scholarly journals Lung Metastases in Patients with Stage IV Pancreatic Cancer: Prevalence, Risk Factors, and Survival Impact

2019 ◽  
Vol 8 (9) ◽  
pp. 1402 ◽  
Author(s):  
Liu ◽  
Hung ◽  
Hsueh ◽  
Chang ◽  
Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Multivariate Analysis ◽  
Palliative Chemotherapy ◽  
Lung Metastases ◽  
Stage Iv ◽  
Survival Outcome ◽  
Entire Cohort ◽  
Isolated Lung ◽  
The Impact

The aim of this study was to evaluate the prevalence, the clinicopathological variables associated with probability of lung metastases, and the impact of lung metastases on survival outcome in patients with stage IV pancreatic cancer (PC) treated with palliative chemotherapy. A total of 654 patients with stage IV PC who underwent palliative chemotherapy from 2010–2016 were retrospectively enrolled in this study. Possible clinical variables associated with lung metastases and survival outcome were examined by univariate and multivariate analysis. Lung metastases were detected in 15.0% (3.4% with isolated lung metastases and 11.6% with synchronic metastases to lung and other organs). Female gender, poorly differentiated tumor grade, and large primary tumor size were independent risk factor in multivariate analysis. The median overall survival (OS) time was 6.5 months in the entire cohort, while the median OS was 11.8, 6.9, 7.7, 10.1, and 5.0 months for patients with isolated lung, isolated liver, isolated peritoneum, isolated distant lymph nodes, and multiple sites metastases, respectively. Isolated lung metastases were a better prognosticator for OS in univariate and multivariate analysis. This study utilized real-world clinical practice data to assess the prevalence, risk factors, and survival impact of lung metastases in patients with stage IV pancreatic cancer.

scholarly journals Incidence, Risk Factors, and Outcomes of Arterial Thromboembolism in Patients with Pancreatic Cancer Following Palliative Chemotherapy

Cancers ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 432
Author(s):  
Yu-Shin Hung ◽  
Jen-Shi Chen ◽  
Yen-Yang Chen ◽  
Chang-Hsien Lu ◽  
Pei-Hung Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Predictive Model ◽  
Palliative Chemotherapy ◽  
Transaminase Level ◽  
Risk Groups ◽  
Survival Outcome ◽  
Arterial Thromboembolism ◽  
Increased Risk ◽  
Incidence Risk

Background: Few studies have explored the association between pancreatic cancer and arterial thromboembolism (aTE). Methods: A total of 838 consecutive patients receiving palliative chemotherapy for pancreatic cancer between 2010 and 2016 were retrospectively enrolled. The clinical characteristics of patients were analyzed to determine the incidence, risk factors, and survival outcome of aTE in patients with pancreatic cancer. Results: aTE occurred in 42 (5.0%) of 838 patients. Patients with aTE had a worse survival outcome than those without (5.1 months versus 7.8 months, hazard ratio 1.53, 95% confidence interval [CI]: 1.12–2.09). Stage IV disease, high aspartate transaminase level, and comorbidity with hypertension or atrial fibrillation were four independent predictors of aTE. A concise predictive model stratified patients into low (0–1 predictor), intermediate (2 predictors), and high (3–4 predictors) risk groups. The hazard ratios for the comparison of patients in intermediate and high risk groups with those in low risk group were 4.55 (95% CI: 2.31–8.98), and 13.3 (95% CI: 5.63–31.6), respectively. Conclusion: Patients with pancreatic cancer undergoing palliative chemotherapy have an increased risk of aTE. A predictive model showed that patients presented with 3 or 4 predictors had the highest risk for developing aTE.

scholarly journals The Presurgical Controlling Nutritional Status (CONUT) Score is Independently Associated with Severe Peristomal Skin Disorders: A Single-center Retrospective Cohort Study

2021 ◽  
Author(s):  
Takuya Shiraishi ◽  
Hiroomi Ogawa ◽  
Chika Katayama ◽  
Katsuya Osone ◽  
Takuhisa Okada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Nutritional Status ◽  
Laparoscopic Approach ◽  
Skin Disorders ◽  
Nutritional Interventions ◽  
Stoma Creation ◽  
Peristomal Skin ◽  
The Impact ◽  
Conut Score

