Clinical outcomes of pancreas cancer patients with peritoneal spread: Results from the chord consortium.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19268-e19268
Author(s):  
Mehrnoosh Pauls ◽  
Abdulaziz AlJassim AlShareef ◽  
Winson Y. Cheung ◽  
Rachel Anne Goodwin ◽  
Brandon M. Meyers ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Advanced Pancreatic Cancer ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
First Line ◽  
The Impact ◽  
Line Chemotherapy

e19268 Background: Prior studies have demonstrated that clonal cells that give rise to pancreatic peritoneal metastases (PM) are geographically and genetically distinct from clonal cells, giving rise to lung and liver metastases. The objective of this study was to assess if there is a distinct difference in prognosis and therapeutic response among patients with pancreatic cancer with (PM compared to the lung/liver. Methods: Using a retrospective cohort design, medical records from adult patients diagnosed with metastatic adenocarcinoma of the pancreas at five Canadian academic cancer centers (2014 - 2019) were reviewed. Prognostic variables including age, Charlson comorbidity index, ECOG, cigarette smoking, nodal status, sites of metastases, and first line chemotherapy were collected. Cox proportional hazards model (MVA) was used to examine the association between peritoneal involvement and survival, adjusted for measured confounders. Analyses were completed using SAS, where alpha of 0.05 was defined as the level of significance. Results: A total of 1161 patients were included. Metastatic sites included peritoneum (n = 170, 14.6%), lung (n = 145, 12.5%) and liver (n = 563, 48.5%). Patients with PM received first-line FOLFIRINOX (FFX, n = 31), Gemcitabine + nab-paclitaxel (G/N, n = 20), Gemcitabine (G, n = 18), and no treatment (n = 97). In univariate analyses, worse ECOG PS was associated with PM (p = 0.002). The majority of patients died (89%), with a median overall survival (OS) of 3 vs 7 months for patients with PM and those without PM (p < 0.001), respectively. The median OS in patient whom receive first-line chemotherapy was 7 months in FFX group (95% CI 1.66-12.33), 6 months in G/N (95% CI 4.54-7.45) and 2 months in G group (95% CI 1.42-2.57). Patients had significantly better OS when treated with FFX or G/N compared to G alone (p = 0.002). Time to treatment failure was significantly shorter among patient treated with G alone compare to patients treated with FFX and G/N (P < 0.005). Conclusions: In the setting of combination chemotherapy for advanced pancreatic cancer, patients with PM continue to have a poor prognosis. This may be due to the impact of PM on PS and the inability to administer palliative chemotherapy. For eligible patients, FFX or G/N results in a higher OS than G monotherapy.

Prognostic role of neutrophil-to-lymphocyte ratio (NLR) dynamics during first-line FOLFOXIRI in advanced pancreatic cancer (aPC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15754-e15754
Author(s):  
Irene Pecora ◽  
Gianna Musettini ◽  
Silvia Catanese ◽  
Caterina Vivaldi ◽  
Giulia Pasquini ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Performance Status ◽  
Advanced Pancreatic Cancer ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
First Line ◽  
Poor Prognostic Factor

e15754 Background: Elevated pre-treatment NLR is a well-known poor prognostic factor in several tumours, including aPC. However, the role of NLR changes during first-line chemotherapy is less investigated. Methods: We retrospectively evaluated aPC patients (pts) treated with FOLFOXIRI (infusional 5-fluorouracil, oxaliplatin, irinotecan). NLR was calculated before the first (NLR-0) and the fourth (NLR-3) cycle, high NLR being defined as > 4. We evaluated the correlation between NLR change and overall survival (OS), progression-free survival (PFS), response rate (RR) and disease-control-rate (DCR). Survival curves were estimated using the Kaplan-Meier method. Log-rank and chi-square tests were applied. Multivariate analysis was performed by Cox proportional hazards model. Results: Ninety-four pts were evaluable. Median age was 62 years; at diagnosis, 38 (40.4%) pts had unresectable stage III and 56 (59.6%) had stage IV disease. In the overall population, median PFS (mPFS) and OS (mOS) were 8.0 and 12.9 months, respectively. NLR-0 was significantly associated with poor prognosis: among the 12 pts with NLR-0 > 4 mOS was 5.1 months compared with 13.5 months for the 82 pts with NLR-0 ≤4 (p < 0.001). As regards NLR dynamics, NLR-3 remained high or was increased (H/I) in 5 pts (5.3%) while was stably low or decreased (L/D) in 89 pts (94.7%). mOS was 5.1 months (95%CI 0.4-9.8) in H/I and 13.5 months (95%CI 10.9-16.1) in L/D (p < 0.001) pts. The same association was found for PFS, with 4.7 (95%CI 2.1-7.3) vs 8.3 months (95%CI 6.2-10.4, p = 0.004), respectively, but not for RR and DCR. At multivariate analysis, NLR change was confirmed as independent predictor of OS (HR 6.854, 95%CI 2.109-22.269, p = 0.001) and, when added to performance status, liver metastases and NLR-0, allowed a better risk stratification in good (no negative factors), intermediate (1-2 factors) and poor (3-4 factors) risk groups, with mOS of 18.0, 10.0 and 5.1 months, respectively (p = 0.012). Conclusions: Not only NLR-0, but also changes after 3 cycles of first-line FOLFOXIRI could predict OS in aPC pts. Early variations in NLR might be a cheap, reproducible and useful factor to predict prognosis and to better refine treatment strategy.

