scholarly journals Disordered Presentation of Paraneoplastic Pancreatitis, Polyarthritis and Panniculitis (PPP) Syndrome in a Patient with End-Stage Pancreatic Cancer

2018 ◽  
Vol 2 (1) ◽  
pp. 54-58
Author(s):  
Melody Maarouf ◽  
Marilyn Wickenheiser ◽  
James Sligh ◽  
Keliegh Culpepper ◽  
Vivian Shi
Keyword(s):  
Infectious Disease ◽  
Pancreatic Cancer ◽  
Rare Case ◽  
Stage Iv ◽  
Initial Presentation ◽  
Pancreatic Panniculitis ◽  
End Stage

We report a rare case of PPP due to stage IV beta-islet pancreatic cancer presenting with polyarthritis, whose diagnosis was delayed due to an incomplete presentation of PPP syndrome. Following an extensive one-month infectious disease workup, tender erythematous papules began to develop, which prompted the consideration and subsequent biopsy for pancreatic panniculitis. Thus, the diagnosis was delayed due to a lagging cutaneous presentation—a component of the triad that is commonly the initial presentation in most patients. 

Analysis of statistical indicators of the population of Saint Petersburg with malignant neoplasms of pancreas

2021 ◽  
Vol 23 (2) ◽  
pp. 155-164
Author(s):  
Vladislav E. Moiseenko ◽  
Alexander V. Pavlovsky ◽  
Dmitry A. Granov ◽  
Larisa V. Kochorova ◽  
Inna V. Dodonova ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Stage Iv ◽  
Malignant Neoplasms ◽  
Number Of Patients ◽  
Incidence And Mortality ◽  
Significant Downward Trend ◽  
Accumulation Index ◽  
One Year ◽  
The One ◽  
Statistical Indicators

Morbidity and mortality from pancreatic cancer is an urgent medical and social problem. Evaluation of statistical indicators in dynamics makes it possible to identify organizational and clinical problems in providing care to patients with malignant neoplasms of the pancreas. Medical and statistical indicators of incidence of malignant pancreatic neoplasms in St. Petersburg residents are evaluated. The assessment of medical and statistical indicators of the incidence of malignant neoplasms of the pancreas in residents of St. Petersburg. Statistical data were studied for the period from 2014 to 2019. The increase in the "rough" indicator of primary morbidity changed from 417.99 per 100 thousand population in 2014 to 505.6 in 2019. In the structure of primary cancer incidence, the indicator of active detection of pancreatic cancer glands in 2014 amounted to 3.6%, in 2019 3.8%. The proportion of patients with diagnoses confirmed morphologically increased from 48.9% to 61.4%. The proportion of patients with newly diagnosed stage IV of the disease changed from 39.5% in 2014 to 51.4% in 2019, and in patients with stage III in 2019 it was 33.3% (a decrease in comparison with 2014 15.3%). In 2019, the disease was diagnosed at stage II in 15.2% of patients. The proportion of patients with stage I in 2019 was 6.6%, this indicator in 2014 was registered at the level of 19.2%. From 2014 to 2019, the one-year mortality rate did not change and amounted to 67.9 and 67.4%, respectively (the decrease was 0.7%). Over the past 5 years, there has been no significant downward trend in the "rough" incidence and mortality rates from pancreatic cancer. However, in the dynamics, there was an increase in the number of patients registered for 5 or more years, and an increase in the accumulation index of the contingent of patients with pancreatic cancer.

Impact of social determinants of health on a late diagnosis and survival of patients with pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18530-e18530
Author(s):  
Jesus C. Fabregas ◽  
Miranda Lam
Keyword(s):  
Pancreatic Cancer ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Late Diagnosis ◽  
Determinants Of Health ◽  
Secondary Outcome ◽  
Black Race ◽  
Cox Analysis

