Pub Date : 2024-10-01Epub Date: 2024-06-21DOI: 10.1097/MPA.0000000000002384
Radmila Choate, Carrigan Wasilchenko, Kshitij Thakur, Rachel Hill, Elizabeth Wright, Darwin L Conwell
Objectives: Patients with chronic illnesses are susceptible to the financial burden of disease-related treatment costs. Financial toxicity is well researched in cancer and several chronic diseases. This review explores the financial challenges faced by patients with chronic pancreatitis and the impact of financial hardship on their well-being.
Materials and methods: We performed a review of the published literature to summarize the body of existing research and to identify knowledge gaps related to the financial burden experienced by patients with chronic pancreatitis.
Results: Research on financial burden, cost-coping behaviors, cost-related nonadherence to prescribed medications, and social vulnerabilities in people with chronic pancreatitis is sparse. No studies have assessed the suitability and validity of instruments measuring subjective financial toxicity in a patient population with chronic pancreatitis.
Conclusions: There is a critical need for further studies of financial toxicity in the patient population with chronic pancreatitis, considering that if the sources of financial burden can be identified, opportunities emerge to dampen or mitigate their impact on patients with chronic pancreatitis.
{"title":"Financial Toxicity in Patients With Chronic Pancreatitis.","authors":"Radmila Choate, Carrigan Wasilchenko, Kshitij Thakur, Rachel Hill, Elizabeth Wright, Darwin L Conwell","doi":"10.1097/MPA.0000000000002384","DOIUrl":"10.1097/MPA.0000000000002384","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with chronic illnesses are susceptible to the financial burden of disease-related treatment costs. Financial toxicity is well researched in cancer and several chronic diseases. This review explores the financial challenges faced by patients with chronic pancreatitis and the impact of financial hardship on their well-being.</p><p><strong>Materials and methods: </strong>We performed a review of the published literature to summarize the body of existing research and to identify knowledge gaps related to the financial burden experienced by patients with chronic pancreatitis.</p><p><strong>Results: </strong>Research on financial burden, cost-coping behaviors, cost-related nonadherence to prescribed medications, and social vulnerabilities in people with chronic pancreatitis is sparse. No studies have assessed the suitability and validity of instruments measuring subjective financial toxicity in a patient population with chronic pancreatitis.</p><p><strong>Conclusions: </strong>There is a critical need for further studies of financial toxicity in the patient population with chronic pancreatitis, considering that if the sources of financial burden can be identified, opportunities emerge to dampen or mitigate their impact on patients with chronic pancreatitis.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-06-24DOI: 10.1097/MPA.0000000000002360
Ella Kesti, Emmy Borgmästars, Jaana Hagström, Harri Mustonen, Hanna Seppänen, Caj Haglund, Malin Sund
Objectives: Pancreatic ductal adenocarcinoma (PDAC) is characterized by poor prognosis and lack of biomarkers. A rich desmoplastic tumor stroma is considered a hallmark of PDAC and previous studies have indicated upregulated expression of collagen VI (COL6) in PDAC. COL6 is shown to associate with prognosis in many cancers but has been less extensively studied in PDAC.
Materials and methods: The expression of COL6 was analyzed by immunohistochemistry in tissue microarrays containing resected tumor tissue samples from PDAC patients (n = 164). Significance of COL6 was estimated with Kaplan-Meier survival estimates and multivariable Cox regression analysis. COL6 protein and mRNA expression patterns were further investigated in publicly available datasets.
Results: There were no statistically significant ( P < 0.05) differences in survival when comparing high and low protein expression of any of the analyzed COL6 α-chains (α1(VI): hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.64-1.28; α2(VI): HR 1.28, 95% CI 0.86-1.89; α3(VI): HR 0.91, 95% CI 0.64-1.29). Similar results were obtained when assessing public data from the Cancer Proteome Atlas, Clinical Proteomic Tumor Analysis Consortium, and The Cancer Genome Atlas.
Conclusions: In contrast with previous studies and some other cancers, we did not find any association of COL6 tissue expression and PDAC survival.
