scholarly journals Impact of Adjuvant Chemoradiotherapy on Survival of Resected Pancreatic Adenocarcinoma Cancer: A Surveillance, Epidemiology and End Results (SEER) Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaomao Shi ◽  
Jin Peng ◽  
Huangang Jiang ◽  
Yu Gao ◽  
Wenbo Wang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Ductal Adenocarcinoma ◽  
Adjuvant Chemoradiotherapy ◽  
Propensity Matching ◽  
Rate Selection ◽  
End Results

BackgroundThe benefits of postoperative adjuvant chemoradiotherapy (CRT) for pancreatic cancer remain controversial. The purpose of this study is to determine if adjuvant CRT can improve the overall survival of postoperative pancreatic cancer patients compared to adjuvant chemotherapy (CT).MethodsPatients with resected pancreas adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2016). Multivariate Cox regression was used to determine the factors related to survival rate. Selection bias was reduced to a minimum through propensity matching analysis. Subgroup analyses by clinical characteristics were performed.ResultsThis study identified 10,097 patients who received adjuvant CT (n = 5,454) or adjuvant CRT (n = 4,643). On multivariate analysis, age, sex, tumor size, site, grade, stage, T stage, and lymph node metastasis were independent risk factors for OS. The basic clinical characteristics were well balanced after propensity matching. After propensity matching, CRT can improve the survival rate compared with CT [median OS: 22 months vs 23 months (HR, 0.928; 95% CI, 0.881–0.977; P = 0.004)]. Subgroup analysis indicated that the survival benefit of adjuvant chemoradiotherapy was more significant in patients with female (HR, 0.860; 95% CI, 0.798–0.926; P = 0.005 for interaction) or T3 (HR, 0.905; 95% CI, 0.855–0.957; P = 0.04 for interaction) or lymph nodes positive (HR, 0.883; 95% CI, 0.832–0.938; P = 0.005 for interaction).ConclusionAdjuvant CRT was associated with improved survival compared with adjuvant CT in patients with resection of pancreatic ductal adenocarcinoma. The benefit was more significant in patients with female or T3 or lymph nodes positive.

Postoperative Chemoradiotherapy of Pancreatic Cancer: What is the Appropriate Target Volume of Radiation Therapy?

2005 ◽  
Vol 91 (6) ◽  
pp. 493-497 ◽  
Author(s):  
Kyubo Kim ◽  
Suzy Kim ◽  
Eui Kyu Chie ◽  
Sun Whe Kim ◽  
Yung-Jue Bang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Treatment Outcome ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Curative Resection ◽  
Target Volume ◽  
Adjuvant Chemoradiotherapy ◽  
Extended Field ◽  
Therapy Target

Aims and Background To evaluate the influence of radiation therapy target volume on the treatment outcome of adjuvant chemoradiotherapy for pancreatic cancer after curative resection. Methods Between February 1987 and July 2001, 70 patients treated with curative resection and adjuvant chemoradiotherapy for pancreatic adenocarcinoma were analyzed. There were 49 males and 21 females, with a median age of 57 years. Whipple's operation was performed in 44 patients, pylorus-preserving pancreaticoduodenectomy in 14, distal pancreatectomy in 9, and subtotal pancreatectomy in 3. Postoperative adjuvant radiotherapy was given up to 40 Gy at 2 Gy per fraction with a two-week planned rest. Intravenous 5-fluorouracil (500 mg/m2/day) was given on days 1 to 3 of each split course of radiotherapy. Until 1991, whole pancreas or preoperative tumor volume and retroperitoneal lymph nodes were irradiated (extended field, n = 14). Thereafter, the target volume included the retroperitoneal lymph nodes and the involved pancreatic resection margin (limited field, n = 56). The median follow-up period of all the patients was 16 months (range, 2-99). Results The overall 2- and 5-year survival rate of all patients was 29.7% and 14.0%, respectively. According to the radiotherapy target volume, the median survival time was 14 months in the extended field group and 16 months in the limited field group ( P = 0.65). Conclusions From the viewpoint of the target volume of radiotherapy, a limited field did not worsen the treatment outcome, although the survival rate was poor in both groups.

scholarly journals Omics Approaches in Pancreatic Adenocarcinoma

Cancers ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1052
Author(s):  
Iranzu González-Boja ◽  
Antonio Viúdez ◽  
Saioa Goñi ◽  
Enrique Santamaria ◽  
Estefania Carrasco-García ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma ◽  
Curative Intent ◽  
Pancreatic Cancers ◽  
Wide Range ◽  
Prevention And Treatment ◽  
Shed Light

