Early-onset pancreatic ductal adenocarcinoma (PDAC) at Memorial Sloan Kettering Cancer Center (MSKCC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15736-e15736
Author(s):  
Siddharth Kunte ◽  
Swathi Sangli ◽  
Alejandro Lemor ◽  
Maeve Aine Lowery ◽  
Kenneth H. Yu ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Early Onset ◽  
Final Analysis ◽  
Oncologic Outcomes ◽  
Smoking History ◽  
Ductal Adenocarcinoma ◽  
Cancer Center ◽  
Small Subset ◽  
Average Patient ◽  
History Of

e15736 Background: PDAC is a leading and rising cause of cancer-related mortality. There is infrequent description of patients and outcomes with PDAC diagnosed aged <=50 years old (Early onset PC: EOPC). We reviewed the epidemiology, risk factors, oncologic outcomes and genomic data of EOPC pts at MSKCC. Methods: Using an institutional dataline search, N=364 patients were identified with EOPC between 2008-2014 at MSKCC. N= 282 were included in final analysis based on data completeness. Results: Baseline characteristics are summarized in table 1. The average patient was male, aged between 40- 50 years, BMI 24 and had metastatic disease at diagnosis. Family history of malignancy was present in N= 216 patients. The median overall survival (OS) for stages IIA, IIB, III and IV was 19.2, 21.8, 18.8 and 9.7 months respectively. Age, gender, diabetes and smoking history did not have a significant impact on OS. No difference in OS was noted between the groups who received gemcitabine based first-line chemotherapy compared to those with 5-fluorouracil based regimen in metastatic disease (9.9 vs 12 months, p= 0.315). Conclusions: EOPC represents a small subset of patients with PDAC and very rarely arises < 30 years of age. For this MSKCC cohort, outcomes appear similar to patients with average age onset PDAC. Further analyses on genomic characteristics may provide insight into outcomes and genetic underpinnings of EOPC. [Table: see text]

Pancreatic ductal adenocarcinoma (PDAC), BRCA: Detailed analysis and outcomes of cohort from Memorial Sloan Kettering Cancer Center (MSK).

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 708-708
Author(s):  
Parisa Momtaz ◽  
Catherine Anne O'Connor ◽  
Joanne F. Chou ◽  
Marinela Capanu ◽  
Kenneth H. Yu ◽  
...  
Keyword(s):  
Stage Iv ◽  
Ductal Adenocarcinoma ◽  
Cancer Center ◽  
Clinicopathologic Characteristics ◽  
Entire Cohort ◽  
Disease Biology ◽  
Kaplan Meier ◽  
Significant Difference ◽  
History Of ◽  
Associated Malignancy

708 Background: Given encouraging responses of platinum agents and poly-ADP ribose polymerase inhibitors (PARPi) in BRCA mutated (mut) PDAC, we sought to identify patients (pts) with BRCA mut PDAC treated at MSKCC and to evaluate outcome. Methods: Institutional database at MSK with IRB approval was queried for PDAC germline (g) or somatic (s) BRCA1/2 mut. Genomic profiling, clinicopathologic characteristics and outcomes were collected. Overall survival (OS) from diagnosis was estimated using Kaplan-Meier method. Results: n = 126 with BRCA1/2 mut PDAC were identified between 1/2011-12/2018. n = 77 (61%) male and median age of 62 (range 24-85) at diagnosis. n = 78 (62%) had g BRCA mut (n = 21 BRCA1; n = 57 BRCA2). n = 54 (43%) had a family history of BRCA-related malignancies; 35pts (28%) with a personal history of other BRCA-associated malignancy. n = 66 (52%) AJCC stage IV; of these 43pts (65%) received platinum-based therapy with a partial response (PR) in 35pts (81%); median duration 7 months (m) (range 0.5-39m). n = 40 (32%) received ≥ 4 lines of therapy (range 1-6 lines). n = 44 (35%) received PARPi and 11% (n = 14) received immunotherapy. Median OS for the entire cohort 32.1 m (95% CI 23.9, 42.6). Median OS for stage I-II 49.9m (95% CI 38.5,-); stage III 43m (95% CI 33.9,-) and stage IV 19.1m (95% CI 19.1 16.1,25.8). We did not observe a statistically significant difference in OS between BRCA1 vs BRCA2 pts. Conclusions: BRCA mut PDAC constitutes a small but likely distinct biologic subgroup. Improved OS was notable relative to historical data, possibly due to the integration of platinum and PARPi therapy and possibly due to contribution from disease biology. [Table: see text]

