjuvant Therapy ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Node Negative ◽  
Independent Risk Factors ◽  
The Impact

Abstract   At present, the primary treatment of esophageal cancer is surgery-based comprehensive treatment, including adjuvant therapy such as chemotherapy and/or radiotherapy. However, the role of adjuvant therapy for esophageal squamous cell carcinoma (ESCC) with pathologically node-negative (pN0) disease is controversial. This study aimed to evaluate the impact of postoperative adjuvant therapy on survival in patients with pN0 ESCC. Methods Patients with ESCC who underwent R0 esophagectomy in the Department of Thoracic Surgery of Sichuan Cancer Hospital from Jan. 2008 to Dec. 2013 were involved. Patients were divided into two groups: surgery alone (Group S) or surgery + adjuvant therapy (Group S + A). The primary outcomes were overall survival (OS) and disease-free survival (DFS) between the two groups, and every consecutive case was followed up to death or the last follow-up. Results The study involved 387 patients with pN0 ESCC. After propensity score matching, each group consisted of 150 patients. In the overall cohort, the 5-year OS (p = 0.004) and 5-year DFS (p = 0.003) rates were higher in Group S + A than in Group S. In matched samples, the same outcomes were observed (5-year OS: p = 0.026; 5-year DFS: p = 0.014). Postoperative chemotherapy was associated with longer OS (p = 0.02) and DFS (p = 0.004); T3 tumors (p = 0.004) and &lt; 15 lymph node dissections (p = 0.002) were independent risk factors for pN0 ESCC. Conclusion As the study revealed, adjuvant therapy, especially chemotherapy, prolonged OS and DFS for patients with ESCC who had pN0 disease. Fewer lymph node dissections and T3 stage tumors were independent risk factors for OS and DFS.

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