Survival analysis of veteran patients with pancreatic cancer

Opioid burden in patients with inoperable pancreatic adenocarcinoma and the development of a multivariable risk prediction model for opioid use: A retrospective cohort study

INTRODUCTION

Risk prediction models to guide patient selection for early pre-emptive endoscopic ultrasound guided coeliac plexus neurolysis are lacking. This study aimed to determine in patients with inoperable pancreatic cancer: (1) opioid burden, (2) the relationship between opioid use and all-cause mortality, (3) risk factors for opioid use, and (4) develop and internally validate a risk prediction model for opioid use at three months.

METHODS

This was a single-centre retrospective cohort study of patients with confirmed pancreatic cancer. Cox proportional hazard regression estimated the association between opioid use at baseline and all-cause mortality. Logistic regression estimated the associations between clinical and radiological variables with opioid use by three months. Two risk prediction models were developed for opioid use (clinical and clinical-radiological). Model discrimination and calibration was assessed.

RESULTS

In total, 383 patients with inoperable pancreatic cancer were included. Prevalence of pain ranged between 37% and 47% at three monthly intervals in the first year of diagnosis. Opioid use at baseline was associated with poorer survival. Age, pain at presentation, performance status, tumour distance from the right ganglion, the anterior-posterior and the latero-lateral tumour dimensions were independent risk factors for the opioid use at three months. The Area Under Curve (AUC) for the clinical and clinical-radiological models was 0.81 and 0.84, respectively. Models were well calibrated.

CONCLUSIONS

Opioid use is prevalent in patients with pancreatic cancer, associated with poor prognosis, and can be predicted based on clinical and radiological variables. External validation of this predictive model is required.

The N6-Methyladenosine- (m6A-) Associated Genes Act as Strong Key Biomarkers for the Prognosis of Pancreatic Adenocarcinoma

BACKGROUND

Pancreatic adenocarcinoma (PAAD) has become the major cause of cancer-related deaths globally. The m6A (N6-methyladenosine) alteration plays a crucial function in carcinogenesis and tumor progression. The role of genes related to m6A and their expression level in pancreatic cancer is not identified yet. The objective of this research analysis is a demonstration of the m6A RNA methylation regulators based as biomarkers for the PAAD diagnosis.

METHODS

About 23 extensively reported m6A RNA methylation regulators were identified through the Cancer Genome Atlas (TCGA) database. This identification was based on consensus clustering analysis, protein-protein integration (PPI) analysis, risk prognostic model, Cox-regression analysis, String Spearman analysis, and LASSO Cox-regression.

RESULTS

Herein, we conclude that 23 m6A methylation regulators have a strong link with the clinical and molecular characteristics of PAAD. The three subgroups (1/2) of pancreatic adenocarcinoma were identified using the clustering of 23 m6A regulators. Subgroup cluster 2 had a lower survival rate than the subgroup of cluster 1, and the difference in grades between the two groups was substantial. An assessment was performed using the 23 reported m6A methylation regulators. Eight of these can be used as independent PAAD prognostic markers. The consequences of variable IGF2BP3 expression in PAAD were then investigated further.

CONCLUSIONS

The key finding of this study was that the m6A methylation regulator gene has the main role in pancreatic tumors, and it may be used as a biomarker in the prognosis of the PAAD and for therapy purposes.

Current controversies and advances in the management of pancreatic adenocarcinoma

Pancreatic adenocarcinoma is a lethal disease with a mortality rate that has not significantly improved over decades. This is likely due to several challenges unique to pancreatic cancer. Most patients with pancreatic cancer are diagnosed at a late stage of disease due to the lack of specific symptoms prompting an early investigation. A small subset of patients who are diagnosed at an early stage have a better chance at survival with curative surgical resection, but most patients still succumb to the disease in a few years. The dismal overall prognosis is due to suspected micro-metastasis at an early stage. Due to this reason, there is a recent interest in treating all patients with pancreatic cancers with systemic therapy upfront (including the ones that are surgically resectable). This approach is still not the standard of care due to the lack of robust prospective data available. Recent advancements in treatment regimens of chemotherapy, radiation and immunotherapy have improved the overall short-term survival but the long-term survival still remains poor. Novel approaches in diagnosis and treatment have shown promise in clinical studies but long-term clinical data is lacking. The following manuscript presents an overview of the epidemiology, diagnosis, staging, recent advances, novel approaches and controversies in the management of pancreatic adenocarcinoma.