Pancreatic ductal adenocarcinoma, which represents 80% of pancreatic cancers, is mainly diagnosed when treatment with curative intent is not possible. Consequently, the overall five-year survival rate is extremely dismal—around 5% to 7%. In addition, pancreatic cancer is expected to become the second leading cause of cancer-related death by 2030. Therefore, advances in screening, prevention and treatment are urgently needed. Fortunately, a wide range of approaches could help shed light in this area. Beyond the use of cytological or histological samples focusing in diagnosis, a plethora of new approaches are currently being used for a deeper characterization of pancreatic ductal adenocarcinoma, including genetic, epigenetic, and/or proteo-transcriptomic techniques. Accordingly, the development of new analytical technologies using body fluids (blood, bile, urine, etc.) to analyze tumor derived molecules has become a priority in pancreatic ductal adenocarcinoma due to the hard accessibility to tumor samples. These types of technologies will lead us to improve the outcome of pancreatic ductal adenocarcinoma patients.

MR-guided laser-induced thermotherapy (LITT) in liver metastases of colorectal cancer: Long-term survival data.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14131-e14131
Author(s):  
Thomas J. Vogl ◽  
Alena Dommermuth ◽  
Katrin Eichler ◽  
Stephan Zangos
Keyword(s):  
Overall Survival ◽  
Survival Analysis ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Liver Metastases ◽  
Median Survival ◽  
Cox Regression ◽  
Term Survival ◽  
Median Survival Rate

e14131 Background: To evaluate retrospectively long-term survival of 594 patients with colorectal liver metastases treated with MR-guided laser-induced thermotherapy (LITT) depending on different factors. Methods: 594 patients with liver metastases from colorectal carcinoma treated with MR-guided LITT between 01/99 and 12/10 were included. For survival analysis tumor localization, TNM classification, number of metastases, diameter and volume of metastases and necrosis, lobular spread, number of treatment sessions, performance of adjuvant chemotherapy and transarterial chemoembolisation were considered. The Kaplan-Meier method was used to conduct this survival analysis. Results: Log-rank test showed statistically significant differences between survival curves, multivariate Cox-regression-analysis (p<0.05) showed prognostic factors regarding overall survival like number of metastases pre intervention, adjuvant chemotherapy, diameter of metastases, ratio of volumes of necrosis and metastases, and affected lymph nodes. Median overall survival rate at the time of first LITT was 25 months, 1-year survival: 78%, 2-year survival: 50.1%, 3-year survival: 28%; 4-year survival: 16.4%; 5-year survival: 7.8%. Numbers of metastases pre intervention: 1-2 metastases with a median survival rate of 60 months; 3-4 metastases: 45 months; ≥5 metastases: 42 months. Median survival rate for metastases <20mm in diameter 36 months; 20-30mm 27 months, 30-40mm 24 months and >40mm 21 months. Affected lymph nodes: median survival rate for patients with N0-classification 30 months, N1-classification 24 months; N2/N3/N4-classification 22 months. Conclusions: Multivariate Cox regression model provided the minimal number of significant variables with the maximal prognostic value concerning overall survival for MR-guided LITT, i.e., diameter and number of metastases and primary classification of lymph nodes.

scholarly journals Aerial View of the Association between m6A-Related LncRNAs and Clinicopathological Characteristics of Pancreatic Cancer

2021 ◽  
Author(s):  
Bowen Huang ◽  
Jun Lu ◽  
Dong Liu ◽  
Wenyan Gao ◽  
Li Zhou ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Prognostic Model ◽  
Cox Regression ◽  
Pearson Correlation ◽  
Clinicopathological Characteristics ◽  
Cancer Genome ◽  
The Cancer Genome Atlas ◽  
Ductal Adenocarcinoma ◽  
Aerial View

