bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rates of unplanned hospital care in Black Americans with pancreatic cancer.
Authors: John Kristen M , Dhillon Harkirat S , King Daniel 
Published: January 2023

666 Background: Individuals with cancer are more likely to visit an emergency department (ED) for issues both related and unrelated to their cancer than individuals without cancer, but data are lacking regarding what subpopulations are most vulnerable. Here, we assessed the characteristics of patients with pancreas cancer across the Northwell Health system who had multiple ED visits. Methods: An IRB-approved retrospective chart review of patients with pancreas cancer diagnosed between 2015 through 2021 was conducted. Patients with > 3 ED visits were defined as high utilization and patients with 0 ED visits were defined as low utilization. Demographic and clinical features were recorded. Median income was extrapolated by zip code using data from the US Census Bureau. Generalized logistic regression models were constructed to analyze characteristics associated with high ED utilization. Results: The cohort consisted of 658 patients, among whom 181 individuals met criteria for high utilization and 140 met criteria for low utilization. Stage, age, gender, ethnicity, history of pancreatitis, median income, preferred language, establishment with primary care provider, and establishment with medical oncologist had no significant association with high utilization. Race (OR: 2.8; p = 0.002) and substance abuse (OR: 4.43; p = 0.02) were the strongest predictors of high ED utilization. We observed that 14% of the individuals who were Black had a history of substance abuse. Conclusions: Our analysis identified a striking and concerning association between high utilization of the ED and patients who are Black or who have a history of substance abuse. Substance abuse may contribute to high ED utilization among Black Americans, however, 86% had no history of substance abuse, suggesting that other causal factors are at play. These results compel further investigation into these casual factors to guide the development of health equity interventions to address these disparities.[Table: see text]
Adjuvant gemcitabine+S1 as adjuvant therapy for resectable pancreatic cancer: A real-world experience in a single-center retrospective study.
Authors: Lin Hsin-Chen , Shih Yu-Hsuan 
Published: January 2023

673 Background: Current clinical guidelines recommended adjuvant chemotherapy for all resectable pancreatic cancer after operation. The treatment choices included Gemcitabine monotherapy, S1 monotherapy, Gemcitabine+Capecitabine or mFOLFIRINOX. However, the role of Gemcitabine+S1 combination as adjuvant chemotherapy was not clear. We aimed to investigate the benefit of adjuvant chemotherapy with Gemcitabine+S1 in resectable pancreatic cancer. Methods: We retrospectively reviewed the medical records of patients with resectable pancreatic cancer who underwent curative surgery and adjuvant treatments at Taichung Veterans General Hospital (Taichung, Taiwan) between January 2014 and July 2021. The clinical characteristics and outcomes were analyzed. Results: A total of 102 patients received operation were analyzed. 73 patients received adjuvant chemotherapy, including 35 patients received Gemcitabine+S1 combination. Median follow-up period was 22.7 months. The disease-free survival (DFS) and overall survival (OS) among patients received Gemcitabine+S1 combination were 15.5 months and 32.8 months, respectively. Compared with Gemcitabine monotherapy, there was a trend of superior DFS (10.5 months in Gemcitabine monotherapy, p = 0.071), but no OS benefits (23.1 months, p = 0.441) with Gemcitabine+S1 combination. When focusing on more advanced disease status (stage II and III), the Gemcitabine+S1 combination had statistically significant longer DFS (14.7 months vs. 8.6 months; p = 0.015) and OS (30.3 months vs. 21.7 months; p = 0.036), compared with Gemcitabine monotherapy. Conclusions: In our retrospective study, Gemcitabine+S1 combination could be another choice for resectable pancreatic cancer, especially in more advanced disease (stage II and III). Further result from prospective study (JSAP-04) is pending.
Effect of resection margin status on recurrence pattern and survival in distal pancreatectomy for left-sided pancreatic ductal adenocarcinoma.
