1,721,013 research outputs found
Efficacy of chemopreventive agents on overall survival in patients with pancreatic ductal adenocarcinoma
Full text linkBackground Previous studies on statins’ effect on survival of patients with pancreatic ductal adenocarcinoma (PDAC) report conflicting results Aims To evaluate the association between statin use and PDAC patients’ survival. Methods A systematic review and meta-analysis was performed including case-control, cohort studies and randomized controlled trials assessing the association between statin use and survival in PDAC patients. Pooled HRs with 95%CIs were calculated using random effects model; publication bias was assessed through Begg and Mazumdar test and heterogeneity by I2 value. Results 14 studies with 33,137 PDAC patients,40% under statins, were included. Statins use was associated to a reduced death risk (HR 0.871; 95%CI: 0.819;0.927; p= 0.0001) suggesting a protective effect, homogeneous for different geographic areas. This effect was significant in surgically resected patients (HR 0.50; 95%CI: 0.32;0.76; p=0.001) but not in those with advanced disease (HR 0.78; 95%CI: 0.59;1.02; p=0.07). In studies providing information on statin type, only rosuvastatin resulted associated to a reduced risk of death (HR 0.88; 95%CI: 0.81;0.96; p=0.004). Conclusions Statins use is significantly associated with a reduced risk of death in resected PDAC patients. This finding has to be considered with caution due to publication bias and the availability of only few studies for sensitivity analyses.BACKGROUND Pancreatic ductal adenocarcinoma is currently the fourth leading cause of cancer-related death in the United States with a 5-year survival rate of 6.7% Surgical resection of early-stage disease remains the only opportunity for potential cure. Despite advances in therapy, pancreatic cancer continues to have a poor prognosis and up to 80–85% of patients undergoing resection experience disease recurrence In this setting cancer chemoprevention with the use of natural or synthetic substances to inhibit, retard or reverse the carcinogenesis has been recently investigated by several authors AIM To investigate the effect of chemopreventive agents on overall survival in patients with pancreatic ductal adenocarcinoma. METHODS A retrospective study has been conducted on patients treated with pancreatic resection for PDAC. Inclusion criteria were as follows: age ≥ 18 years, absence of distant metastasis at preoperative imaging, use of statin and/or metformin and/or ACE-inhibitors and/or B-Blockers and/or aspirin (chemopreventive agents). A patient was considered in therapy with the drugs above mentioned in case of assumption for at least 6 months before diagnosis. RESULTS The median follow-up time was 29 months (IQR: 19-43 months). The median DFS and DSS of the entire population was 21 months (95% CI: 17-24 months) and 34 (95% CI: 30-38) respectively. On multivariable analysis factors associated with DFS were: pT3/pT4 (HR: 2.46; p=0.001); N1 (H.R.: 1.42, p=0.08) and N2 (HR: 2.52; p<0.0001); No adjuvant treatment (HR: 2.0; p<0.0001). Moreover, Aspirin assumption maintain its protective effect on DFS at multivariate analysis (HR: 0.62; p=0.038). On multivariable analysis factors associated with DSS were: pT3/pT4 (HR: 2.55; p=0.001); N1 (H.R.: 2.61, p<0.001) N2 (HR: 4.83; p<0.001); No adjuvant treatment (HR:1.6; p<0.0001); G3 (HR: 1.57; p=0.011); ASA score >3 (HR: 1.45; p=0.025). The regular treatment with ACE-inhibitors is associated with a poor prognosis and lower survival (p=0.027) at univariate analysis ad the data is confirmed at multivariate analysis (HR: 1.65; p=0.009). DISCUSSION The present study demonstrates that the routinely assumption of metformin and/or aAspirin is associated with an increased DFS among patients with PDAC. Also among Metformin-assuming patients a clear trend to a better DFS was observed but without reaching the statistical significance
Indications to total pancreatectomy for positive neck margin after partial pancreatectomy: a review of a slippery ground
No full textThe extension of a partial pancreatectomy up to total pancreatectomy because of positive neck margin examined at intraoperative frozen section (IFS) analysis is an accepted procedure in modern pancreatic surgery with good accuracy. The goal of this practice is to improve the rate of radical (R0) resection in malignant tumors, mainly pancreatic ductal adenocarcinoma (PDAC), and to completely resect pre-invasive neoplasms such as intraductal papillary mucinous neoplasms (IPMNs). In the setting of IPMNs there is a consensus for pancreatic re-resection when high-grade dysplasia and invasive cancer are present at the neck margin. The presence of denudation is another indication for further resection in IPMNs. The role of IFS analysis in the management of pancreatic cancer is more debated. The presence of a positive intraoperative transection margin can be considered the surrogate of a biologically aggressive disease associated with a poorer prognosis. There are conflicting data regarding possible advantages of pancreatic re-resection up to total pancreatectomy, and the lack of randomized trials comparing different strategies does not offer a definitive answer. The goal of this review is to provide an up-to-date overview of the role IFS analysis of pancreatic margin and of pancreatic re-resection up to total pancreatectomy considering different pancreatic tumors
Does chronic consumption of angiotensin-converting enzyme inhibitors affect survival after surgical resection of pancreatic ductal adenocarcinoma?