scholarly journals A Time-Trend Survival Analysis of Elderly Resectable Pancreatic Cancer Patients

2021 ◽  
Author(s):  
Rui Jing ◽  
Yuru Shang ◽  
Bing Li ◽  
Xiaodong Bai ◽  
Guangrui Shao
Keyword(s):  
Pancreatic Cancer ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Time Trend ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Young Patients ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model

Abstract Background: The time-trend in the survival of elderly pancreatic cancer patients was still unclear. Thus, the aim of this study was to compare the survival benefit of young and elderly pancreatic cancer patients by a time-trend analysis. Methods: From 2004-2013, we obtained 5,341 of young patients (< 80 years) and 569 elderly patients (≥ 80 years) from the Surveillance, Epidemiology, and End Results (SEER) database, and the overall survival of these patients were analyzed by Kaplan-Meier estimator. The independent factors which could predict the survival of patients were determined by cox proportional hazards model.Results: We observed that the median overall survival of the young patients in 2004-2008 cohort was significantly (P < 0.001) increased when compared to that in the 2009-2013 cohort. However, we did not observe the survival benefit for the elderly patients. The Cox proportional hazards model demonstrated that the tumor size, lymph node ratio, grade, and AJCC TNM stage were independent factors of survival. Conclusions: This study demonstrated that compared to 2004-2008, the survival of elderly patients in 2009-2013 was not significantly improved. Thus, the clinicians still need to administer more care to elderly patients.

Symptomatic and Incidental Thromboses Are Both Associated with Mortality In Pancreatic Cancer

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3167-3167 ◽  
Author(s):  
Laurel A. Menapace ◽  
Derick R. Peterson ◽  
Andrea Berry ◽  
Tarek Sousou ◽  
Alok A. Khorana
Keyword(s):  
Pancreatic Cancer ◽  
Cancer Patients ◽  
Median Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Conflicts Of Interest ◽  
Significant Proportion ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Significant Difference

Abstract Abstract 3167 Background: Incidentally diagnosed venous thromboembolism (VTE) is a growing clinical problem. Although pancreatic cancer is well-known to be associated with VTE, contemporary rates of incidental and symptomatic VTE events and their association with mortality are incompletely understood. Methods: We conducted a retrospective cohort study of consecutive pancreatic adenocarcinoma patients seen at the University of Rochester from 2006–2009. Radiologic reports were reviewed for presence of pulmonary embolism (PE), deep venous thrombosis (DVT), and visceral vein thrombosis. Multiple clinical variables and mortality outcomes were collected. Data were analyzed using a multivariate Cox proportional hazards model. Results: A total of 1151 radiologic exams for 135 patients were included. Forty-seven patients (34.8%) experienced at least one VTE event. There were 12 PEs (n=12 patients, 8.9%), 34 DVTs (n=17 patients, 12.6%), 47 visceral vein (n=31 patients, 22.9%) and 2 arterial (n=2 patients, 1.5%) events. Twenty-one patients (15.5%) experienced more than one event. Incidental events comprised 33.3% (n=4) of PEs, 17.6% (n=6) of DVTs and 100% (n=47) of visceral VTE. Median survival for the study population was 237 (95% CI 199–277) days. Patients with VTE had significantly reduced survival (73 vs. 233 days at 3 months post-diagnosis; 66 vs. 245 days at 6 months post-diagnosis). There was no significant difference between asymptomatic and symptomatic events in terms of conditional median survival at 3 months-, 6 months- or 1 year-post diagnosis. In multivariate analysis, occurrence of either DVT (HR 7.4 95% CI 3.8–14.6, P<0.0001) or visceral asymptomatic events (HR 2.5 95% CI 1.6–3.8, P=0.0001) was significantly associated with mortality along with advanced stage. Conclusions: VTE occurs in over one-third of pancreatic cancer patients, including a significant proportion with incidentally discovered events. Patients with visceral vein events are generally not anticoagulated but these findings suggest a similar association with mortality as symptomatic DVT. Our findings require reconsideration of prognosis and anticoagulation options in pancreatic cancer patients with both incidental and symptomatic VTE. Disclosures: No relevant conflicts of interest to declare.