Abstract Background There have been few reports on how long non-coding RNA (lncRNA) under the regulation of N6-methyladenosine (m6A) modification influences pancreatic cancer progression. In our study, the association between m6A-related lncRNAs and pancreatic ductal adenocarcinoma (PDAC) was comprehensively described for the first time based on the construction of a lncRNAs prognostic model. Methods The lncRNAs expression level and the prognostic value were investigated in 440 PDAC patients and 171 normal tissues from Genotype-Tissue Expression (GTEx), The Cancer Genome Atlas (TCGA), and International Cancer Genome Consortium (ICGC) databases. We implemented Pearson correlation analysis to explore the m6A-related lncRNAs, univariate Cox regression and Kaplan-Meier (K-M) methods were performed to screen the critical lncRNAs in PDAC patients. Then we used bioinformatic analysis and statistical analysis to illustrate the association between m6A-related lncRNAs and pancreatic cancer. Results Seven prognostic m6A-related lncRNAs were identified as prognostic lncRNAs, and they were inputted in the Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression to establish an m6A-related lncRNAs prognostic model in the TCGA database. Each patient has calculated a risk score and divided into low-risk and high-risk subgroups by the median value in two cohorts. Moreover, the model showed a robust prognostic ability in the stratification analysis of different risk subgroups, pathological grades, and recurrence events. The Cox regression demonstrated that the risk classification was an independent prognostic predictor. We established a competing endogenous RNA (ceRNA) network based on seven pivotal lncRNAs and twenty-six m6A regulators. Enrichment analysis indicated that malignancy-associated biological function and signaling pathways were enriched in the high-risk subgroup and m6A-related lncRNAs target mRNAs. We have even identified small molecule drugs that may affect the progression of pancreatic cancer. Conclusions In conclusion, we provide the first comprehensive aerial view between m6A-related lncRNAs and pancreatic cancer's clinicopathological characteristics.

scholarly journals Microbial Dysbiosis and polyamine metabolism as predictive markers for early detection of pancreatic cancer

2018 ◽  
Author(s):  
Roberto Mendez ◽  
Kousik Kesh ◽  
Nivedita Arora ◽  
Leá Di Martino ◽  
Florencia McAllister ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Early Detection ◽  
Gut Microbiota ◽  
Gut Microbiome ◽  
Ductal Adenocarcinoma ◽  
Metabolic Reconstruction ◽  
Microbiome Analysis ◽  
Early Stages ◽  
Kpc Mice

AbstractPurposeThe lack of tools for early detection of pancreatic ductal adenocarcinoma (PDAC) is directly correlated to the abysmal survival rate in patients. In addition to several potential detection tools under active investigation, we tested the gut microbiome and its metabolic complement as one of the earliest detection tools that could be useful in patients at high-risk for PDAC.Experimental DesignA combination of 16s pyrosequencing and whole-genome sequencing of gut microbiota was used in a spontaneous genetically engineered PDAC murine model (KRASG12DTP53R172HPdxCre or KPC). Metabolic reconstruction of microbiome was done using the HUmanN2 pipeline. Serum polyamine levels were measured from murine and patient samples using standard methods.ResultsResults showed a progressive Proteobacterial and Firmicutes dominance in gut microbiota in early stages of PDAC development. Upon in silico reconstruction of active metabolic pathways within the altered microbial flora, polyamine and nucleotide biosynthetic pathways were significantly elevated. These metabolic products are known to be actively assimilated by the host and eventually utilized by rapidly dividing cells for proliferation validating their importance in the context of tumorigenesis. In KPC mice, as well as PDAC patients, we show significantly elevated serum polyamine concentration. Therefore, at the early stages of tumorigenesis, the gut microbial composition changes in a way to release metabolites that foster host tumorigenesis, thereby fulfilling the ‘vicious cycle hypothesis’ of the role of the microbiome in health and disease states.ConclusionsOur results provide a potential, precise, non-invasive tool for early detection of PDAC, which will result in improved outcomes.SynopsisGut microbiota changes during early stages of pancreatic ductal adenocarcinoma (PDAC) progression and contributes towards host polyamine pool. Both changes can be used as an early predictive marker for PDAC.Translational RelevancePancreatic carcinogenesis progresses through pre-cancerous PanIN lesions to invasive cancer. Even though these morphological changes are histologically distinct, imaging techniques are not able to distinguish the pre-invasive PanINs from normal pancreas, making detection of a tumor at a precancerous stage impossible. Thus, majority of cases (85–90%) present with advanced pancreatic cancer at the time of diagnosis. This contributes to the dismal survival rate in this disease. Our study of gut microbiome analysis on KPC mice during tumor progression followed by metabolic reconstruction and experimental validation in human samples indicate that gut-microbiome analysis along with an analysis of the microbial metabolites can be developed as potential biomarkers for detection of PDAC at early stages when histological changes are not yet grossly apparent.