{"title":"The Prognostic Significance of Collagen VI in Pancreatic Ductal Adenocarcinoma.","authors":"Ella Kesti, Emmy Borgmästars, Jaana Hagström, Harri Mustonen, Hanna Seppänen, Caj Haglund, Malin Sund","doi":"10.1097/MPA.0000000000002360","DOIUrl":"10.1097/MPA.0000000000002360","url":null,"abstract":"<p><strong>Objectives: </strong>Pancreatic ductal adenocarcinoma (PDAC) is characterized by poor prognosis and lack of biomarkers. A rich desmoplastic tumor stroma is considered a hallmark of PDAC and previous studies have indicated upregulated expression of collagen VI (COL6) in PDAC. COL6 is shown to associate with prognosis in many cancers but has been less extensively studied in PDAC.</p><p><strong>Materials and methods: </strong>The expression of COL6 was analyzed by immunohistochemistry in tissue microarrays containing resected tumor tissue samples from PDAC patients (n = 164). Significance of COL6 was estimated with Kaplan-Meier survival estimates and multivariable Cox regression analysis. COL6 protein and mRNA expression patterns were further investigated in publicly available datasets.</p><p><strong>Results: </strong>There were no statistically significant ( P < 0.05) differences in survival when comparing high and low protein expression of any of the analyzed COL6 α-chains (α1(VI): hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.64-1.28; α2(VI): HR 1.28, 95% CI 0.86-1.89; α3(VI): HR 0.91, 95% CI 0.64-1.29). Similar results were obtained when assessing public data from the Cancer Proteome Atlas, Clinical Proteomic Tumor Analysis Consortium, and The Cancer Genome Atlas.</p><p><strong>Conclusions: </strong>In contrast with previous studies and some other cancers, we did not find any association of COL6 tissue expression and PDAC survival.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141446608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: The study is to evaluate serum HSP70 and VEGF for predicting the chemoradiosensitivity of the pancreatic cancer patients.
Materials and methods: 255 pancreatic cancer patients and 60 healthy subjects were measured for serum HSP70 and VEGF using ELISA for the pretreatment, during treatment, and postchemoradiotherapy timepoints.
Results: The serum HSP70 and VEGF were found to be elevated in pancreatic cancer patients as compared to healthy subjects. After chemoradiotherapy treatment, 179 patients showed effective clinical response while 76 patients showed ineffective clinical response. Serum HSP70 and VEGF were higher during chemoradiotherapy, and lower posttreatment in the effective group. However, serum HSP70 and VEGF were higher during and after treatment in the ineffective group. At any given timepoint, serum HSP70 and VEGF were higher in the ineffective group compared with the effective group. The overall survival and progression-free survival trends were as follows: HSP70 High /VEGF High < HSP70 High /VEGF Low or HSP70 Low /VEGF High < HSP70 Low /VEGF Low . Serum HSP70 and VEGF were individually effective, and their combination was even more effective in predicting the chemoradiosensitivity of pancreatic cancer patients. HSP70 and VEGF were independent risk factors for overall survival and progression-free survival of pancreatic cancer patients.
Conclusions: Low levels of serum HSP70 and VEGF were associated with improved radiosensitivity and better prognosis of pancreatic cancer patients.