scholarly journals EVALUATING THE INFLUENCE OF FRAILTY IN SURVIVAL ANALYSIS OF CANCER PATIENTS IN NORTH-WESTERN NIGERIA

2020 ◽  
Author(s):  
BOYI ABUBAKAR DALATU ◽  
SHEHU LADAN ◽  
FARUK ABDULLAHI ZAGGA ◽  
ISHAQ .O. OLAWOYIN
Keyword(s):  
Cancer Patients ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
University Teaching ◽  
Cancer Type ◽  
Cancer Data ◽  
The Impact ◽  
North Western

Not much is known about the influence of frailty along side otherexplanatory variables on cancer patients’ survival in the north-western Nigeria. In this work, the impact of variables; age sex cancer type, and frailty on patient survival has been estimated using Cox proportional hazards model. Fitting the model to the cancer data obtained from Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Cancer Registry Center, the results indicate that the covariates studied are relevant prognostic factors to patients’ survival. Also, presence of frailty has impact on the estimates. Female patients were found to be slightly more prone to failure than the male patients. Key words:Cancer Survival, Covariates, Frailty, Cox Proportional Hazards

Age at Exposure to Parental Suicide and the Subsequent Risk of Suicide in Young People

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 27-36 ◽  
Author(s):  
Kuan-Ying Lee ◽  
Chung-Yi Li ◽  
Kun-Chia Chang ◽  
Tsung-Hsueh Lu ◽  
Ying-Yeh Chen
Keyword(s):  
Young People ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Birth Registry ◽  
Data Set ◽  
Parental Suicide ◽  
The Impact ◽  
Age At Exposure

Abstract. Background: We investigated the age at exposure to parental suicide and the risk of subsequent suicide completion in young people. The impact of parental and offspring sex was also examined. Method: Using a cohort study design, we linked Taiwan's Birth Registry (1978–1997) with Taiwan's Death Registry (1985–2009) and identified 40,249 children who had experienced maternal suicide (n = 14,431), paternal suicide (n = 26,887), or the suicide of both parents (n = 281). Each exposed child was matched to 10 children of the same sex and birth year whose parents were still alive. This yielded a total of 398,081 children for our non-exposed cohort. A Cox proportional hazards model was used to compare the suicide risk of the exposed and non-exposed groups. Results: Compared with the non-exposed group, offspring who were exposed to parental suicide were 3.91 times (95% confidence interval [CI] = 3.10–4.92 more likely to die by suicide after adjusting for baseline characteristics. The risk of suicide seemed to be lower in older male offspring (HR = 3.94, 95% CI = 2.57–6.06), but higher in older female offspring (HR = 5.30, 95% CI = 3.05–9.22). Stratified analyses based on parental sex revealed similar patterns as the combined analysis. Limitations: As only register-­based data were used, we were not able to explore the impact of variables not contained in the data set, such as the role of mental illness. Conclusion: Our findings suggest a prominent elevation in the risk of suicide among offspring who lost their parents to suicide. The risk elevation differed according to the sex of the afflicted offspring as well as to their age at exposure.

Between National Polarization and Local Ideology: The Impact of Partisan Competition on State Medicaid Expansion Decisions

2019 ◽  
Vol 50 (2) ◽  
pp. 237-255 ◽  
Author(s):  
Joshua Meyer-Gutbrod
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Electoral Competition ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Party Competition ◽  
Medicaid Expansion ◽  
Hazards Model ◽  
Partisan Competition ◽  
The Impact

Abstract The U.S. Supreme Court’s decision to grant states the authority to reject Medicaid expansion under the Affordable Care Act without penalty threatened the implementation of this polarized health policy. While many Republican-controlled states followed their national allies and rejected Medicaid expansion, others engaged in bipartisan implementation. Why were some Republican states willing to reject the national partisan agenda and cooperate with Democrats in Washington? I focus on the role of electoral competition within states. I conclude that although electoral competition has been shown to encourage partisan polarization within the states, the combination of intergovernmental implementation and Medicaid expansion’s association with public welfare reverses this dynamic. I employ a Cox proportional-hazards model to examine the impact of state partisan ideology and competition on the likelihood of state Medicaid expansion. I find that strong inter-party competition mitigates the impact of more extreme partisan ideologies, encouraging potentially bipartisan negotiation with the federal administration.