scholarly journals Recent Trends in the Incidence and Survival of Stage 1A Pancreatic Cancer: A Surveillance, Epidemiology, and End Results Analysis

2020 ◽  
Vol 112 (11) ◽  
pp. 1162-1169 ◽  
Author(s):  
Amanda L Blackford ◽  
Marcia Irene Canto ◽  
Alison P Klein ◽  
Ralph H Hruban ◽  
Michael Goggins
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Age At Diagnosis ◽  
Ductal Adenocarcinoma ◽  
Newly Diagnosed ◽  
Annual Percent Change ◽  
Stage Ia ◽  
Recent Trends ◽  
Adjusted Incidence ◽  
End Results

Abstract Background Rapid access to pancreatic imaging and regular pancreatic surveillance may help identify stage I pancreatic cancer. We investigated recent trends in the stage of newly diagnosed pancreatic ductal adenocarcinoma (PDACs), age at diagnosis, and survival. Methods Trends in age-adjusted incidence of stage IA PDAC between 2004 and 2016 were determined from the National Cancer Institute’s Surveillance, Epidemiology and End Results database. All tests were two-sided. Results The incidence of stage IA PDAC cases diagnosed increased statistically significantly from 2004 to 2016 (annual percent change = 14.5, 95% confidence interval [CI] = 11.4 to 17.7; P &lt; .001). During the study period, average age at diagnosis for stage IA and IB casesAQ3 declined by 3.5 years (95% CI = 1.2 to 5.9; P = .004) and 5.5 years (95% CI = 3.4 to 7.6; P &lt; .001), whereas average age increased for higher-stage cases (by 0.6 to 1.4 years). Among stage IA cases, the proportion of blacks was smaller (10.2% vs 12.5%), and the proportion of other non-Caucasians was higher compared with higher-stage cases (11.9% vs 8.4%; P &lt; .001). Stage IA cases were more likely to carry insurance (vs Medicaid or none) than higher-stage cases (cases aged younger than 65 years; odds ratio = 2.45, 95% CI = 1.96 to 3.06; P &lt; .001). The 5-year overall survival for stage IA PDAC improved from 44.7% (95% CI = 31.4 to 63.7) in 2004 to 83.7% (95% CI = 78.6% to 89.2%) in 2012; 10-year survival improved from 36.7% (95% CI = 24.1 to 55.8) in 2004 to 49.0% (95% CI = 37.2% to 64.6%) in 2007. Conclusions In recent years, the proportion of patients diagnosed with stage IA PDAC has increased, their average age at diagnosis has decreased, and their overall survival has improved. These trends may be the result of improved early diagnosis and early detection.

scholarly journals Gemcitabine plus Nab-paclitaxel as a second-line treatment following FOLFIRINOX failure in advanced pancreatic cancer: a multicenter, single-arm, open-label, phase 2 trial

2021 ◽  
Vol 13 ◽  
pp. 175883592110561
Author(s):  
Gunn Huh ◽  
Hee Seung Lee ◽  
Jin Ho Choi ◽  
Sang Hyub Lee ◽  
Woo Hyun Paik ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Advanced Pancreatic Cancer ◽  
Ductal Adenocarcinoma ◽  
Second Line ◽  
Phase 2 ◽  
First Line ◽  
Open Label ◽  
Phase 2 Trial ◽  
Open Label Phase

Background: The aim of this study was to evaluate the efficacy and safety of gemcitabine plus nab-paclitaxel (GnP) as second-line chemotherapy following first-line FOLFIRINOX treatment failure in advanced pancreatic cancer. Methods: This was a multicenter, single-arm, open-label, phase 2 trial done at three tertiary centers in South Korea from May 2018 to December 2019. Eligible patients were aged 20 years or older, had histologically confirmed advanced pancreatic ductal adenocarcinoma, and disease progression after receiving first-line FOLFIRINOX. Patients received a second-line GnP regimen as intravenous nab-paclitaxel at a dose of 125 mg/m2 and gemcitabine at a dose of 1000 mg/m2, on days 1, 8, and 15 every 4 weeks until disease progression or unacceptable toxicity. The primary outcome was survival rate at 6 months and the secondary outcomes were median progression-free survival (PFS), overall survival (OS), disease control rate (DCR), and adverse events. This study is registered with Clinicaltrials.gov. (NCT03401827) Results: Forty patients were enrolled in the study. The survival rate at 6 months was 72.5% [95% confidence interval (CI), 59.9–87.7], achieving superiority over prespecified assumed 6-month OS rate of 20% for best supportive care only ( p < 0.001). The median PFS and OS were 5.8 months (95% CI, 4.3–8.7) and 9.9 months (95% CI, 7.5–12.4), respectively. DCR was 87.5% with six partial responses and 29 stable diseases. Grade 3 or higher treatment-related adverse events occurred in 25 (62.5%) patients with the most common being thrombocytopenia, anemia, neutropenia, peripheral neuropathy, and peripheral edema. Conclusion: GnP demonstrated favorable efficacy with acceptable toxicity in patients with advanced pancreatic ductal adenocarcinoma after FOLFIRINOX failure.