{"title":"Serum HSP70 and VEGF Levels Are Effective Predictive Factors of Chemoradiosensitivity and Prognosis of Pancreatic Cancer Patients.","authors":"Liumei Xiong, Danming Li, Gui Xiao, Sipin Tan, Jianbo Wen, Guiliang Wang","doi":"10.1097/MPA.0000000000002358","DOIUrl":"10.1097/MPA.0000000000002358","url":null,"abstract":"<p><strong>Aim: </strong>The study is to evaluate serum HSP70 and VEGF for predicting the chemoradiosensitivity of the pancreatic cancer patients.</p><p><strong>Materials and methods: </strong>255 pancreatic cancer patients and 60 healthy subjects were measured for serum HSP70 and VEGF using ELISA for the pretreatment, during treatment, and postchemoradiotherapy timepoints.</p><p><strong>Results: </strong>The serum HSP70 and VEGF were found to be elevated in pancreatic cancer patients as compared to healthy subjects. After chemoradiotherapy treatment, 179 patients showed effective clinical response while 76 patients showed ineffective clinical response. Serum HSP70 and VEGF were higher during chemoradiotherapy, and lower posttreatment in the effective group. However, serum HSP70 and VEGF were higher during and after treatment in the ineffective group. At any given timepoint, serum HSP70 and VEGF were higher in the ineffective group compared with the effective group. The overall survival and progression-free survival trends were as follows: HSP70 High /VEGF High < HSP70 High /VEGF Low or HSP70 Low /VEGF High < HSP70 Low /VEGF Low . Serum HSP70 and VEGF were individually effective, and their combination was even more effective in predicting the chemoradiosensitivity of pancreatic cancer patients. HSP70 and VEGF were independent risk factors for overall survival and progression-free survival of pancreatic cancer patients.</p><p><strong>Conclusions: </strong>Low levels of serum HSP70 and VEGF were associated with improved radiosensitivity and better prognosis of pancreatic cancer patients.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To evaluate the suitability of the MIA PaCa-2 cell line for studying pancreatic cancer intratumor heterogeneity, we aim to further characterize the nature of MIA PaCa-2 cells' phenotypic, genomic, and transcriptomic heterogeneity.
Materials and methods: MIA PaCa-2 single-cell clones were established through flow cytometry. For the phenotypic study, we quantified the cellular morphology, proliferation rate, migration potential, and drug sensitivity of the clones. The chromosome copy number and transcriptomic profiles were quantified using SNPa and RNA-seq, respectively.
Results: Four MIA PaCa-2 clones showed distinctive phenotypes, with differences in cellular morphology, proliferation rate, migration potential, and drug sensitivity. We also observed a degree of genomic variations between these clones in form of chromosome copy number alterations and single nucleotide variations, suggesting the genomic heterogeneity of the population, and the intrinsic genomic instability of MIA PaCa-2 cells. Lastly, transcriptomic analysis of the clones also revealed gene expression profile differences between the clones, including the uniquely regulated ITGAV , which dictates the morphology of MIA PaCa-2 clones.
Conclusions: MIA PaCa-2 is comprised of cells with distinctive phenotypes, heterogeneous genomes, and differential transcriptomic profiles, suggesting its suitability as a model to study the underlying mechanisms behind pancreatic cancer heterogeneity.
研究目的为了评估 MIA PaCa-2 细胞系是否适合用于研究胰腺癌瘤内异质性，我们旨在进一步确定 MIA PaCa-2 细胞的表型、基因组和转录组异质性的性质：方法：通过流式细胞术建立 MIA PaCa-2 单细胞克隆。在表型研究中，我们对克隆细胞的形态、增殖率、迁移潜力和药物敏感性进行了量化。染色体拷贝数和转录组图谱分别通过 SNPa 和 RNA-seq 进行量化：结果：四个MIA PaCa-2克隆表现出独特的表型，在细胞形态、增殖率、迁移潜力和药物敏感性方面存在差异。我们还观察到这些克隆之间存在一定程度的基因组变异，表现为染色体拷贝数改变和单核苷酸变异，这表明该群体存在基因组异质性，以及 MIA PaCa-2 细胞内在的基因组不稳定性。最后，克隆的转录组分析也揭示了克隆间基因表达谱的差异，包括独特调控的ITGAV，它决定了MIA PaCa-2克隆的形态：结论：MIA PaCa-2由具有独特表型、异质性基因组和差异转录组谱的细胞组成，这表明它适合作为研究胰腺癌异质性背后潜在机制的模型。