Prevalence of radiologic evidence of metastatic pancreatic ductal adenocarcinoma (PDAC) at first post-operative restaging studies in patients (pts) undergoing pancreatic cancer surgery with curative intent.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 225-225
Author(s):  
Sofia Palacio ◽  
Peter Joel Hosein ◽  
Joe U Levi ◽  
Jaime R. Merchan ◽  
Jorge Monge ◽  
...  
Keyword(s):  
Ct Scan ◽  
Disease Progression ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Disease Recurrence ◽  
Early Recurrence ◽  
Ductal Adenocarcinoma ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Curative Intent

225 Background: Surgical resection is the only potentially curative modality for PDAC. However, even after a successful surgical resection outcomes are poor due to both local and distant disease recurrence. Patients with early recurrence likely derive no benefit from surgery and could be considered for a non-surgical approach as initial therapy. Since the incidence of recurrent/metastatic disease at first post-operative staging scan is not well documented, our aim was to determine this incidence. Methods: This IRB-approved analysis identified all pts diagnosed with resectable PDAC that underwent surgery with intent to cure at the University of Miami/Sylvester Comprehensive Cancer Center between 2010 and 2012. Patients with imaging before and within 6 months after surgery were included. All post-operative CT scans performed within 3 months after surgery were reviewed for the presence of recurrent and/or metastatic disease. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Results: Data from105 pts were analyzed. Mean age was 61, 63% were male, 91% had adenocarcinoma, 84% had disease in the head of the pancreas. 11 out of 85 (13%) pts had recurrent/metastatic disease detected on first post-operative CT scan; 64% stage IIB and 73% had positive lymph nodes. 54 out of 105 (51%) had disease progression. 60% had local recurrence, 40% had distant metastasis. The mean time from preoperative CT scan to surgery was 35 days. Patients with early and late recurrence had similar OS from diagnosis (median 27.7 and 27.1 months, respectively) but worse than those with no disease recurrence (median not reached, OS rate 78% at 36 months). Conclusions: The relatively high incidence (13%) of early recurrence in this retrospective cohort suggests that further studies aimed at improving patient selection for surgery are warranted and provides a strong rationale for the use of neoadjuvant therapy to select patients with early disease progression who would not have benefitted from surgery.

scholarly journals An unusual presentation of very early onset metastatic pancreatic adenocarcinoma in a young man: case report

2021 ◽  
Vol 8 (8) ◽  
pp. 2460
Author(s):  
Abhishek Arora ◽  
Ashesh K. Jha ◽  
Manoj Kumar ◽  
Manoj Kumar
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Early Onset ◽  
Ductal Adenocarcinoma ◽  
Diagnostic Dilemma ◽  
Normal Limits ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
History Of ◽  
Abdominal Examination ◽  
Upper Abdomen

Pancreatic ductal adenocarcinoma (PDAC) is rare below 45 years of age and usually presents with constitutional symptoms, pain and jaundice. A 25 year old man, non-smoker, non-alcoholic presented to us with a lump in central upper abdomen of 1 month duration. Abdominal examination revealed a hard epigastric mass of size 7×10 cm. There were no other associated symptoms and no history of any similar illnesses in the family members. All laboratory parameters were within normal limits. Computed tomography showed a heterogeneous mass of size 7×13×15 cm arising from the head and neck of pancreas abutting the anterior abdominal wall with multiple abdominal and pelvic peritoneal deposits. Ultrasound guided core needle biopsy suggested PDAC. Hence, a diagnosis of very early onset metastatic PDAC was rendered and the patient was referred for palliative chemotherapy. PDAC below 45 years of age is known as very early onset PDAC. It is usually associated with family history of PDAC and known risk factors. This case was unique because of absence of the characteristic clinical features and known risk factors, early onset of occurrence and negative family history, which led to a diagnostic dilemma.