Authors: Kwon Jaewoo , Lee Sung Ryol , Shin Jun Ho , Kim Song Cheol 
Published: January 2023

675 Background: The association of resection margin status with recurrence and survival after pancreatectomy for pancreas ductal adenocarcinoma (PDAC) remains controversial. The aim of this study was to identify the effect of R1 resection on recurrence pattern and survival after distal pancreatectomy for left-sided PDAC. Methods: Patients who underwent distal pancreatectomy for PDAC at two high-volume institutions between January 2010 and December 2017 were retrospectively reviewed. Perioperative characteristics, pathological outcomes, recurrence pattern and survival data were collected to compare R0 resection and R1 resection. Results: Among 558 patients who underwent distal pancreatectomy for PDAC, 158 patients (28.3%) showed R1 resection margin. R1 patients were associated with large tumor size (3.3 cm vs. 3.7 cm, p= 0.006) and lower number of positive lymph nodes (1.3 vs. 2.0, p= 0.001). Median overall survival (37.3 months vs. 20.1 months, p< 0.001) and recurrence-free survival (14.6 months vs. 6.9 months, p< 0.001) significantly differed between the R0 and R1 groups. Disease recurrence patterns were not statistically different between the two groups ( p = 0.182). Among the recurrence patterns, peritoneal carcinomatosis had the shortest recurrence-free survival (5.6 months, p < 0.05) and overall survival (13.6 months, p < 0.05) compared with all other recurrence patterns. Conclusions: R1 resection margin after distal pancreatectomy was associated with poor survival and early recurrence. There is no significant difference in recurrence pattern between R0 and R1. Among the recurrence patterns, peritoneal carcinomatosis showed the worst prognosis.
First-line chemotherapy regimens associated with survival in advanced pancreatic cancer: A Mexican single-center, real-world study.
Authors: Herrera Marytere , Maliachi Diaz Andrea , Diaz Consuelo , Salais Michaus Veronica , Ruiz Erika , Garcia Sebastian , Miyagui Adame Sayako , Calderillo Ruiz German 
Published: January 2023

683 Background: Effectiveness of FOLFIRINOX and Gemcitabine – Nabpaclitaxel as first-line chemotherapy regimens in advanced pancreatic cancer has been demonstrated in phase III clinical trials. However, prospective studies directly comparing both interventions are lacking. Gemcitabine has proved effective when combined with other drugs such as Oxaliplatin. Despite GEMOX has not proved overall survival benefit over Gemcitabine and it is unclear if its effectiveness could be similar to FOLFIRINOX or Gemcitabine-Nabpaclitaxel, it is broadly used as first line chemotherapy in our center due to safety concerns and higher costs associated to FOLFIRINOX and Nabpaclitaxel. Methods: We retrospectively analyzed data of patients with stage IV Pancreatic Adenocarcinoma treated at Instituto Nacional de Cancerología from 2014 to 2021. Our aim was to compare Overall Survival (OS) in patients treated with GEMOX, FOLFIRINOX, Gemcitabine-Nabpaclitaxel, or Gemcitabine in the front-line setting. Progression Free Survival (PFS), Overall Response Rate (ORR) and Adverse Effects (AEs) were also assessed. Results: A total of 141 patients were analyzed, 72 (51.0%) were treated with GEMOX, 13 (9.2%) with FOLFIRINOX, 9 (6.4%) with Gemcitabine-Nabpaclitaxel and 47 (33.3%) with Gemcitabine. Median Overall Survival for each regimen was: 11.0, 10.7, 6.7 and 4.7 months; (p = 0.078), and median PFS was 9.2, 6.5, 5.7 and 4.0 months, respectively (p = 0.026).ORR was 21.6%, 20.0%, 11.1%, 4.8% with GEMOX, FOLFIRINOX, Gemcitabine-Nabpaclitaxel and Gemcitabine, respectively. The percentage of patients who received a second line chemotherapy after progression was 43.1%, 61.5%, 55.6% and 23.4%, (p = 0.031). Regarding AEs, G3/4 most common effects ( > 5%) were Neutropenia (9.8%, 30.0%, 55.6%, 4.8%; p = 0.001), Diarrhea (2.0%, 10.0%, 11.1%, 0.0%; p = 0.247), and Increased Liver Enzymes (7.8%, 20.0%, 0.0%, 4.8%; p = 0.371). Grade 1/2 Neuropathy was found in 43.1%, 60.0%, 44.4% and 9.5%, p = 0.018. The percentage of patients who required GCSF was 9.8%, 60.0%, 22.2% and 9.5%, P = 0.001. Conclusions: In patients with advanced pancreatic cancer treated with different chemotherapy regimens, median OS was similar in this real-world analysis. Though PFS was higher in the group of patients treated with GEMOX, a higher percentage of patients initially treated with FOLFIRINOX or Gemcitabine – Nabpaclitaxel reached 2nd line chemotherapy after progression. Percentage G3/4 Neutropenia, G1/2 Neuropathy and use of GCSF were significantly higher in patients treated with FOLFIRINOX.