{"title":"Phenotypic, Genomic, and Transcriptomic Heterogeneity in a Pancreatic Cancer Cell Line.","authors":"Gengqiang Xie, Liting Zhang, Olalekan H Usman, Sampath Kumar, Chaity Modak, Dhenu Patel, Megan Kavanaugh, Xian Mallory, Yue Julia Wang, Jerome Irianto","doi":"10.1097/MPA.0000000000002371","DOIUrl":"10.1097/MPA.0000000000002371","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the suitability of the MIA PaCa-2 cell line for studying pancreatic cancer intratumor heterogeneity, we aim to further characterize the nature of MIA PaCa-2 cells' phenotypic, genomic, and transcriptomic heterogeneity.</p><p><strong>Materials and methods: </strong>MIA PaCa-2 single-cell clones were established through flow cytometry. For the phenotypic study, we quantified the cellular morphology, proliferation rate, migration potential, and drug sensitivity of the clones. The chromosome copy number and transcriptomic profiles were quantified using SNPa and RNA-seq, respectively.</p><p><strong>Results: </strong>Four MIA PaCa-2 clones showed distinctive phenotypes, with differences in cellular morphology, proliferation rate, migration potential, and drug sensitivity. We also observed a degree of genomic variations between these clones in form of chromosome copy number alterations and single nucleotide variations, suggesting the genomic heterogeneity of the population, and the intrinsic genomic instability of MIA PaCa-2 cells. Lastly, transcriptomic analysis of the clones also revealed gene expression profile differences between the clones, including the uniquely regulated ITGAV , which dictates the morphology of MIA PaCa-2 clones.</p><p><strong>Conclusions: </strong>MIA PaCa-2 is comprised of cells with distinctive phenotypes, heterogeneous genomes, and differential transcriptomic profiles, suggesting its suitability as a model to study the underlying mechanisms behind pancreatic cancer heterogeneity.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11384550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-05-04DOI: 10.1097/MPA.0000000000002370
Galande Sheethal, Archana Verma, Raghvendra Mall, Kishore Vl Parsa, Ranjeet K Tokala, Ratnakar Bynigeri, Pavan Kumar Pondugala, Krishna Vemula, S Sai Latha, Divya Tej Sowpati, Surya S Singh, G V Rao, Rupjyoti Talukdar, Thirumala-Devi Kanneganti, D Nageshwar Reddy, Mitnala Sasikala
Objectives: Diabetes secondary to chronic pancreatitis (CP) presents clinical challenges due to lack of understanding on factor(s) triggering insulin secretory defects. Therefore, we aimed to delineate the molecular mechanism of β-cell dysfunction in CP.
Materials and methods: Transcriptomic analysis was conducted to identify endocrine-specific receptor expression in mice and human CP on microarray. The identified receptor (NR4A1) was overexpressed in MIN6 cells using PEI linear transfection. RNA-Seq analysis of NR4A1-overexpressed (OE) MIN6 cells on NovaSeq6000 identified aberrant metabolic pathways. Upstream trigger for NR4A1OE was studied by InBio Discover and cytokine exposure, whereas downstream effect was examined by Fura2 AM-based fluorimetric and imaging studies. Mice with CP were treated with IFN-γ-neutralizing monoclonal antibodies to assess NR4A1 expression and insulin secretion.
Results: Increased expression of NR4A1 associated with decreased insulin secretion in islets (humans: controls 9 ± 0.2, CP 3.7 ± 0.2, mice: controls 8.5 ± 0.2, CP 2.1 ± 0.1 μg/L). NR4A1OE in MIN6 cells (13.2 ± 0.1) showed reduction in insulin secretion (13 ± 5 to 0.2 ± 0.1 μg/mg protein per minute, P = 0.001) and downregulation of calcium and cAMP signaling pathways. IFN-γ was identified as upstream signal for NR4A1OE in MIN6. Mice treated with IFN-γ-neutralizing antibodies showed decreased NR4A1 expression 3.4 ± 0.11-fold ( P = 0.03), showed improved insulin secretion (4.4 ± 0.2-fold, P = 0.01), and associated with increased Ca 2+ levels (2.39 ± 0.06-fold, P = 0.009).
Conclusions: Modulating NR4A1 expression can be a promising therapeutic strategy to improve insulin secretion in CP.