Abstract Purpose: While nutritional interventions may potentially lower the risk of peristomal skin disorders (PSDs) and their exacerbation, no prior studies have evaluated the relationship between PSDs and nutritional status using the Controlling Nutritional Status (CONUT) score. Therefore, the purpose of this study was to assess the impact of preoperative nutritional status on stoma development, and determine risk factors for postoperative PSDs and their increased severity. Methods: A retrospective analysis was performed in 116 consecutive patients with rectal cancer who underwent radical surgery with stoma creation, including ileostomy and colostomy. Results: PSDs were diagnosed in 32 patients (27.6%); 10 (8.7%) cases were defined as severe based on the ABCD-stoma score. A multivariate analysis indicated that the laparoscopic approach (odds ratio [OR], 3.221; 95% confidence interval [CI], 1.001–10.362; P = 0.050) and ileostomy (OR, 3.394; 95% CI, 1.349–8.535; P = 0.009) were both independent risk factors for PSD. In a separate multivariate analysis for severe PSD, the only independent risk factor was the CONUT score (OR, 11.298; 95% CI, 1.382–92.373; P = 0.024). Conclusion: Severe PSDs are associated with preoperative nutritional disorders, as determined via the CONUT score. Furthermore, PSDs may potentially increase in severity, regardless of stoma type.

The impact of multiple high-risk factors on survival outcome of surgically treated early-stage cervical cancer

2014 ◽  
Vol 133 ◽  
pp. 62
Author(s):  
K. Matsuo ◽  
S. Mabuchi ◽  
M. Okazawa ◽  
Y. Matsumoto ◽  
K. Yoshino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Early Stage ◽  
Survival Outcome ◽  
High Risk Factors ◽  
Early Stage Cervical Cancer ◽  
The Impact

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.

The impact of body mass index dynamics on survival of patients with advanced pancreatic cancer receiving chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15066-e15066
Author(s):  
Younak Choi ◽  
Do-Youn Oh ◽  
Tae-Yong Kim ◽  
Kyung-Hun Lee ◽  
Sae-Won Han ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Clinical Characteristics ◽  
Palliative Chemotherapy ◽  
Advanced Pancreatic Cancer ◽  
High Body Mass Index ◽  
Good Health ◽  
Increased Risk ◽  
The Impact

e15066 Background: The obesity is increasing worldwide. High body mass index (BMI) is linked with an increased risk of developing pancreatic cancer (PC). However, in patients with advanced PC (APC), especially those are receiving palliative chemotherapy (the majority of all PC patients), the impact of BMI and its change during disease course on survival has not been fully investigated. Methods: Consecutive patients with APC were enrolled during years 2003-2010, all treated with palliative chemotherapy. The BMI measured at the point of starting the first cycle of palliative chemotherapy was called as “BMI at diagnosis”. “Pre-cancer weight” which means the weight in good health was the sum of “weight at diagnosis” and “weight loss at diagnosis” that the patients’ self- reported at the first visit. “Pre-cancer BMI” was calculated using pre-cancer weight. We got weight data measured at every visit during chemotherapy to investigate BMI change during chemotherapy period. Clinical characteristics and outcomes were analyzed. Results: A total of 425 patients were enrolled (median age, 60.1 years). At diagnosis of APC, the BMI distribution of patients was as follows: <18.5 (45, 10.6%); 18.5-19.9 (67, 15.8%); 20.0-22.4 (156, 36.7%); 22.5-24.9 (107, 25.2%); 25.0-29.9 (49, 11.5%); and ≥30.0 (1, 0.2%). Clinical characteristics were balanced across BMI groups. Median overall survival (OS) was 8.1 months (95% CI, 7.2-9.1). Pre-cancer BMI and BMI at diagnosis had no impact on OS (p = 0.488, p = 0.348, respectively), although patients at BMI range of 22.5-24.9 achieved the longest OS (9.9 months; 95% CI, 8.5-11.3). BMI loss at diagnosis (pre-cancer BMI minus BMI at the diagnosis) and BMI loss during chemotherapy (both stipulated as BMI change ≥1) were associated with shortened OS (HR, 1.300; p = 0.012 and HR, 1.367; p= 0.010, respectively). Conclusions: In patients with APC undergoing palliative chemotherapy, both declines in BMI at diagnosis of APC and during chemotherapy are more hazardous for OS than pre-cancer BMI or BMI at diagnosis itself as absolute values. Further research evaluating strategies to maintain BMI during chemotherapy in this setting is thus warranted.

Initial evaluation of patients diagnosed with pancreatic cancer within a community health system.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 269-269
Author(s):  
Kathryn Tzung-Kai Chen
Keyword(s):  
Pancreatic Cancer ◽  
Emergency Department ◽  
Health System ◽  
Community Health ◽  
Outpatient Clinic ◽  
Care Center ◽  
Tertiary Care ◽  
Initial Evaluation ◽  
Entire Cohort ◽  
The Impact