LUNGRADS AND UPDATE OF LUNG NODULES SCREENING BY LOW DOSE COMPUTED TOMOGRAPHY

2015 ◽  
pp. 12-19
Author(s):  
Thi Ngoc Ha Hoang ◽  
Trong Khoan Le
Keyword(s):  
Lung Cancer ◽  
Low Dose ◽  
False Negative ◽  
Lung Nodule ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Low Dose Ct ◽  
History Of ◽  
Chest X Ray ◽  
Low Dose Computed Tomography

Background: A pulmonary nodule is defined as a rounded or irregular opacity, well or poorly defined, measuring up to 3 cm in diameter. Early detection the malignancy of nodules has a significant role in decreasing the mortality, increasing the survival time and consider as early diagnosis lung cancer. The main risk factors are those of current or former smokers, aged 55 to 74 years with a smoking history of at least 1 pack-day. Low dose CT: screening individuals with high risk of lung cancer by low dose CT scans could reduce lung cancer mortality by 20 percent compared to chest X-ray. Radiation dose has to maximum reduced but respect the rule of ALARA (As Low as Resonably Archivable). LungRADS 2014: Classification of American College of Radiology, LungRADS, is a newly application but showed many advantages in comparison with others classification such as increasing positive predict value (PPV), no result of false negative and cost effectiveness. Key words: LungRADS, screening lung nodule, low dose CT, lung cancer

scholarly journals Predicting COVID-19 mortality with electronic medical records

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Hossein Estiri ◽  
Zachary H. Strasser ◽  
Jeffy G. Klann ◽  
Pourandokht Naseri ◽  
Kavishwar B. Wagholikar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Information ◽  
Age Groups ◽  
Prognostic Models ◽  
Smoking History ◽  
Risk Scores ◽  
Gradient Boosting ◽  
Chronic Obstructive ◽  
Clinical Expertise ◽  
History Of

AbstractThis study aims to predict death after COVID-19 using only the past medical information routinely collected in electronic health records (EHRs) and to understand the differences in risk factors across age groups. Combining computational methods and clinical expertise, we curated clusters that represent 46 clinical conditions as potential risk factors for death after a COVID-19 infection. We trained age-stratified generalized linear models (GLMs) with component-wise gradient boosting to predict the probability of death based on what we know from the patients before they contracted the virus. Despite only relying on previously documented demographics and comorbidities, our models demonstrated similar performance to other prognostic models that require an assortment of symptoms, laboratory values, and images at the time of diagnosis or during the course of the illness. In general, we found age as the most important predictor of mortality in COVID-19 patients. A history of pneumonia, which is rarely asked in typical epidemiology studies, was one of the most important risk factors for predicting COVID-19 mortality. A history of diabetes with complications and cancer (breast and prostate) were notable risk factors for patients between the ages of 45 and 65 years. In patients aged 65–85 years, diseases that affect the pulmonary system, including interstitial lung disease, chronic obstructive pulmonary disease, lung cancer, and a smoking history, were important for predicting mortality. The ability to compute precise individual-level risk scores exclusively based on the EHR is crucial for effectively allocating and distributing resources, such as prioritizing vaccination among the general population.

scholarly journals Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Shweta R Singh ◽  
Bunsoth Mao ◽  
Konstantin Evdokimov ◽  
Pisey Tan ◽  
Phana Leab ◽  
...  
Keyword(s):  
Final Analysis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Middle Income ◽  
E Coli ◽  
Middle Income Countries ◽  
Siem Reap ◽  
High Prevalence ◽  
Significant Public Health ◽  
History Of

Abstract Background The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries. Methods We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2–14 years) had been hospitalized for at least 48 h in the preceding 2–4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage. Results Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts. Conclusions The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.

scholarly journals Pancreatic ductal adenocarcinoma in colonic wall: metastatic disease or cancerized pancreatic ectopic tissue?

