bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of 30-day readmission rate after liver transplant in patients with hepatocellular carcinoma.
Authors: Salazar Miguel , Upadhyay Banskota Shristi Upadhyay , Acevedo Lou Anne , Palacios Pedro , Gauto Estefania , Baral Binav , Shrivastava Trilok , Khanal Nabin 
Published: June 2021

e16193 Background: Liver transplantation (LT) is curative for hepatocellular carcinoma (HCC) in patients within the Milan criteria. Readmissions are common postoperatively, and can be associated with increased morbidity and healthcare burden. Hence we aim to identify incidence, impact and independent predictors for readmission in patients who underwent LT in HCC. Methods: Retrospective study of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an index admission for LT with an underlying diagnosis of HCC, in patients with cirrhosis we used the BAVENO score to categorize between compensated and decompensated cirrhosis. We aim to identify 30-day readmission rate, mortality, healthcare related utilization resources and independent predictors of readmission. Results: A total of 2,092 patients with HCC underwent liver transplantation. The 30-day readmission rate was 25.6%. Main causes for readmission were post-surgical complications from LT, sepsis, liver failure. Readmitted patients were less likely to have private insurance (40.5% vs 34.5%; P<0.01), to be obese (18.2% vs 7.9%; P<0.01), hypertensive (51.2% vs 39.5%; P<0.01), have history of non-alcoholic steatohepatitis (16.5% vs 2.3%; P<0.01). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P<0.01). The total health care in-hospital economic burden of readmission was $56.1 million in total charges and $15.2 million in total costs. Independent predictors of readmission were type 2 diabetes, transfusion of blood products during index admission, protein-caloric malnutrition, sepsis, and preventive factors were younger age, private insurance and cannabis use. Conclusions: Readmissions after LT in HCC are associated with higher mortality and pose a high health care burden. We identified risk factors that can be targeted to decrease overall patient morbidity, mortality and health care burden.[Table: see text]
Long-term survival and toxicity in patients with progressive advanced neuroendocrine tumors treated with lutetium peptide radiolabelled radiotherapy: A Western Australian long-term follow-up study.
Authors: Kennedy Kim Robyn , Claringbold Phillip , Macdonald William , Boardman Glenn , Ransom David Turner , Turner Harvey 
Published: June 2021

e16202 Background: There are limited treatment options for advanced neuroendocrine tumours, and radiolabelled somatostatin analogues have shown favourable safety and efficacy over other existing treatments. Lutetium Octreotate has been shown to be the somatostatin analogue of choice in Peptide Radiolabelled Radiotherapy (PRRT) for advanced neuroendocrine tumours (NETs). Methods: We conducted a retrospective review of the long term safety and survival outcomes of 104 patients prospectively treated on the CLEMENT1, CLEMENT2, NETTLE, and NETT VALuE trials where patients with advanced progressive NETs were treated with Lutetium Octreotate PRRT in Perth, Western Australia. With a median follow-up time of 68 months, this is the longest follow-up study of advanced NETs treated with Lutetium PRRT in the literature to date. Results: Results showed comparable periods of disease stability as other studies, with median progression free survival of 43 months, and superior survival to other series, with a median survival of 71 months. There were patients who had very durable responses, with five year overall survival 61.5%, five year progression free survival 30.1%, 10 year overall survival 30.1%, and 10 year progression free survival of 29.3%, demonstrating Lu 177 can provide a very long duration of response in some patients. PRRT treatment was well tolerated with 1.9% of patients suffering long term renal impairment, and 1% with long term mild thrombocytopenia attributed to PRRT. Importantly, there was a higher rate of MDS and leukaemia in our series (6.7%), which is likely attributed to the longer period of follow-up with all except one case occurring 48 months after PRRT treatment, which is later than the median follow up in most other studies. Conclusions: Overall, this study showed that Lutetium PRRT remains an efficacious and well tolerated treatment in long term follow-up. For clinicians deciding on the timing of PRRT for individual patients the 6.7% long term risk of MDS/leukaemia needs to be balanced against the 29.3% PFS at 10 years. Clinical trial information: ACTRN12610000440022.
Incidence and patterns of secondary malignancies in patients with neuroendocrine neoplasms: A SEER database analysis.