{"title":"Modulation of Nuclear Receptor 4A1 Expression Improves Insulin Secretion in a Mouse Model of Chronic Pancreatitis.","authors":"Galande Sheethal, Archana Verma, Raghvendra Mall, Kishore Vl Parsa, Ranjeet K Tokala, Ratnakar Bynigeri, Pavan Kumar Pondugala, Krishna Vemula, S Sai Latha, Divya Tej Sowpati, Surya S Singh, G V Rao, Rupjyoti Talukdar, Thirumala-Devi Kanneganti, D Nageshwar Reddy, Mitnala Sasikala","doi":"10.1097/MPA.0000000000002370","DOIUrl":"10.1097/MPA.0000000000002370","url":null,"abstract":"<p><strong>Objectives: </strong>Diabetes secondary to chronic pancreatitis (CP) presents clinical challenges due to lack of understanding on factor(s) triggering insulin secretory defects. Therefore, we aimed to delineate the molecular mechanism of β-cell dysfunction in CP.</p><p><strong>Materials and methods: </strong>Transcriptomic analysis was conducted to identify endocrine-specific receptor expression in mice and human CP on microarray. The identified receptor (NR4A1) was overexpressed in MIN6 cells using PEI linear transfection. RNA-Seq analysis of NR4A1-overexpressed (OE) MIN6 cells on NovaSeq6000 identified aberrant metabolic pathways. Upstream trigger for NR4A1OE was studied by InBio Discover and cytokine exposure, whereas downstream effect was examined by Fura2 AM-based fluorimetric and imaging studies. Mice with CP were treated with IFN-γ-neutralizing monoclonal antibodies to assess NR4A1 expression and insulin secretion.</p><p><strong>Results: </strong>Increased expression of NR4A1 associated with decreased insulin secretion in islets (humans: controls 9 ± 0.2, CP 3.7 ± 0.2, mice: controls 8.5 ± 0.2, CP 2.1 ± 0.1 μg/L). NR4A1OE in MIN6 cells (13.2 ± 0.1) showed reduction in insulin secretion (13 ± 5 to 0.2 ± 0.1 μg/mg protein per minute, P = 0.001) and downregulation of calcium and cAMP signaling pathways. IFN-γ was identified as upstream signal for NR4A1OE in MIN6. Mice treated with IFN-γ-neutralizing antibodies showed decreased NR4A1 expression 3.4 ± 0.11-fold ( P = 0.03), showed improved insulin secretion (4.4 ± 0.2-fold, P = 0.01), and associated with increased Ca 2+ levels (2.39 ± 0.06-fold, P = 0.009).</p><p><strong>Conclusions: </strong>Modulating NR4A1 expression can be a promising therapeutic strategy to improve insulin secretion in CP.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Pancreatic cancer and Prediabetes pose significant public health challenges. Given the lack of strong evidence and inconsistencies, we performed a meta-analysis to assess the risk of pancreatic cancer in prediabetes.
Methods: We performed a thorough search of the major databases over the last 10 years to identify relevant articles. The Pooled odds ratio(OR) and Hazard Ratio(HR) were combined to calculate the effect size(ES).
Results: We analyzed 5 studies including 5,425,111 prediabetic individuals and 16,096,467 normoglycemic population across five countries with a median follow-up of 8.5 years. We identified a noteworthy association between prediabetes and pancreatic cancer, reporting an unadjusted effect size (ES) of 1.36 (95% CI 1.05-1.77, P = 0.02) and an adjusted ES of 1.40 (1.23-1.59, P < 0.01). Subgroup analyses by age revealed variations in risk, with studies involving participants aged 60 and above exhibiting a higher effect size (ES 1.83, 95% CI 1.28-2.62, P < 0.01). Geographical differences were also observed, with Japanese studies reporting a higher risk (ES 1.89, 95% CI 1.15-3.10, P < 0.01) compared to those from the USA (ES 1.32, 95% CI 1.13-1.53, P < 0.01).
Conclusion: We identified 40% higher risk of pancreatic cancer in patients with prediabetes than those with normal blood glucose necessitating urgent attention for further research and policy change.