269 Background: The management of pancreatic patients who are referred to a tertiary care center is well described. However, many patients receive their initial evaluation and care at community health systems. We sought to describe how patients present within the community, the patterns of initial evaluation, and the impact on management. Methods: In a period spanning 3 years (2010-2013), 82 patients were newly diagnosed with pancreatic cancer, as identified by a cancer registry at a community health system. Under IRB approval, data regarding patient characteristics, initial evaluation, and management were retrospectively collected from the electronic medical record (EMR) and analyzed. Results: Of the 82 patients, 68 patients had sufficient data available in the EMR for analysis. Thirty-two patients (47%) initially presented to outpatient clinic, and 36 patients (53%) presented to the emergency department. The presenting complaint was identified as abdominal pain in 33 patients (49%), jaundice in 20 patients (29%), and general malaise in 9 patients (13%). Patients who presented through outpatient clinic vs. emergency department received similar initial imaging studies upfront, including CT of the abdomen and pelvis (61% vs. 72%) and abdominal ultrasound (27% vs. 17%). Sixteen percent of those patients evaluated in outpatient clinic were subsequently admitted, compared to 94% of those patients evaluated in the emergency department. Finally, 31% of those presenting in outpatient clinic eventually underwent surgical resection, compared to 8% of those presenting through the ER, and the median time to surgery for the entire cohort was 1.1 months. Conclusions: Within the community, half of all patients present through the emergency department, and the majority of these are admitted for work up and management of symptoms. In contrast, those patients who present through outpatient clinic are less likely to be admitted, and are more likely to undergo definitive resection. This likely represents a disparity on several levels: the acuity of patients presenting to the emergency department vs. clinic, and how they are managed in each setting.

Impact of postoperative complications on pancreatic cancer survival and recurrence.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 446-446
Author(s):  
Masahiro Asari ◽  
Toru Aoyama ◽  
Yusuke Katayama ◽  
Masaaki Murakawa ◽  
Koichiro Yamaoku ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Cancer Survival ◽  
Disease Recurrence ◽  
Lymphatic Invasion ◽  
Curative Surgery ◽  
Independent Risk Factors ◽  
The Impact

446 Background: We investigated the impact of postoperative complications on pancreatic cancer survival and recurrence after curative surgery. Methods: This study included 164 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. The patients were classified into those with postoperative complications (C group) and those without postoperative complications (NC group). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. Results: Postoperative complications were found in 61 of the 164 patients (37.2%). The RFS rate at five years after surgery was 10.6% in the C group patients and was 21.0% in the NC group patients. The RFS tended to be worse in the C group than in the NC group (p=0.1756). The OS rate at five years after surgery was 7.4% in the C group and 22.8% in the NC group, which was significantly different (p=0.0189). The multivariate analysis demonstrated that postoperative complications and lymphatic invasion were significant independent risk factors for the RFS and OS. Conclusions: The development of postoperative complications was a risk factor for a decreased overall survival and for disease recurrence in patients who underwent curative surgery for pancreatic cancer. The surgical procedure, perioperative care and the surgical strategy should be carefully planned to avoid complications.

scholarly journals Bacterial Vaginosis and Risk Factors in Pregnant Women in Senegal

2021 ◽  
Author(s):  
Marion Bonneton ◽  
Bich-Tram Huynh ◽  
Abdoulaye Seck ◽  
Raymond Bercion ◽  
Fatoumata Diene Sarr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Rural Areas ◽  
Vaginal Flora ◽  
Obstetric Outcomes ◽  
Vaginal Smear ◽  
Sub Saharan ◽  
The Impact

Abstract Background Bacterial vaginosis (BV) is associated with a higher risk of preterm delivery and spontaneous abortion. Yet little data on BV prevalence exist for sub-Saharan countries. The aim of this study was to estimate the prevalence of bacterial vaginosis and associated risk factors among pregnant women in Senegal.MethodsFrom October 2013 to December 2018, pregnant women in their third trimester were recruited in two primary health centers (one suburban, one rural) in Senegal. Healthcare workers interviewed women and collected a lower vaginal swab and a blood sample. Vaginal flora were classified into four categories using vaginal smear microscopic examination and Gram’s coloration. In our study, BV was defined as vaginal flora with no Lactobacillus spp. Variables associated with BV were analyzed using STATA® through univariate and multivariate analysis.Results A total of 457 women provided a vaginal sample for analysis. Overall, BV prevalence was 18.6% (85/457) [95% CI: 15.4-22.6]) and was similar in suburban and rural areas (18.9 % versus 18.1%, p=0.843). Multivariate analysis showed that primigravidity was the only factor independently associated with a lower risk of BV (aOR=0.35 [95% CI 0.17-0.72]).Conclusions Our study showed significant BV prevalence among pregnant women in Senegal. Although the literature has underscored the potential consequences of BV for obstetric outcomes, data are scarce on BV prevalence in sub-Saharan African countries. Before authorities consider systematic BV screening for pregnant women, a larger study would be useful in documenting prevalence, risk factors and the impact of BV on pregnancy outcomes.