Potential mechanism of ferroptosis in pancreatic cancer

Despite the incidence rates of pancreatic cancer being low worldwide, the mortality rates remain high. To date, there is no effective drug treatment for pancreatic cancer. Numerous signalling pathways and cytokines regulate the occurrence and development of pancreatic cancer. Ferroptosis is a non-traditional form of cell death resulting from iron-dependent lipid peroxide accumulation. Studies have demonstrated that ferroptosis is associated with a variety of different types of cancer, such as breast cancer, hepatocellular carcinoma and pancreatic cancer. The present study demonstrated that ferroptosis controls the growth and proliferation of pancreatic cancer, providing a new approach for the treatment of pancreatic cancer. Iron metabolism and reactive oxygen species metabolism are the key pathways involved in ferroptosis in pancreatic cancer. In addition, a number of regulators of ferroptosis, such as glutathione peroxidase 4 and the cystine/glutamate antiporter system Xc-, also play pivotal roles in the regulation of ferroptosis. In the present review, the regulatory mechanisms associated with ferroptosis in pancreatic cancer are summarized, alongside other associated forms of digestive system cancer. The treatment of ferroptosis-based diseases is also addressed.

Actual long-term outcome of T1 and T2 pancreatic ductal adenocarcinoma after surgical resection

BACKGROUND

The prognosis for patients with pancreatic cancer is extremely poor. The diagnosis of pancreatic ductal adenocarcinoma at an early stage is uncommon. The purpose of this study was to analyze the clinicopathological characteristics of patients with pathologically proven pancreatic ductal adenocarcinoma following surgical resection and their actual 5 year survival rates, especially for those with T1 and T2 early stage cancer.

METHODS

Retrospective analysis was performed for 433 patients with pancreatic ductal adenocarcinoma who underwent resection at Samsung medical center between May 1995 and December 2010. The actual 5 year survival rates and prognostic factors were analyzed.

RESULTS

Multivariate analysis showed that positive resection margin, poor differentiation, large tumor size, large amount of blood loss, and T3/T4 were independent prognostic factors on overall survival. The median survival for T1/T2 stage was 71.7 months compared to 16.1 months for those with T3/T4 stage. The actual 5 year survival rates for T1/T2 and T3/T4 stages were 66.7% and 18.4%, respectively.

CONCLUSIONS

T stage is one of the strongest independent prognostic factor for overall survival of patients with pancreatic cancer. T1/T2 pancreatic ductal adenocarcinoma showed good survival outcome. Therefore, additional efforts are needed to improve the screening for early detection.

High expression of GFAT1 predicts poor prognosis in patients with pancreatic cancer

Pancreatic cancer is one of the most lethal of all types of cancer, with the 5-year survival rate ranging only at 6–7%. The aberrant glucose metabolism is one of the hallmarks of cancer cells, and as a branch of glucose metabolism, hexosamine biosynthesis pathway (HBP) has been reported to play a critical role in the insulin resistance and progression of cancer. Glutamine:fructose-6-phosphate amidotransferase (GFAT1) is the rate-limiting enzyme of the HBP; nevertheless, the prognostic value of GFAT1 in pancreatic cancer remains elusive. In this study, we found that the expression of GFAT1 was increased in pancreatic cancer samples compared to peri-tumor tissues. High expression of GFAT1 was positively associated with lymph node metastasis, pTNM stage and shorter overall survival (OS) in pancreatic cancer patients. GFAT1 was identified as an independent prognosticator for OS, and combining GFAT1 expression with pTNM stage generated a predictive nomogram, which showed better prognostic efficiency for OS in patients with pancreatic cancer. In summary, high GFAT1 expression is identified as an independent predictor of adverse clinical outcome in our small number of pancreatic cancer patients, and the practical prognostic nomogram model may help clinicians in decision making and the design of clinical studies.