Ten years of experience in patients with resected pancreatic tumors: Real-world data in a public institution in Peru.
Authors: Macetas Jackeline , Vallejos Heberth Daniel , Veramendi Cabana Eder Christian , Serrano Mariana , Pacheco Cristian , Castro Oliden Victor , Mantilla Raul , Montenegro Paola Catherine 
Published: January 2023

686 Background: In Peru, the incidence of pancreatic tumors is 3.59 per 100,000 inhabitants, being the ninth cause of death. The standard of treatment in the world is surgery, achieved in 13% of patients, with overall survival (OS) and disease-free survival (PFS) at 5 years of 10% and 34%, respectively. In our study, the different subtypes of pancreatic tumors that were resected by surgery, their clinical/pathological characteristics, OS and PFS were evaluated. Methods: A retrospective review was carried out, in patients older than 18 years, diagnosed and treated with first intention surgery, during 2010 - 2019. 36.9% were adenocarcinoma (AD), 36.2% solid pseudopapillary neoplasm, 20.6% serous cystadenoma, 3.5% intraductal papillary mucinous neoplasm, 2.1% mucinous cystic neoplasm, and 0.7% acinar cell carcinoma. The Kaplan Meir method was used to estimate OS and PFS, and the log-rank test to differentiate between estimated curves. Results: 141 patients with resected pancreatic tumors; 73.8% without comorbidities and 2.1% with Diabetes Mellitus. Jaundice at debut was present in 22.7%, of whom 60% were AD; with OS at 5 years, 23.7% of patients with jaundice vs 69.9% without jaundice, 55.3% of tumors were located in the head of pancreas, 78.8% were AD; an OS at 5 years of 50.1% vs 67.3% of not located in the head of the pancreas. According to staging (S), 14.2% S I, 43.3% S IIA, 20.6% S IIB, and 22% S III; 100% were AD in S IIB-III vs 8.9% non-AD, with OS at 5 years S III of 16.2% and IIB of 39.3%. OS and PFS at 5 years, in pancreatic tumors were 57.7% and 73.5%, respectively. For patients with AD, the OS and PFS were 22.9% and 36.9%, respectively. Conclusions: The study suggests that jaundice at debut, located in head of the pancreas, S IIB-III, are worse prognostic factor in our patients with pancreatic tumors, especially in AD. And our patients with resected AD, presents greater survival compared to literature, although more evidence is still required due to the type of study.
Comparison of pancreatic cancer outcomes diagnosed in surveillance and the general population: A propensity score-matched analysis.
Authors: Klatte Derk C.F. , Boekestijn Bas , Onnekink Anke M. , Dekker Friedo W. , van der Geest Lydia G. , Wasser Martin N.J.M.M. , Feshtali Shirin , Mieog J. Sven D. , Morreau Hans , Potjer Thomas P. , Inderson Akin , Boonstra Jurjen J. , Vasen Hans F.A. , Luelmo Saskia , van Hooft Jeanin E. , Bonsing Bert A. , van Leerdam Monique E. 