scholarly journals Exploring the determinants of real estate liquidity from an alternative perspective: censored quantile regression in real estate research

2020 ◽  
Vol 90 (7) ◽  
pp. 1057-1086 ◽  
Author(s):  
Marcelo Cajias ◽  
Philipp Freudenreich ◽  
Anna Freudenreich
Keyword(s):  
Real Estate ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Quantile Regressions ◽  
The Real Estate ◽  
Censored Quantile Regression ◽  
The Impact ◽  
German Cities

Abstract In this paper, the liquidity (inverse of time on market) of rental dwellings and its determinants for different liquidity quantiles are examined for the seven largest German cities. The determinants are estimated using censored quantile regressions in order to investigate the impact on very liquid to very illiquid dwellings. As market heterogeneity is not only observed between cities but also within a city, each of the seven cities is considered individually. Micro data for almost 500,000 observations from 2013 to 2017 is used to examine the time on market. Substantial differences in the magnitude and direction of the regression coefficients for the different liquidity quantiles are found. Furthermore, both the magnitude and direction of the impact of an explanatory variable on the liquidity, differ between the cities. To the best of the authors’ knowledge this is the first paper, to apply censored quantile regressions to liquidity analysis of the real estate rental market. The model reveals that the proportionality assumption underlying the Cox proportional hazards model cannot be confirmed for all variables across all cities, but for most of them.

scholarly journals Outcomes of Peritoneal Dialysis Patients and Switching to Hemodialysis: A Competing Risks Analysis

2014 ◽  
Vol 34 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Jernej Pajek ◽  
Alastair J. Hutchison ◽  
Shiv Bhutani ◽  
Paul E.C. Brenchley ◽  
Helen Hurst ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Residual Renal Function ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Adjusted Analysis ◽  
Ultrafiltration Failure ◽  
The Impact ◽  
Technique Failure

BackgroundWe performed a review of a large incident peritoneal dialysis cohort to establish the impact of current practice and that of switching to hemodialysis.MethodsPatients starting peritoneal dialysis between 2004 and 2010 were included and clinical data at start of dialysis recorded. Competing risk analysis and Cox proportional hazards model with time-varying covariate (technique failure) were used.ResultsOf 286 patients (median age 57 years) followed for a median of 24.2 months, 76 were transplanted and 102 died. Outcome probabilities at 3 and 5 years respectively were 0.69 and 0.53 for patient survival (or transplantation) and 0.33 and 0.42 for technique failure. Peritonitis caused technique failure in 42%, but ultrafiltration failure accounted only for 6.3%. Davies comorbidity grade, creatinine and obesity (but not residual renal function or age) predicted technique failure. Due to peritonitis deaths, technique failure was an independent predictor of death hazard. When successful switch to hemodialysis (surviving more than 60 days after technique failure) and its timing were analyzed, no adverse impact on survival in adjusted analysis was found. However, hemodialysis via central venous line was associated with an elevated death hazard as compared to staying on peritoneal dialysis, or hemodialysis through a fistula (adjusted analysis hazard ratio 1.97 (1.02 – 3.80)).ConclusionsOnce the patients survive the first 60 days after technique failure, the switch to hemodialysis does not adversely affect patient outcomes. The nature of vascular access has a significant impact on outcome after peritoneal dialysis failure.

Comorbidities and Myelodysplatic Syndromes.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2789-2789 ◽  
Author(s):  
Kiran Naqvi ◽  
Guillermo Garcia-Manero ◽  
Sagar Sardesai ◽  
Jeong Oh ◽  
Sherry Pierce ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Median Survival ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier ◽  
Comorbidity Scores ◽  
Severe Comorbidity