Authors: Sadaps Meena , Mehta Neal , Li Hong , Estfan Bassam N. 
Published: June 2021

e16208 Background: Neuroendocrine neoplasms (NENs) are a group of biologically and clinically heterogenous malignancies of different anatomic sites, the majority of which lie within the gastrointestinal (GI) tract. Prior literature has reported on the association between NENs and other primary malignancies (OPM), but these studies are limited by small sample sizes. We aim to further analyze the association of NENs and OPM on a larger scale using a population-based cancer registry. Methods: Primary malignancies with NEN features were identified from the Surveillance Epidemiology and Ends Results registry between 1975-2017. The histology/behavior of NEN included carcinoid tumor, neuroendocrine carcinoma (NEC), pancreatic endocrine tumor, atypical carcinoid tumor, and other (insulinoma, glucagonoma, gastrinoma, VIPoma, somatostatinoma and enterochromaffin cell carcinoid). First NEN observation from each patient was examined. Patients with NEN were grouped into 3 categories: NEN only, NEN first followed by OPM, and non-NEN first followed by NEN based on sequence number of primary cancer. Secondary malignancy sites were analyzed. Distribution of NEN between GI and non-GI sites was described. Demographics were compared by NEN sequence groups and between GI and non-GI sites. Results: 45,896 patients with NEN were analyzed (77.9% Caucasian, 47.0% male, median age 62.0 yrs). 65.7% of NENs were observed in GI sites. Within the GI tract, 31.3% were small intestine, 25.1% rectum, 16.6% pancreatobiliary, and < 11% in other GI locations. Age at NEN diagnosis was younger in those with GI NENs (median 60.0 vs 65.0, p < 0.001). 71.2% of patients had NEN only, 10.4% had NEN first followed by OPM, and 18.4% had a non-NEN primary followed by NEN. Mean age was 58.9 for NEN primary only, 61.0 for NEN primary first and 68.3 for non-NEN primary first (p < 0.0001). More Caucasian patients had non-NEN primary first (82.3%) compared to NEN primary only (76.9%) and NEN primary first (75.5%). There were no gender differences amongst the three groups. Carcinoid tumor histology was more prevalent in NEN primary first (78.6%) compared to NEN primary only (67.3%) and non-NEN primary first (66.6%), while NEC histology was more prevalent in NEN only (27.4%) and non-NEN first (29.3%) compared to NEN first. Among patients with NEN first followed by a second primary malignancy (SPM), 23.6% of females had a secondary breast malignancy and 28.9% of males had a secondary prostate malignancy. Conclusions: 28.8% of patients with NENs were found to have OPM, either preceding or following their NEN diagnosis. Of those with a SPM following NEN, breast and prostate were the most common sites for women and men, respectively. It is imperative that patients with NEN undergo age-appropriate cancer screening to help identify any concurrent malignancies. Further research is warranted to identify the timeframe in which they occur in relation to the NEN.
Real-world neo-adjuvant with or without adjuvant treatment patterns among pancreatic ductal adenocarcinoma patients in the U.S.
Authors: Navaratnam Prakash , Chase Monica , Friedman Howard Steven , Joo Seongjung , Pishvaian Michael J. 