e18530 Background: While disparities in pancreatic cancer (PC) are documented, it is unclear whether these inequities occur at the time of diagnosis or throughout treatment. We hypothesize social determinants of health (SDH) such as income, education, race and insurance status are a) associated with a late diagnosis of PC (Stage IV vs Stages 0-III) and b) associated with overall survival (OS) in Stage IV patients. Methods: The National Cancer Database 2017 version was accessed. Primary outcome: diagnosis of Stage IV PC. Secondary outcome: OS. Primary predictors: race, income, education, insurance. Confounders: Charlson comorbidity score, age, sex. Univariate and multivariate regression models evaluated the association between SDH and a late diagnosis of PC. Univariate and multivariate Cox proportional hazards model examined OS. 95% Confidence Intervals were used. Results: 230,877 patients were included. Median 68 yrs, mean 67.3 SD(12.1). In univariate analysis, education (>93% high school completion (HSC) vs <82.4%, OR 0.93 [0.91 – 0.95]), income (>$63,333 vs<$40,277, OR 0.94 [0.92– 0.96]), and insurance (Private vs No, OR 0.70 [0.66 – 0.73]), decreased the odds of Stage IV PC. Black race was associated with higher odds of Stage IV PC (vs White, OR 1.11 [1.08 – 1.14]). In multivariate analysis, education and having insurance decreased the risk of a late diagnosis, whereas black race increased it (table). In univariate Cox analysis, higher income (>$63,333 (vs<$40,277), HR 0.82 [0.81– 0.83]), insurance (Private vs No, HR 0.77 [0.73 – 0.76]) and education (>93% HSC vs <82.4%, HR 0.87 [0.86 – 0.88]) improved OS. Black race was associated with poorer OS (vs White, HR 1.03 [1.02 – 1.05]). In multivariate Cox analysis, only higher income (>$63,333 (vs<$40,277), HR 0.87 [0.85 – 0.89]) and having insurance (Private vs No, HR 0.77 [0.74 – 0.79]) were associated with improved OS. Conclusions: SDH impacted the continuum of pancreatic neoplasia care, from diagnosis to treatment. Expanding insurance coverage could be an effective public health intervention to improve early diagnosis and survival rates.[Table: see text]

The Effect of Celiac Neurolysis and Splanchnicectomy on Survival in Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-9
Author(s):  
Linhan Ye ◽  
Stephan Schorn ◽  
Ilaria Pergolini ◽  
Okan Safak ◽  
Elke Demir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Stage Iv ◽  
Stage Iii ◽  
Cochrane Library ◽  
Unresectable Pancreatic Cancer ◽  
Relevant Effect ◽  
The Impact

<b><i>Background:</i></b> Intractable pancreatic pain is one of the most common symptoms of patients with pancreatic ductal adenocarcinoma (PDAC). Celiac neurolysis (CN) and splanchnicectomy were already described as effective methods to manage abdominal pain in unresectable PDAC, but their impact on overall survival (OS) has not yet been established. <b><i>Objective:</i></b> We aimed to investigate the impact of CN and splanchnicectomy on the survival of patients with unresectable pancreatic cancer. <b><i>Methods:</i></b> A systematic review of PubMed and Cochrane Library according to predefined searching terms was conducted in March 2020. Hazard ratios (HR) of OS data were calculated using the Mantel-Haenszel model for random effects or fixed effects. <b><i>Result:</i></b> Four randomized-controlled trials (RCTs) and 2 non-RCTs with a total of 2,507 patients were identified. The overall pooled HR did not reveal any relevant effect of CN and splanchnicectomy on OS (HR: 1.03; 95% CI: 0.81–1.32), which was also underlined by the sensitivity analysis of RCTs (HR: 1.0; 95% CI: 0.72–1.39) and non-RCTs (HR: 1.07; 95% CI: 0.71–1.63). However, subgroup analyses depending on tumor stage revealed that CN or splanchnicectomy was associated with a worsened OS in AJCC (American Joint Committee on Cancer) stage III patients with unresectable PDAC (HR: 1.22; 95% CI: 1.03–1.45), but nor for AJCC stage IV patients (HR: 1.27; 95% CI: 0.9–1.80). <b><i>Conclusion:</i></b> Although only few data are currently available, this systematic review with meta-analysis showed that in unresectable PDAC, CN or splanchnicectomy is associated with a worsened survival in stage III PDAC patients, with no effect on stage IV PDAC patients. These data call for caution in the usage of CN or splanchnicectomy in stage III PDAC and for further studies addressing this observation.