目标：胰腺癌和糖尿病前期对公共健康构成重大挑战。鉴于缺乏有力证据且存在不一致之处，我们进行了一项荟萃分析，以评估糖尿病前期患者胰腺癌的风险：我们对过去 10 年中的主要数据库进行了全面搜索，以确定相关文章。结果：我们分析了包括5,000名糖尿病前期患者在内的5项研究：我们分析了 5 项研究，其中包括 5,425,111 名糖尿病前期患者和 16,096,467 名血糖正常者，这些研究分布在 5 个国家，中位随访时间为 8.5 年。我们发现糖尿病前期与胰腺癌之间存在显著关联，未经调整的效应大小 (ES) 为 1.36 (95% CI 1.05-1.77, P = 0.02)，调整后的效应大小 (ES) 为 1.40 (1.23-1.59, P < 0.01)。按年龄进行的分组分析显示风险存在差异，涉及 60 岁及以上参与者的研究显示出更高的效应大小（ES 1.83，95% CI 1.28-2.62，P <0.01）。我们还观察到了地域差异，日本的研究报告与美国的研究报告（ES 1.32，95% CI 1.13-1.53，P <0.01）相比，风险更高（ES 1.89，95% CI 1.15-3.10，P <0.01）：我们发现，糖尿病前期患者罹患胰腺癌的风险比血糖正常者高出 40%，因此急需进一步研究和改变政策。
{"title":"Pancreatic Cancer Risk in Prediabetes: A Systematic Meta-Analysis Approach.","authors":"Akhil Jain, Praneeth Reddy Keesari, Yashwitha Sai Pulakurthi, Rewanth Katamreddy, Meekoo Dhar, Rupak Desai","doi":"10.1097/MPA.0000000000002391","DOIUrl":"https://doi.org/10.1097/MPA.0000000000002391","url":null,"abstract":"<p><strong>Objectives: </strong>Pancreatic cancer and Prediabetes pose significant public health challenges. Given the lack of strong evidence and inconsistencies, we performed a meta-analysis to assess the risk of pancreatic cancer in prediabetes.</p><p><strong>Methods: </strong>We performed a thorough search of the major databases over the last 10 years to identify relevant articles. The Pooled odds ratio(OR) and Hazard Ratio(HR) were combined to calculate the effect size(ES).</p><p><strong>Results: </strong>We analyzed 5 studies including 5,425,111 prediabetic individuals and 16,096,467 normoglycemic population across five countries with a median follow-up of 8.5 years. We identified a noteworthy association between prediabetes and pancreatic cancer, reporting an unadjusted effect size (ES) of 1.36 (95% CI 1.05-1.77, P = 0.02) and an adjusted ES of 1.40 (1.23-1.59, P < 0.01). Subgroup analyses by age revealed variations in risk, with studies involving participants aged 60 and above exhibiting a higher effect size (ES 1.83, 95% CI 1.28-2.62, P < 0.01). Geographical differences were also observed, with Japanese studies reporting a higher risk (ES 1.89, 95% CI 1.15-3.10, P < 0.01) compared to those from the USA (ES 1.32, 95% CI 1.13-1.53, P < 0.01).</p><p><strong>Conclusion: </strong>We identified 40% higher risk of pancreatic cancer in patients with prediabetes than those with normal blood glucose necessitating urgent attention for further research and policy change.</p>","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1097/mpa.0000000000002389
Savannah R Smith,Juan M Sarmiento
BACKGROUNDSmall mucinous cystic neoplasms (MCN) of the pancreas are managed with operative resection in otherwise healthy patients; however, postoperative diabetes development is not considered in recommendations for resection.METHODSVia probabilistic microsimulation Markov modeling, we assessed clinical and economic implications of laparoscopic distal pancreatectomy (LDP) versus surveillance for non-DM patients with suspected MCN of 2 cm without high-risk or worrisome features. Primary outcomes included quality-adjusted life years (QALYs), medical costs (2021 USD), and incremental cost-effectiveness ratios (ICERs). We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters. All analyses were repeated for a population with pre-DM.RESULTSSurveillance resulted in 6.52 QALYs and $61,200, while LDP accumulated 6.12 QALYs and $63,700. Almost 20% of the LDP cohort developed DM over the first 10 years, compared to 11% of the surveillance cohort. In a pre-DM cohort, LDP remained Dominated in the base case, with over 40% developing DM postoperatively. In sensitivity analyses, surveillance remained the preferred strategy in most iterations for both cohorts.CONCLUSIONSSurveillance for small suspected MCNs without high-risk features is the preferred strategy from a clinical and economic standpoint. Consensus guidelines should consider the long-term implications of postoperative diabetes development following LDP.