Abstract Abstract 2789 Poster Board II-765 Background: Cancer patients often experience comorbidities that may affect their therapeutic options, prognosis, and outcome (1). Limited studies have evaluated the characteristics and impact of comorbidities in myelodysplastic syndromes (MDS). The aim of this study was to determine the effect of comorbidities on the survival of patients with MDS. Methods: We reviewed the medical records of 500 consecutive MDS patients who presented to MD Anderson Cancer Center from January 2002 to June 2004. The Adult Comorbidity Evaluation-27 (ACE-27), a validated 27-item comorbidity index for cancer patients (2), was used to assess the severity of comorbid conditions. For each patient, we obtained demographic data and specific staging information based on the International Prognostic Scoring System (IPSS). We also collected information on stem cell transplantation (SCT), mortality and survival. Kaplan-Meier methods and log-rank tests were used to assess survival. Multivariate analysis was performed using the Cox Proportional Hazards Model. Results: Of the 500 patients included in this study, 327 (65.4%) were male, and 436 (87.9%) were white; median age at presentation was 66.6 years (17.7, 93.5); mean duration of follow-up was 23.5 months (0, 88). A total of 49% of patients had IPSS intermediate-1 or lower risk. The ACE-27 comorbidity scores were as follows: none, 106 patients (21.2%); mild, 213 (42.6%); moderate, 108 (21.6%); and severe, 73 (14.6%). Three hundred and eighty one (76.2%) patients died, and 44 (8.8%) patients underwent SCT. Overall median survival using the Kaplan-Meier method was 17.6 months. Median survival according to ACE-27 scores was: 27.9 months for no comorbidity, 18.9 months for mild comorbidity, 15.2 months for moderate comorbidity, and 9.7 months for severe comorbidity. This trend reached statistical significance (p < 0.0001). The median survival by IPSS ranged from 40.9 months for patients in the low risk group versus 8.1 months for those in the high risk category (p < 0.0001). The hazards ratio obtained from the multivariate Cox Proportional Hazards Model was 1.5 and 2.0 for moderate and severe comorbidity scores when adjusted for age and IPSS (p < 0.0001). A linear trend was also observed between the severity of comorbidity and having received SCT (p = 0.001). Of the 44 patients who had SCT, 21 (47.7%) died. The median survival of patients who did not undergo stem cell transplantation ranged from 22.7 months for patients with no comorbidity to 9.3 months for patients with severe comorbidity (p = 0.0002). Conclusion: Comorbidities had a significant impact on the survival of patients with myelodysplastic syndrome. Patients with higher ACE-27 comorbidity scores had a shorter survival than those with no comorbidity, independent of their age and the IPSS risk group. Also patients with comorbid conditions received SCT less often than those without comorbidity. A comprehensive assessment of comorbidity is therefore needed to determine the prognosis in patients with MDS. References: (1) Extermann M. Measurement and impact of comorbidity in older cancer patients. Crit Rev Oncol Hematol. 2000;35:181-200. (1) Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA. 2004;291:2441-47. Disclosures: No relevant conflicts of interest to declare.

Chemotherapy-induced neutropenia as a prognostic factor in patients with unresectable pancreatic cancer treated with gemcitabine and nab-paclitaxel.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 324-324
Author(s):  
Motoyasu Kan ◽  
Hiroshi Imaoka ◽  
Masafumi Ikeda ◽  
Shuichi Mitsunaga ◽  
Izumi Ohno ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Prognostic Factor ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Unresectable Pancreatic Cancer ◽  
Who Grade ◽  
Chemotherapy Induced Neutropenia ◽  
Time Varying Covariates

324 Background: Chemotherapy-induced neutropenia (CIN) has been reported to be associated with a longer survival in patients with various cancers. The aim of our study was to assess whether CIN could also be a prognostic factor in patients with unresectable pancreatic cancer receiving treatment with gemcitabine (GEM) and nab-paclitaxel (nab-PTX). Methods: We retrospectively analyzed the medical records of pancreatic cancer patients who had been treated with GEM and nab-PTX as first-line chemotherapy. CIN was categorized on the basis of the worst WHO grade during chemotherapy: absent/mild (≦ grade 2), or severe (≧ grade 3). The background characteristics and CIN as time-varying covariates (TVCs) were analyzed as potential prognostic factors using a Cox proportional hazards model. Results: We analyzed a total of 291 patients (absent/mild CIN: 116 patients; severe CIN: 174 patients). The median time to severe CIN was 14 days (interquartile range: 10–39 days). The median overall survival (OS) was significantly longer in the severe CIN group than in the absent/mild CIN group (19.2 vs. 11.3 months; p < 0.001) After adjustments, severe CIN was identified as an independent predictor of the OS (HR, 0.54; 95% CI, 0.38–0.77; p = 0.001). In the TVC model also, severe CIN was identified as an independent factor (HR, 0.79; 95% CI, 0.68–0.92; p = 0.002). Conclusions: Severe CIN was associated with a longer survival in patients with pancreatic cancer treated with GEM and nab-PTX.

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