scholarly journals Solid Pseudopapillary Neoplasm of the Pancreas: Unfolding an Intriguing Condition

2021 ◽  
pp. 1-12
Author(s):  
Manuel António Alves Cruz ◽  
Pedro Moutinho-Ribeiro ◽  
Pedro Costa-Moreira ◽  
Guilherme Macedo
Keyword(s):  
Pancreatic Cancer ◽  
Survival Rate ◽  
Malignant Neoplasm ◽  
World Health ◽  
Ductal Adenocarcinoma ◽  
Malignant Neoplasms ◽  
Low Grade ◽  
Solid Pseudopapillary Neoplasm ◽  
Imaging Characteristics ◽  
Health Organization

Pancreatic cancer is one of the most lethal malignant neoplasms, with a 1-year survival rate after diagnosis of 24%, and a 5-year survival rate of only 9%. While this illustrates the behavior of its main histologic type – ductal adenocarcinoma, there are other histologic subtypes of pancreatic cancer that can harbor excellent prognosis. Solid pseudopapillary neoplasm, described as a rare low-grade malignant neoplasm by the World Health Organization, is the best example of that, having an overall 5-year survival rate of about 97%. Not only the prognosis, but everything about this entity is unique: its histogenesis, epidemiology, presentation, imaging characteristics, cytology features, immunohistochemical profile, and treatment. This explains the urge to improve our understanding about this entity and thus our ability to accurately recognize and manage it. Having this in mind, this article aims to summarize the most relevant topics regarding this entity.

Predictors of venous thromboembolic complications in patients with pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16220-e16220
Author(s):  
Oksana V. Katelnitskaya ◽  
Oleg I. Kit ◽  
Elena M. Frantsiyants ◽  
Yuriy A. Gevorkyan ◽  
Oleg Yu. Kaymakchi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Venous Thrombosis ◽  
Clinical Characteristics ◽  
Stage Iv ◽  
Distant Metastases ◽  
Underlying Disease ◽  
Ductal Adenocarcinoma ◽  
Tumor Type ◽  
D Dimer

e16220 Background: Patients with pancreatic cancer are at high risk for venous thrombosis. Thrombotic episodes are most often recorded at the tumor diagnosis, surgical treatment and chemotherapy courses, or the disease recurrence. This complication postpones the beginning of treatment of the underlying disease and increases the mortality rate of cancer patients. The purpose of the study was to reveal the relationship between clinical characteristics and disorders of hemostasis indicators in patients with pancreatic cancer, and to identify predictors of venous thrombosis. Methods: 246 patients diagnosed with pancreatic cancer were recruited in 2019. The most common histological tumor type was pancreatic ductal adenocarcinoma (91.9%). The most common tumor site was the head of the pancreas (68.3%). Almost half of the patients were initially diagnosed with stage IV cancer (TanyNanyM1). Surgery was performed in 28% of patients. VTEC incidence during the 12-month follow-up period was 15.4%. Results: Analysis of the clinical characteristics and initial hemostasis parameters in patients with and without venous thrombosis revealed that the risk of thrombosis was higher in patients with larger tumors and the presence of distant metastases. High levels of D-dimers at diagnosis doubled the risk of venous thrombosis during antitumor treatment. Conclusions: The most significant predictors of venous thrombosis in patients with pancreatic cancer are tumor size, stage IV, and initially high levels of D-dimer. The study of hemostasis indicators at the stage of diagnosis of pancreatic cancer (D-dimer) can help to identify patients with a high risk of VTEC, for whom anticoagulant prophylaxis with a low hemorrhagic risk is advisable.

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