Published: January 2023

690 Background: Recent pancreatic cancer surveillance programs of high-risk individuals have reported improved outcomes. This study assessed to what extent outcomes of pancreatic ductal adenocarcinoma (PDAC) in patients with a CDKN2A/p16 pathogenic variant (PV) diagnosed during surveillance are better as compared to PDAC patients diagnosed outside surveillance. Methods: In a propensity score matched cohort using data from the Netherlands Cancer Registry, we compared resectability, stage and survival between patients diagnosed in surveillance with non-surveillance PDAC patients. Survival analysis were repeated after adjustment for lead-time bias. Results: Between January 2000 and December 2020, 43 762 patients with PDAC were identified from the NCR. Thirty-one patients with PDAC in surveillance were matched in a 1:5 ratio with 155 non-surveillance patients based on age at diagnosis, sex, and year of diagnosis. In total, 71% of patients in surveillance, as compared to 16% of non-surveillance patients underwent a surgical resection (OR 14.03; 95% CI, 5.92 – 35.85). In surveillance, 39% of patients was diagnosed with stage I cancer, as compared to 6% of non-surveillance PDAC patients (OR 0.10; 95% CI, 0.04 – 0.21). Patients in surveillance had a better prognosis, reflected by a 3-year survival of 32.4% and a median overall survival (OS) of 26.8 months vs. 1.4% 3-year survival and 5.3 months median OS in non-surveillance patients (HR 0.22; 95% 0.14 – 0.36). After adjustment for lead time, PDAC diagnosis in surveillance remained strongly associated with improved survival. Conclusions: Surveillance for PDAC in carriers of a CDKN2A/p16 PV results in earlier detection, increased resectability and improved survival as compared to non-surveillance PDAC patients.[Table: see text]
Patterns of pancreatic enzyme replacement therapy (PERT) use among U.S. patients with pancreatic cancer.
Authors: Dang Trang Quynh , Stenehjem David D. , Gupta Arjun 
Published: January 2023

696 Background: PERT is an important but costly and inconsistently used supportive care medication in PC. We sought to characterize patterns of PERT use among U.S. insured patients with PC. Methods: We conducted a retrospective observational analysis of patients with a primary diagnosis of pancreatic adenocarcinoma in the IBM MarketScan national claims database between 2013-2019. We identified pharmacy claims for PERT (Creon, Pancreaze, Pertzye, Viokace, and Zenpep) and classified patients as PERT-users (≥ 1 PERT prescription [Rx]) and non-PERT users. We used descriptive statistics for clinical, demographics, and costs. Multiple logistic regression identified predictors of PERT use. Kaplan-Meier method assessed time from PC diagnosis to first PERT Rx. Results: Of 19,866 patients with PC (median age 62 years, 49% women), 6,918 (35%) were PERT-users. The median follow-up was 11 months (PERT users: 14 months, non-PERT users: 9 months). Overall, 43% of patients received no cancer-directed treatment. PERT-users were more likely to have a history of pancreatitis (acute, odds ratio [OR] = 1.9; chronic, OR = 3.6), and received chemotherapy (OR = 1.2), surgery (OR = 2.3), and radiation (OR = 1.4). Among all PERT-users, the median time from PC diagnosis to first fill was 1.9 months (95% CI: 1.8,2.0). The median time from surgery to first fill was 1.6 months (95% CI: 1.4,1.7). The median number of PERT Rxs was 4; 22% of PERT-users received 1 Rx. A median of 150 days of PERT was supplied across all Rxs per patient. The median (IQR) cost of each PERT Rx was $25 ($0- $50). PERT accounted for 16% of all drug out-of-pocket costs (OOPC) (excluding systemic outpatient cancer-directed treatment), and 7% of all healthcare OOPC. Patients with PERT had significantly higher monthly OOPC on Rxs but lower on all other services, including inpatient and outpatient services (all p < 0.0001). Overall, PERT-users had significantly lower per-patient per-month (PPPM) OOPC vs non-PERT users ($469, vs $520, p < 0.0001). They also had fewer PPPM outpatient (0.7 vs 1.2, p < 0.0001) and ER (0.4 vs 0.5, p < 0.0001) visits. Conclusions: In this national study of insured U.S. adults with PC, only one-third received PERT. Of those receiving PERT, approximately a fifth received just a single Rx. PERT users, despite higher OOP drug spending had reduced overall OOP costs and fewer healthcare visits. These data highlight the need to explore non cost-related reasons for lack of and ways to standardize PERT use.