{"title":"Cost-effectiveness of operative intervention for mucinous cystic neoplasm: the role of post-operative diabetes.","authors":"Savannah R Smith,Juan M Sarmiento","doi":"10.1097/mpa.0000000000002389","DOIUrl":"https://doi.org/10.1097/mpa.0000000000002389","url":null,"abstract":"BACKGROUNDSmall mucinous cystic neoplasms (MCN) of the pancreas are managed with operative resection in otherwise healthy patients; however, postoperative diabetes development is not considered in recommendations for resection.METHODSVia probabilistic microsimulation Markov modeling, we assessed clinical and economic implications of laparoscopic distal pancreatectomy (LDP) versus surveillance for non-DM patients with suspected MCN of 2 cm without high-risk or worrisome features. Primary outcomes included quality-adjusted life years (QALYs), medical costs (2021 USD), and incremental cost-effectiveness ratios (ICERs). We conducted sensitivity analyses to evaluate the robustness of our model to changes in input parameters. All analyses were repeated for a population with pre-DM.RESULTSSurveillance resulted in 6.52 QALYs and $61,200, while LDP accumulated 6.12 QALYs and $63,700. Almost 20% of the LDP cohort developed DM over the first 10 years, compared to 11% of the surveillance cohort. In a pre-DM cohort, LDP remained Dominated in the base case, with over 40% developing DM postoperatively. In sensitivity analyses, surveillance remained the preferred strategy in most iterations for both cohorts.CONCLUSIONSSurveillance for small suspected MCNs without high-risk features is the preferred strategy from a clinical and economic standpoint. Consensus guidelines should consider the long-term implications of postoperative diabetes development following LDP.","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-12DOI: 10.1097/mpa.0000000000002390
Gretchen A Cress,Karen T Scudiero,Fuchenchu Wang,Vanessa B Patrick,Phoebe M Wood,Ying Yuan,Mark E Lowe,Aliye Uc,
OBJECTIVESThe aim of this study was to determine patient reported burdensome experiences and research interests in children with acute recurrent pancreatitis or chronic pancreatitis and their families.METHODSChildren with pancreatitis and their families completed a web-based survey. Subject prioritized rankings of symptoms or quality of life issues and topics for future research were assessed. Data are presented as family and children scores.RESULTSAmong 80 participants, 18 were children with pancreatitis and 62 were family members. Top 5 ranked symptoms or quality of life issues were:1) pain, 2) fatigue, 3) missing school, 4) upset stomach, and 5) not knowing when an attack will occur. Top 5 ranked future research topics were:1) how to prevent a pancreatitis attack, 2) how pancreatitis affects other parts of the body, 3) ways to treat or handle pain, 4) what is the cause of pancreatitis, and 5) teach doctors about pancreatitis.CONCLUSIONSThis study highlights the importance of patient and family input in caring for children with pancreatitis. The most bothersome symptoms were pain, fatigue and upset stomach. Children with pancreatitis and families would like future research to primarily focus on prevention of pancreatitis attacks, pain therapy, and complications of pancreatitis.