Published: June 2021

e16217 Background: The vast majority of pancreatic ductal adenocarcinoma (PDAC) patients have unresectable disease at diagnosis, with only about 20% presenting with either resectable or borderline resectable tumors and who may receive adjuvant with or without neo-adjuvant treatment with surgery. This study seeks to characterize these treatment patterns in the real-world setting. Methods: This was a retrospective observational study to evaluate adjuvant treatment of PDAC patients, with or without neo-adjuvant treatment in the U.S. Patients with at least two medical claims with a primary diagnosis for PDAC between 2016 to 2019 were identified in the Truven MarketScan administrative claims database. A surgical resection within 3 months of any primary PDAC coded medical encounter was the index event, with patients required to be continuously enrolled for at least 3 months before and 6 months after the surgery. Patient demographics and treatment patterns (chemotherapy, radiotherapy, and chemoradiation) were evaluated over the pre-index (3 months) and post-index (3 and 6 months) observation windows. Neo-adjuvant and adjuvant treatment patterns were reported for the overall population and also stratified by age and sex. Results: 737 patients met the selection criteria with a majority (n=520, 71%) being <65 years old and 53% females (n=387). 65% (n=478) of patients received adjuvant chemotherapy during the 6-month post-index compared with 28% (n=207) receiving neo-adjuvant treatment. In the neo-adjuvant setting, patients were likely to receive leucovorin+fluorouracil+irinotecan+oxaliplatin (FOLFIRINOX; 43%, n=88) followed by gemcitabine+pacitaxel (18%, n=37), across all patients, as well as stratified by age or sex. Among patients that received adjuvant but did not receive neo-adjuvant treatment, patients were likely to receive gemcitabine monotherapy (35%, n=112) followed by gemcitabine+capecitabine (GEMCAP; 23%, n=72). Among adjuvant patients that had received neo-adjuvant treatment, the most common chemotherapy regimens were gemcitabine monotherapy (22%, n=35), GEMCAP (18%, n=29) and FOLFIRINOX (16%, n=26). For patients ≥ 65 years old, the most common adjuvant regimen was gemcitabine monotherapy (n=62, 29%) whereas for patients <65, the most common regimens were GEMCAP (25%, n=90) and gemcitabine monotherapy (16%, n=85). Gemcitabine monotherapy (41%; n=118 of 453) was the main adjuvant regimen for patients with index dates of 2016-2017 but for those with index dates of 2018-2019 the most common was FOLFIRINOX (34%; n=64 of 284) followed by GEMCAP (18%; n=35 of 284). Conclusions: The majority (70%) of patients that underwent PDAC resection surgery did not receive neo-adjuvant treatment and about a third of patients did not receive any adjuvant treatment. These results suggest an unmet need in the management of PDAC.
Adjuvant therapy in patients with resected pancreatic adenocarcinoma: Analysis of treatment patterns in a Canadian provincial institution.
Authors: Chahal Manik , Lim Howard John , Davies Janine Marie , Loree Jonathan M. , Renouf Daniel John , Gill Sharlene 
Published: June 2021

e16236 Background: In recent years adjuvant therapy (AT) options for pancreatic cancer have evolved. Compared to gemcitabine (Gem) alone, improved overall survival (OS) was demonstrated first in 2017 with gemcitabine and capecitabine (GemCap), and then further improved in 2018 with FOLFIRINOX. Given these options, we retrospectively reviewed the patterns of AT use in British Columbia (BC), Canada during these periods of availability of newer AT regimens. Methods: Patients (pts) treated at BC cancer centers between January 2017 to June 2018 (“GemCap era”), and July 2018 to December 2019 (“FOLFIRINOX era”), who had undergone curative intent resection and received at least one cycle of AT were included for chart review. Patient and disease characteristics, treatment details, and stated rationale for choice of AT regimen were collected. Analyses were performed with one-way ANOVA for comparison of means between regimens, and Chi-squared or Fisher Exact tests to determine correlation between clinicopathologic factors and likelihood of undergoing a given AT regimen. Results: 148 pts were identified: 67 treated in the GemCap era (Gem: 25, 37%, and GemCap: 42, 63%) and 81 treated in the FOLFIRINOX era (Gem: 26, 32%, GemCap: 20, 25%, FOLFIRINOX: 35, 43%). Examined variables included age, gender, ECOG, T and N stage, margins, lymphovascular invasion and post-operative CA19-9. In the GemCap era, use of GemCap vs. Gem was associated with younger average age (p = 0.001) and positive lymph node status (91% vs. 60%, p = 0.003). In the FOLFIRINOX era, use of Gem AT was associated with a delayed time from surgery to treatment (p = 0.045). AT assignment was not influenced by high volume vs low volume centre in the GemCap era. However, when not assigned treatment with FOLFIRINOX in the FOLFIRINOX era, pts were more likely to receive GemCap in low-volume centers, and more likely to recieve Gem in high-volume centers (p = 0.026). The most common stated reasons for choice of an inferior AT regimen were pt comorbidities or functional status (GemCap era: 24% and FOLFIRINOX era: 35%). In total, 40% of patients treated with GemCap and 49% of patients treated with FOLFIRINOX did not complete the intended treatment, with regimen-specific toxicity accounting for 32% (GemCap) and 29% (FOLFIRINOX) of incomplete treatment. Conclusions: With improvements in survival with newer AT regimens, the majority of pts in our real-world setting were assigned the more efficacious AT regimen. Within the limits of a small sample size, significant pt or disease factors predictive of AT assignment were not identified aside from age and lymph node positivity in the GemCap era, and time from surgery to treatment in the FOLFIRINOX era. However, many pts were not able to complete planned AT due to toxicity. Efforts to optimize pt eligibility to improve FOLFIRINOX tolerability are warranted.