Prognostic role of a novel clinical-nutritional index in pancreatic ductal adenocarcinoma: The Pancreatic Adenocarcinoma Nutritional-Clinical Index (PANCIN).
Authors: Orsi Giulia , Abati Martina , Palumbo Diego , Pavarini Maddalena , Burini Alice , Cardellini Sara , Macchini Marina , Mori Martina , Fiorino Claudio , Peretti Umberto , Valente Maria Maddalena , Militello Anna Maria , Briccolani Maria Assunta , Mele Roberto , Falconi Massimo , Cascinu Stefano , Capurso Gabriele , Reni Michele 
Published: January 2023

697 Background: Impaired nutritional status is often associated with Pancreatic Ductal Adenocarcinoma (PDAC) and poor prognosis. Little is known on the prognostic role of nutritional variables in PDAC patients (pts) receiving chemotherapy (CT). Methods: Locally advanced or metastatic PDAC pts enrolled at our Institute in a prospective observational study (PAC-MAIN) and treated with 1st-line CT between April 2019 and July 2021 were included in the analysis. Clinical and nutritional variables entailed biohumoral parameters, bioimpedance vector analysis (BIVA)- and Computed Tomography-derived body composition. Progression-free and Overall survival (PFS and OS) were calculated from CT start to progression or death. A Multivariate Cox proportional-hazards model for PFS prediction was generated by backward selection of features with a p-value (p) ≤ 0.06. The resultant index, named PANCIN, was calculated as linear combination of the covariates (Xi are the N) and the b Cox coefficients (bi), according to the formula: PANCIN = ∑Ni=1 bi Xi Kaplan–Meier test was performed to assess the ability of PANCIN to stratify pts according to its median value for PFS and OS prediction. Results: 74 pts were included in the study. The variables retained in the model were: serum Vitamin B12 (pg/ml) [Hazard Ratio (HR)= 1.001, 95% Confidence Interval (CI) 1.0004-1.0016, p=0.002]; BIVA-derived Body Cell Mass (%) [HR= 0.94, 95% CI 0.887-1.002, p=0.058]; ECOG Performance Status (0 vs 1-2) [HR= 3.25, 95% CI 1.048-10.077, p=0.041]; Albumin (g/L) [HR= 0.91, 95% CI 0.86-0.97, p=0.002]; FAACT Score [HR= 1.041, 95% CI 1.006-1.077, p=0.022]. Median PFS was 15.3 (95% CI 7.6-21.8) and 5.8 months (95% CI 2.7-9.0) for pts with PANCIN < or ≥ -1.7768 median value respectively [HR= 3.7, 95% CI 1.9-7.0, p=0.0001]. Median OS was 23.8 (95% CI 12.6-33.3) and 10.0 months (95% CI 5.7-12.7) for pts with PANCIN < or ≥ -1.7768 respectively [HR= 4.1, 95% CI 2.1-7.9, p<0.0001]. Conclusions: PANCIN is a novel nutritional-clinical index able to predict outcome of advanced PDAC pts receiving CT. If furtherly validated, it may represent a stratification tool both in clinical practice and in prospective trials. Our findings also support the relevance of a baseline comprehensive nutritional assessment, to define tailored nutritional interventions.[Table: see text]
Identifying predictors of on-table adaptation for pancreas stereotactic body radiotherapy (SBRT).