No full textIncidental diagnosis as prognostic factor in different tumor stages of nonfunctioning pancreatic endocrine tumors
No full textBACKGROUND:
Incidentally discovered nonfunctioning pancreatic endocrine tumors (NF-pNETs) increasingly are being detected, and their management is debated. Moreover, the prognostic importance of incidental diagnosis for locally advanced or metastatic NF-pNETs is unknown. The aim of this study is to analyze the outcomes of incidentally discovered/symptomatic NF-pNETs stratified by tumor stage. A preliminary experience with nonoperative treatment of incidental NF-pNETs is reported.
METHODS:
Consecutive patients with symptomatic/incidental NF-PETs observed between 1990 and 2009 were analyzed, with different tumor stages considered. Nonoperative management of incidental NF-pNETs was evaluated.
RESULTS:
Among 355 patients with NF-pNETs, the diagnosis was incidental in 124 (35%). Incidental NF-pNETs were associated more commonly with lower tumor stages compared with symptomatic tumors (P < .0001), but 30% of incidental NF-pNETs were stage III-IV. Incidental NF-pNETs had greater rates of radical resections and of R0 margins (P < .0001). Five-year progression-free survival (PFS) was 83% and 32% for incidental and symptomatic NF-pNETs, respectively (P < .0001). Five-year PFS was better for incidental NF-pNETs compared with symptomatic tumors for each tumor stage, including stage III (69% vs 27%, P < .0001) and stage IV (60% vs 17%, P = .112). After a median follow-up of 36 months, there was no tumor progression in 12 patients who underwent nonoperative management of incidental NF-pNETs.
CONCLUSION:
A total of 30% of incidental NF-pNETs present with stage III-IV disease. PFS is much greater for incidental NF-pNETs compared with symptomatic patients, and this difference is evident also for stage III-IV tumors, suggesting that absence of symptoms may indicate a less-aggressive disease. Nonoperative management can be an alternative to surgery in selected incidental NF-pNETs
Selection criteria in resectable pancreatic cancer: a biological and morphological approach
No full textHow to Select Patients Affected by Neuroendocrine Neoplasms for Surgery
No full textPurpose of Review The aim of this review was to discuss how to select patients with gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) for surgery. Recent Findings Surgical resection represents the mainstay for the curative treatment of GEP-NENs. Conservative strategies, such as endoscopic resection and active surveillance, have been recently advocated for the management of patients with small and asymptomatic GEP-NENs. On the other hand, patients with GEP-NENs showing features of aggressiveness should be managed by surgical resection with lymphadenectomy, when the surgical risk is considered acceptable. An accurate selection is important also in the setting of advanced disease, where surgery can provide a survival benefit in the context of a multimodal treatment strategy. Surgical and oncological risk should be always assessed in order to define indications for surgery in patients with GEP-NENs. Given the variety of available treatment options, surgical indication should be always shared with a dedicated multidisciplinary team
Endoscopic ultrasound-guided gastrojejunostomy does not prevent pancreaticoduodenectomy after long-term symptom-free neoadjuvant treatment
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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