scholarly journals Biomarkers of Haemostasis and Occurrence of Venous Thromboembolism Are Associated with Disease Progression and Poor Prognosis in Patients with Pancreatic Cancer

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 7-8
Author(s):  
Florian Moik ◽  
Gerald Prager ◽  
Sarah Wiedemann ◽  
Florian Posch ◽  
Ingrid Pabinger ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Disease Progression ◽  
Poor Prognosis ◽  
Palliative Chemotherapy ◽  
Stage Iv ◽  
Therapy Response ◽  
Competing Risk Analysis ◽  
Landmark Analyses ◽  
Pai 1 ◽  
D Dimer

Background: Patients with pancreatic cancer have a high risk for venous thromboembolism (VTE). Activation of haemostasis has been suggested to contribute to the progression of cancer and its metastatic spread. However, clinical data to support the contribution of activation of haemostasis to disease progression are scarce. Our aim was to evaluate the association biomarkers indicating activation of haemostasis and/or hypercoagulability and of VTE occurrence with survival and therapy response in patients with pancreatic cancer. Methods: Within a prospective, observational cohort study (Vienna Cancer and Thrombosis Study, CATS), we evaluated the subgroup of patients with pancreatic cancer (n=145). Levels of a comprehensive panel of haemostatic biomarkers (D-dimer, prothrombin fragment 1+2, fibrinogen, factor VIII, plasminogen activator inhibitor 1 (PAI-1), soluble (s)P-selectin, peak thrombin generation, endogenous thrombin potential) were measured at baseline. Differences in levels of haemostatic biomarkers between disease stages were tested for statistical significance by Kruskal-Wallis-test. The association of biomarker levels with overall survival (OS) and therapy response (progression-free survival (PFS) and radiological disease control rate; sub-cohort of patient initiating palliative chemotherapy, n=95) was analysed by multivariable Cox regression, adjusting for disease stage, grade, sex, age, ECOG, VTE (as time-dependent covariable) and vascular infiltration or compression by the primary tumour. Cumulative incidence of VTE was estimated in competing risk analysis, considering death as competing outcome event. The impact of VTE on OS and PFS was evaluated by multi-state modelling, adjusting for stage, grade, sex, age, ECOG and vascular involvement. Results: We observed higher baseline levels of biomarkers according to increasing stage of disease for D-dimer (stage I/II: median 1.25 µg/ml [interquartile range (IQR): 0.65-2.10]; stage III: 1.41 µg/ml [IQR: 0.65-2.24]; stage IV: 1.68 µg/ml [IQR: 0.98-3.82], p=0.035), and sP-selectin (stage I/II: median 34.2 ng/ml [IQR: 26.8-43.1]; stage III: 37.6 ng/ml [IQR: 31.4-49.1]; stage IV: 38.8 ng/ml [IQR:32.9-51.5], p=0.033). Higher levels of D-dimer, PAI-1 and sP-selectin were associated with shorter OS in multivariable analysis (hazard ratio (HR) for death per doubling: 1.33 [95% confidence interval (CI): 1.08-1.66], 1.25 [95% CI: 1.08-1.45, and 1.42 [95% CI: 1.00-2.01] (Figure 1). In the subgroup of patients initiating palliative chemotherapy, pre-therapeutic levels of D-dimer predicted for shorter PFS (HR for disease progression per double: 1.29 [95% CI: 1.03-1.61]) and a decreased probability for radiological therapy response (odds ratio to achieve radiological disease control per double: 0.61 [95% CI: 0.38-0.99]). Cumulative incidence estimates of VTE in competing risk analysis at 3, 6, 12, and 24 months were 9.0% [95% CI: 5.0-14.3], 13.1% [95% CI: 8.2-19.1], 16.6% [95% CI: 11.1-23.1], and 19.5% [95% CI: 13.4-26.2], respectively. The occurrence of VTE was associated with an immediate increase in risk of death (transition hazard ratio, (THR): 2.37 [95% CI: 1.47-3.84]) and early disease progression (THR: 2.34 [95% CI: 1.50-3.66]), which prevailed upon multivariable adjustment. In landmark analyses, median OS and PFS after VTE were 5.5 months [95% CI: 2.2-6.5] and 3.0 months [95% CI: 1.5-3.9] compared to 13.4 months [95% CI: 9.7-16.6] and 7.5 months [95% CI: 5.9-9.8] in those without VTE (Mantel-Byar: both p&lt;0.001). Figure 2 displays landmark analyses of OS and PFS according to occurrence of VTE within the first 3 months of observation. Conclusion: Occurrence of VTE, activation of haemostasis and hypercoagulability, as indicated by elevated levels of D-dimer, PAI-1 and sP-selectin are associated with poor prognosis and D-dimer predicts for unfavourable response to palliative chemotherapy in patients with pancreatic cancer. Disclosures No relevant conflicts of interest to declare.

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