Authors: Wu Trudy , Yoon Stephanie , Cao Minsong , Raldow Ann C. , Xiang Michael 
Published: January 2023

702 Background: There is growing interest in the use of stereotactic body radiotherapy (SBRT) to treat pancreatic cancer. The purpose of this study was to identify any clinical or dosimetric parameters that predict which individuals may benefit from on-table adaptation during pancreas SBRT with MRI-guided radiotherapy. Methods: This was a single center retrospective study of patients undergoing MRI-guided SBRT to the pancreas from 2016 to 2022. An online daily adaptive workflow was in place for all fractions according to pre-specified criteria. Pre-treatment clinical variables and dosimetric parameters on the patient’s simulation scan were recorded for each SBRT course, and their ability to predict for on-table adaptation was analyzed using ordinal logistic regression. The outcome measure was number of fractions adapted. Results: Seventy-three SBRT courses consisting of 365 fractions were included in this study. Median prescription dose was 40 Gy in five fractions (range, 33-50 Gy); 56% and 44% of courses were prescribed ≤ 40 Gy and > 40 Gy, respectively. Median gross and planning target volume (GTV and PTV) coverage were 94.7% and 84.3%, respectively. Median number of fractions adapted per course was three, with overall 58% (211 out of 365) total fractions adapted. On univariable analysis, the prescription dose ( > 40 Gy vs ≤ 40 Gy), GTV size, stomach V20 and V25, duodenum V20 and Dmax, large bowel V33 and V35, heterogeneity index, and gradient index were significant determinants of the use of on-table adaptation (all p < 0.05). On multivariable analysis, only prescription dose remained significant (adjusted odds ratio 7.66, p = 0.003). Conclusions: Prescription dose in MRI-guided pancreas SBRT is the only reliable predictor of on-table adaptation. Providers should strongly consider utilization of adaptive technology when delivering ablative doses to the pancreas.[Table: see text]
Updated results of a phase 1 study of SEA-CD40, gemcitabine, nab-paclitaxel, and pembrolizumab in patients with metastatic pancreatic ductal adenocarcinoma (PDAC; SGNS40-001).
Authors: Coveler Andrew L. , Gutierrez Martin , Vaccaro Gina M. , Brown-Glaberman Ursa , Grilley-Olson Juneko E. , Kindler Hedy L. , Zalupski Mark , Heath Elisabeth I. , Piha-Paul Sarina A. , Wehr Allison , Lu Hailing , Hayman Jonathan , Bajor David L 
Published: January 2023

708 Background: PDAC has a 5-year survival rate of <5% in patients with metastatic disease. Despite established frontline therapy with gemcitabine + nab-paclitaxel (GnP), outcomes remain poor and additional therapies are urgently needed. SEA-CD40 is a receptor-agonistic, nonfucosylated IgG1 antibody directed to CD40. SEA-CD40 binding to FcγRIIIa results in enhanced effector function and CD40 agonism, allowing amplification of immune stimulation and antitumor activity. In preliminary results of a phase 1 study, SEA-CD40 + GnP + pembrolizumab (pembro) showed a tolerable safety profile and evidence of immune activation in patients (pts) with PDAC. Here, we present updated clinical results for this cohort. Methods: Pts were ≥18 years old with untreated metastatic PDAC and ECOG Performance Status of 0 or 1. Gemcitabine (1000 mg/m2) and nab-paclitaxel (125 mg/m2) were given on days 1, 8, and 15 and SEA-CD40 (10 or 30 µg/kg) was given on day 3 of each 28-day cycle. Pembro (400 mg) was given every 6 weeks starting on day 8 for up to 2 years. Results: As of August 16, 2022, 61 pts were treated with 10 µg/kg (N=40) or 30 µg/kg (N=21) SEA-CD40. Median duration of exposure was 25.1 weeks. Confirmed objective responses were observed in 19 pts (48% [95% CI 31.5, 63.9]) at 10 µg/kg and 8 pts (38% [95% CI 18.1, 61.6]) at 30 µg/kg. Median duration of response (months) was 5.7 (95% CI 3.9, 7.4) and 5.7 (95% CI 2.3, 9.2) for the 10 and 30 µg/kg dose groups, respectively. Additional efficacy results are summarized. The most common treatment-emergent adverse events (TEAEs) across dose groups were fatigue (84%), nausea (74%), and neutropenia (67%). The most common grade ≥3 TEAEs across the groups were neutropenia (61%), anemia (33%), and thrombocytopenia (20%). TEAEs leading to treatment discontinuation were reported in 10% of pts, including immune-mediated lung disease (n=3) and septic shock (n=1) in the 10 µg/kg dose group, and colitis (n=1) and portal vein thrombosis (n=1) in the 30 µg/kg dose group. Conclusions: The combination of SEA-CD40 + GnP + pembro has an acceptable safety profile and shows evidence of antitumor activity in pts with PDAC. This regimen may warrant further evaluation. Clinical trial information: NCT02376699 . [Table: see text]