Improving outcomes and shared decisions in pancreatic cancer using animated pancreas patient (APP) visual formats of learning: A National Pancreas Foundation (NPF) patient education initiative.
Authors: Munigala Satish , O'Reilly Eileen Mary , Alsante Matthew , Holt Jane , Ko Andrew H. , Gelrud Andres 
Published: June 2021

e16242 Background: Pancreatic cancer (PC) outcomes continue to be dismal in the United States (US) and worldwide. Efforts are focused on early diagnosis, treatment, and prevention. However, knowledge translation in PC and effective resources that address patient-provider collaborative decisions are limited and barriers to health literacy continue to impede patient understanding. Evidence increasingly supports the need for informative education for patients to facilitate shared decisions in critical cancer interventions. We evaluated the National Pancreas Foundation’s APP, a visual approach to learning, to determine how shared-decision making and patient barriers to health literacy can be improved, leading to better patient-provider decisions and outcomes. Methods: Using visual formats of learning (animations, videos, and slide shows), we monitored APP website and YouTube metrics from September 2013 to February 2021. We evaluated learner activity, number of views with highest retention in US and globally. Results: APP gathered 4,551,079 views (489,091 views on the APP website and 4,061,988 views on YouTube) from over 100 countries. The majority of viewers (60%) were from the US with 54% being patients, 17% family/caregivers, 16% healthcare providers and 13% other. The animations "Understanding Clinical Trials", "Pancreatic Cancer: Treatment and Outcomes", “Pancreatic Cancer: Signs, Symptoms and Risk Factors", and "Pancreatic Cancer: Pathophysiology, Diagnosis and Staging" had 1,372; 4,643; 8,819 and 4,359 views respectively on the website and 180,845; 77,942; 56,151 and 23,112 views respectively on YouTube. Top expert videos viewed most were "What are the different stages of pancreatic cancer?", "What are the symptoms of pancreatic cancer?", “What is a “Placebo” in a clinical trial and is it always used?”, and “What should I expect following surgery to remove a malignant pancreatic cancer tumor?" with 488; 1,558; 76 and 239 views respectively on the website and 14,869; 10,917; 5,206 and 3,624 views respectively on YouTube. Conclusions: Our study suggests visual formats of education are effective in communicating complex health information to persons with poor health literacy. Pancreatic cancer education based on visual formats have vast potential to provide effective learning for patients. Continued efforts should be made to provide resources for patient-provider shared decisions and address patient health literacy barriers for best health outcomes.
Surgical outcomes and rate of pathological response in resectable/borderline resectable pancreatic cancer patients undergoing neoadjuvant gemcitabine/nab-paclitaxel versus FOLFIRINOX: A retrospective institutional analysis.
Authors: Attah Abraham Attah , Rizwan Saleha , Alhamad Khaled , Turk Micheal , Asawa Palash , Shankar Karthik , Alnimer Lynna , Srinivasamaharaj Srividya , Samhouri Yazan , Monga Dulabh K. 