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Graziana Gallo ◽  
Alessandro Mangogna ◽  
Gianrocco Manco ◽  
Stefania Caramaschi ◽  
Tiziana Salviato
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Metastatic Disease ◽  
Ductal Adenocarcinoma ◽  
Colonic Wall ◽  
Ectopic Tissue

scholarly journals Vaccination strategy and anti - SARS-CoV-2 S titers in healthcare workers of the INT – IRCCS “Fondazione Pascale” Cancer Center (Naples, Italy)

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ernesta Cavalcanti ◽  
Maria Antonietta Isgrò ◽  
Domenica Rea ◽  
Lucia Di Capua ◽  
Giusy Trillò ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Responses ◽  
Healthcare Workers ◽  
Geometric Mean ◽  
Vaccination Strategy ◽  
Antibody Responses ◽  
Cancer Center ◽  
Serum Samples ◽  
Humoral Immune ◽  
History Of

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and the resulting disease, coronavirus disease 2019 (COVID-19), have spread to millions of people globally, requiring the development of billions of different vaccine doses. The SARS-CoV-2 spike mRNA vaccine (named BNT162b2/Pfizer), authorized by the FDA, has shown high efficacy in preventing SARS-CoV-2 infection after administration of two doses in individuals 16 years of age and older. In the present study, we retrospectively evaluated the differences in the SARS-CoV-2 humoral immune response after vaccine administration in the two different cohorts of workers at the INT - IRCCS “Fondazione Pascale” Cancer Center (Naples, Italy): previously infected to SARS-CoV-2 subjects and not infected to SARS-CoV-2 subjects. Methods We determined specific anti-RBD (receptor-binding domain) titers against trimeric spike glycoprotein (S) of SARS-CoV-2 by Roche Elecsys Anti-SARS-CoV-2 S immunoassay in serum samples of 35 healthcare workers with a previous documented history of SARS-CoV-2 infection and 158 healthcare workers without, after 1 and 2 doses of vaccine, respectively. Moreover, geometric mean titers and relative fold changes (FC) were calculated. Results Both previously infected and not infected to SARS-CoV-2 subjects developed significant immune responses to SARS-CoV-2 after the administration of 1 and 2 doses of vaccine, respectively. Anti-S antibody responses to the first dose of vaccine were significantly higher in previously SARS-CoV-2-infected subjects in comparison to titers of not infected subjects after the first as well as the second dose of vaccine. Fold changes for subjects previously infected to SARS-CoV-2 was very modest, given the high basal antibody titer, as well as the upper limit of 2500.0 BAU/mL imposed by the Roche methods. Conversely, for naïve subjects, mean fold change following the first dose was low ($$ \overline{x} $$ x ¯ =1.6), reaching 3.8 FC in 72 subjects (45.6%) following the second dose. Conclusions The results showed that, as early as the first dose, SARS-CoV-2-infected individuals developed a remarkable and statistically significant immune response in comparison to those who did not contract the virus previously, suggesting the possibility of administering only one dose in previously SARS-CoV-2-infected subjects. FC for previously infected subjects should not be taken into account for the generally high pre-vaccination values. Conversely, FC for not infected subjects, after the second dose, were = 3.8 in > 45.0% of vaccinees, and ≤ 3.1 in 19.0%, the latter showing a potential susceptibility to further SARS-CoV-2 infection.

Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽  
2000 ◽  
Vol 96 (3) ◽  
pp. 1191-1193 ◽  
Author(s):  
Takashi Tarumi ◽  
Danko Martincic ◽  
Anne Thomas ◽  
Robert Janco ◽  
Mary Hudson ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Early Onset ◽  
Family Members ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Common Cause ◽  
History Of ◽  
Prophylactic Anticoagulation ◽  
Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

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