A Rare Case of Stage IV Adrenocortical Carcinoma with Acute Adrenocortical Dysfunction After Trans-Catheter Arterial Chemo-Embolization (TACE)

2020 ◽  
Author(s):  
Zhilong Wang ◽  
Xin Sun ◽  
Fengli Zhang ◽  
Ting Wang ◽  
Ping Li
Keyword(s):  
Liver Metastasis ◽  
Adrenocortical Carcinoma ◽  
Poor Prognosis ◽  
Rare Case ◽  
Stage Iv ◽  
Postoperative Recurrence ◽  
Tumor Burden ◽  
Case Presentation ◽  
Embolization Therapy ◽  
New Treatment

Abstract Background: Adrenocortical carcinoma(ACC) is a rare and highly invasive endocrine malignant tumor with poor prognosis and insensitivity tochemotherapy, which don't have effective treatment. Although Surgical resection is considered to be the main treatment for ACC, postoperative recurrence and metastasis have become the most important factors of death. Therefore, local treatments such as trans-catheter arterial chemo-embolization, radiofrequency ablation become be new treatment for ACC. Trans-catheter arterial chemo-embolization therapy for ACC patients with liver metastasis has good efficacy and can effectively reduce the tumor burden of patients, which is considered to be safe and easy for patients. Case presentation: We report a 47-year-old female patient diagnosed with stage Ⅳ ACC with liver metastases, who developed symptoms of acute adrenocortical dysfunctions after hepatic arterial catheter chemo-embolization.Conclusion: Trans-catheter arterial chemo-embolization therapy for ACC patients with liver metastasis is not completely safe, and there is a certain probability that it will lead to secondary adrenal dysfunction. Hydrocortisone supplementation can effectively alleviate the symptoms.

scholarly journals Is there an oligometastatic state in pancreatic cancer? Practical clinical considerations raise the question

2020 ◽  
Vol 93 (1106) ◽  
pp. 20190627
Author(s):  
Marta Scorsetti ◽  
Tiziana Comito ◽  
Davide Franceschini ◽  
Ciro Franzese ◽  
Maria Giuseppina Prete ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Pancreatic Adenocarcinoma ◽  
Local Treatment ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Free Survival ◽  
Number Of Patients ◽  
Clinical Considerations

Objectives: To evaluate the role of stereotactic body radiotherapy (SBRT) as a local ablative treatment (LAT) in oligometastatic pancreatic cancer. Methods: Patients affected by histologically confirmed stage IV pancreatic adenocarcinoma were included in this analysis. Endpoints are local control (LC), progression-free survival (PFS), and overall survival (OS). Results: From 2013 to 2017, a total of 41 patients were treated with SBRT on 64 metastases. Most common sites of disease were lung (29.3%) and liver (56.1%). LC at 1 and 2 years were 88.9% (95% CI 73.2–98.6) and 73.9% (95% CI 50–87.5), respectively. Median LC was 39.9 months (95% CI 23.3—not reached). PFS rates at 1 and 2 years were 21.9% (95% CI 10.8–35.4) and 10.9% (95% CI 3.4–23.4), respectively. Median PFS was 5.4 months (95%CI 3.1–11.3). OS rates at 1 and 2 years were 79.9% (95% CI 63.7–89.4) and 46.7% (95% CI 29.6–62.2). Median OS was 23 months (95%CI 14.1–31.8). Conclusions: Our results, although based on a retrospective analysis of a small number of patients, show that patients with oligometastatic pancreatic cancer may benefit from local treatment with SBRT. Larger studies are warranted to confirm these results. Advances in knowledge: Selected patients affected by oligometastatic pancreatic adenocarcinoma can benefit from local ablative approaches, like SBRT

scholarly journals Comprehensive molecular and phenotypic profiling of end-stage IV cancer identifies treatable targets and improves survival in individual patients

2017 ◽  
Vol 28 ◽  
pp. vii22
Author(s):  
A. Samsen ◽  
S. Schneider ◽  
S. Von Der Heyde ◽  
W. Saeger ◽  
B. Grebenstein ◽  
...  
Keyword(s):  
Stage Iv ◽  
Stage Iv Cancer ◽  
End Stage
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