Published: June 2021

e16247 Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal solid tumors, predicted to become the second leading cause of cancer related death in some regions of the world. It often presents at an advanced stage, which contributes to poor five-year survival rates of 2%-9%, ranking firmly last amongst all cancer sites in terms of prognostic outcomes for patients. Only about 20% of the cases are diagnosed early enough to undergo surgical resection leading to complete remission. While chemotherapy has an established role in the setting of metastatic disease, utilizing it in the neo-adjuvant setting has been adopted by most institutes for resectable/ borderline resectable cases. Ongoing trials are exploring the use of different regimens in the neo-adjuvant setting. The aim of our study was to identify patients with resectable/borderline resectable PDAC undergoing neoadjuvant chemotherapy and differences in surgical outcome based on the regimen received i.e gemcitabine/ nab-Paclitaxel vs FOLFIRINOX. Methods: A retrospective review was conducted of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Summary statistics were presented using percentages for categorical variables and medians with interquartile ranges for continuous variables. Results: Out of 121 patients who received and completed treatment in our institution, 30 underwent neoadjuvant chemotherapy treatment followed by surgical intervention. 21 (70%) patients were found to be borderline resectable, 8 (27%) patients were resectable and 1 patient had locally advanced PDAC. 16 (53%) patients received FOLFIRINOX compared to 13 (43%) patients received gem/nab-paclitaxel. Among patients who received neoadjuvant FOLFIRINOX, 5 out of 16 (31%) patients had moderate to significant treatment response at the time of surgery compared to 7 out of 13 (54%) patients who received gemcitabine/nab-paclitaxel. Conclusions: Our study revealed no significant difference (p=0.21) between the patients who received neoadjuvant gemcitabine/nab-paclitaxel vs FOLFIRINOX in terms of treatment response assessed pathologically at the time surgical resection. We recognize the limitations of our study in terms of it being a retrospective analysis with a small sample size and therefore further prospective and randomized controlled trials are needed to determine the most suitable and effective regimen in the neoadjuvant setting for resectable/borderline resectable PDAC patients. Response to treatment among different chemotherapy groups.[Table: see text]
Assessment of compliance with national guidelines in genetic testing and tumor profiling in patients diagnosed with pancreatic adenocarcinoma: A retrospective review.
Authors: Shankar Karthik , Srinivasamaharaj Srividya , Samhouri Yazan , Rizwan Saleha , Shah Deep , Liu Jiaxiang , Helfand Alexander M , Patibandla Naga Sai Krishna , Miller Katherine , Kancharla Pragnan , Khattab Ahmed , White Richard , Bakalov Veli , Monga Dulabh K. 
Published: June 2021

e16260 Background: Pancreatic ductal adenocarcinoma (PDAC) remains one of poor prognosis, portending a 5-year survival rate of 9% when considering all stages. Although the mainstay of treatment of PDAC remains cytotoxic chemotherapy in both the early and advanced stages, recent advances in tumor profiling and germline testing have allowed for the incorporation of poly-ADP-ribose polymerase (PARP) inhibitors, immune checkpoint inhibitors and targeted therapy to be utilized in the maintenance and subsequent-line settings for metastatic PDAC, respectively. We sought to identify our institutional compliance rate in germline testing and tumor profiling in all patients diagnosed with PDAC. Methods: A retrospective review was conducted of all patients diagnosed with PDAC from 2017-2019 at Allegheny General Hospital. Data analysis was completed using IBM SPSS v23. Summary statistics were presented using percentages for categorical variables and medians with interquartile ranges for continuous variables. Results: Out of 171 patients reviewed, 121 received and completed treatment in our institution, and were included in the analysis. Median age was 69 years. 55 patients (45%) were male and 66 (55%) were female. Germline testing was done in 28 patients (23%) and tumor molecular profiling was done in 25 patients (21%). Testing for microsatellite instability was performed in 28 patients (23%). Testing for programmed death-ligand (PD-L1) expression was done in 16 patients (13%). On univariate analysis, family history of malignancy was a predictor for germline testing (OR 5.3; 95% CI 1.4-2.01; p=0.01). No predictors were identified in association with tumor molecular profiling likely due to low sample size. Conclusions: Our analysis reveals an institutional compliance rate of 20-23% in adherence to national guidelines with respect to germline testing and tumor profiling in the management of PDAC. A family history of malignancy demonstrated predictive association with germline testing. Factors which may limit pathological evaluation of microsatellite stability status, assessment of PD-L1 expression and molecular profiling include lack of institutional protocol for reflex histological testing, financial or insurance constraints, and lack of adequate tissue. As part of our Quality improvement project, we identified that incorporation of reflex histological testing based on tumor-type, standardization of tissue biopsy to optimize yield, and utilization of support staff, such as Oncology Navigators, to facilitate scheduling for germline testing may increase compliance rates.