{"title":"PATIENT AND FAMILY INPUT TO DETERMINE EXPERIENCES AND RESEARCH INTERESTS IN PEDIATRIC PANCREATITIS: AN INSPPIRE-2 STUDY.","authors":"Gretchen A Cress,Karen T Scudiero,Fuchenchu Wang,Vanessa B Patrick,Phoebe M Wood,Ying Yuan,Mark E Lowe,Aliye Uc,","doi":"10.1097/mpa.0000000000002390","DOIUrl":"https://doi.org/10.1097/mpa.0000000000002390","url":null,"abstract":"OBJECTIVESThe aim of this study was to determine patient reported burdensome experiences and research interests in children with acute recurrent pancreatitis or chronic pancreatitis and their families.METHODSChildren with pancreatitis and their families completed a web-based survey. Subject prioritized rankings of symptoms or quality of life issues and topics for future research were assessed. Data are presented as family and children scores.RESULTSAmong 80 participants, 18 were children with pancreatitis and 62 were family members. Top 5 ranked symptoms or quality of life issues were:1) pain, 2) fatigue, 3) missing school, 4) upset stomach, and 5) not knowing when an attack will occur. Top 5 ranked future research topics were:1) how to prevent a pancreatitis attack, 2) how pancreatitis affects other parts of the body, 3) ways to treat or handle pain, 4) what is the cause of pancreatitis, and 5) teach doctors about pancreatitis.CONCLUSIONSThis study highlights the importance of patient and family input in caring for children with pancreatitis. The most bothersome symptoms were pain, fatigue and upset stomach. Children with pancreatitis and families would like future research to primarily focus on prevention of pancreatitis attacks, pain therapy, and complications of pancreatitis.","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVESEndoscopic pancreatic stenting (EPS) is an effective treatment modality for painful chronic pancreatitis. However, little is known about the factors that cause pain recurrence after stent removal, and there are no clear criteria for stent removal. We aimed to develop a prediction model for pain recurrence by identifying its risk factors.METHODSWe retrospectively reviewed 95 patients who underwent EPS due to pain for the first time using a single plastic stent between January 2007 and July 2022 at our institute. Univariate and multivariate stepwise Cox proportional hazards models were used to identify the risk factors for pain recurrence, and a prediction model was developed based on the identified factors.RESULTSOf the 95 enrolled patients, 89 (93.7%) achieved pain relief and 73 (76.8%) did stent removal. Of the 69 patients with a follow-up period ≥6 months after stent removal, 29 (42.0%) had pain recurrence during the median follow-up period of 59 months. Serum lipase level (p = 0.034) and pancreatic parenchymal thickness (p = 0.022) on computed tomography or magnetic resonance imaging were identified as independent risk factors for pain recurrence. The prediction model based on the identified factors had good discrimination ability, with a concordance index of 0.74, and could stratify pain recurrence rates.CONCLUSIONSWe identified the risk factors and developed a new prediction model for pain recurrence following stent removal. This model might be useful for decision-making in pancreatic stent management, such as deciding whether to remove a pancreatic stent, continue EPS, or convert to surgery.
{"title":"Risk factors and a prediction model for pain recurrence after pancreatic stent removal in painful chronic pancreatitis.","authors":"Tetsuya Takikawa,Kiyoshi Kume,Yu Tanaka,Kazuhiro Kikuta,Yohei Ogata,Waku Hatta,Shin Hamada,Shin Miura,Ryotaro Matsumoto,Takanori Sano,Akira Sasaki,Hidehiro Hayashi,Misako Sakano,Tomoo Manaka,Atsushi Masamune","doi":"10.1097/mpa.0000000000002392","DOIUrl":"https://doi.org/10.1097/mpa.0000000000002392","url":null,"abstract":"OBJECTIVESEndoscopic pancreatic stenting (EPS) is an effective treatment modality for painful chronic pancreatitis. However, little is known about the factors that cause pain recurrence after stent removal, and there are no clear criteria for stent removal. We aimed to develop a prediction model for pain recurrence by identifying its risk factors.METHODSWe retrospectively reviewed 95 patients who underwent EPS due to pain for the first time using a single plastic stent between January 2007 and July 2022 at our institute. Univariate and multivariate stepwise Cox proportional hazards models were used to identify the risk factors for pain recurrence, and a prediction model was developed based on the identified factors.RESULTSOf the 95 enrolled patients, 89 (93.7%) achieved pain relief and 73 (76.8%) did stent removal. Of the 69 patients with a follow-up period ≥6 months after stent removal, 29 (42.0%) had pain recurrence during the median follow-up period of 59 months. Serum lipase level (p = 0.034) and pancreatic parenchymal thickness (p = 0.022) on computed tomography or magnetic resonance imaging were identified as independent risk factors for pain recurrence. The prediction model based on the identified factors had good discrimination ability, with a concordance index of 0.74, and could stratify pain recurrence rates.CONCLUSIONSWe identified the risk factors and developed a new prediction model for pain recurrence following stent removal. This model might be useful for decision-making in pancreatic stent management, such as deciding whether to remove a pancreatic stent, continue EPS, or convert to surgery.","PeriodicalId":19733,"journal":{"name":"Pancreas","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142178531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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