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Rustgi SD, Shah SC. Reply. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00291-X. [PMID: 38548143 DOI: 10.1016/j.cgh.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Sheila D Rustgi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California
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Rustgi SD, McKinley M, McBay B, Zylberberg HM, Gomez SL, Hur C, Kastrinos F, Gupta S, Kim MK, Itzkowitz SH, Shah SC. Epidemiology of Gastric Malignancies 2000-2018 According to Histology: A Population-Based Analysis of Incidence and Temporal Trends. Clin Gastroenterol Hepatol 2023; 21:3285-3295.e8. [PMID: 36792000 PMCID: PMC10809276 DOI: 10.1016/j.cgh.2023.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND & AIMS Gastric cancer (GC) remains a leading cause of cancer and cancer-related mortality. Recent reports suggest noncardia GC is increasing in certain U.S. POPULATIONS However, whether these trends are driven by gastric adenocarcinoma (GA) or other histologies, including neuroendocrine tumors (NETs), lymphoma, or gastrointestinal stromal tumors (GISTs), is unclear. METHODS We analyzed the Surveillance, Epidemiology and End Results-18 cancer registry (2000-2018) to determine age-standardized incidence rates (ASIR) and annual percentage change (APC) trends for histologically-confirmed GCs, stratified by anatomic location (noncardia vs cardia), age group (20-49 vs 50+ years), sex, race, and ethnicity. Joinpoint regression modeling estimated the statistical significance of trend comparisons. RESULTS Of 74,520 individuals with noncardia GC, most (66.2%) were GA, with the next largest categories being non-mucosa-associated lymphoid tissue (non-MALT) lymphomas (6.9%), GIST (6.7%), NET (6.4%), and MALT lymphoma (5.6%). Noncardia GA ASIR was significantly higher than other histologies and demonstrated the greatest differences by race and ethnicity. APCs for GA and MALT, both Helicobacter pylori-associated cancers, declined significantly over time, which was driven primarily by trends among individuals ≥50 years-old. NET and GIST APCs significantly increased irrespective of age group, with the highest APCs observed among non-Hispanic white individuals. Cardia GC was rarer than noncardia GC and comprised primarily by GA (87.9%). Cardia GC incidence fell during the study period, which was primarily driven by decline in cardia GA. CONCLUSIONS GA was the most common histology. On the basis of our findings, the rise in noncardia GC among certain U.S. populations appears predominantly driven by NET and GIST, not GA. Further studies are needed to clarify underlying etiologies for these findings.
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Affiliation(s)
- Sheila D Rustgi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Brandon McBay
- Department of Public Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Haley M Zylberberg
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Chin Hur
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Samir Gupta
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Michelle Kang Kim
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven H Itzkowitz
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California, San Diego, San Diego, California.
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Rustgi SD, Zylberberg HM, Hur C, Shah SC. Management of Gastric Intestinal Metaplasia. Clin Gastroenterol Hepatol 2023; 21:2178-2182. [PMID: 37086748 PMCID: PMC10526696 DOI: 10.1016/j.cgh.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Sheila D Rustgi
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York; Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
| | - Haley M Zylberberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York; Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York; Department of Medicine, Vagelos College of Physicians and Surgeons, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, University of California San Diego, San Diego, California
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Rustgi SD, Kastrinos F. Screening for Lynch Syndrome: Optimal Strategies and Performance Remain a Moving Target. Am J Gastroenterol 2023; 118:259-260. [PMID: 36735557 PMCID: PMC9907004 DOI: 10.14309/ajg.0000000000002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Sheila D Rustgi
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Fay Kastrinos
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer and the Vagelos College of Physicians and Surgeons, New York, New York, USA
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Stillman MD, Kusche N, Toledano S, Hilfrank KJ, Yoon C, Gabre JT, Rustgi SD, Hur C, Kastrinos F, Ryeom SW, Yoon SS. Short and long-term outcomes of prophylactic total gastrectomy in 54 consecutive individuals with germline pathogenic mutations in the CDH1 gene. J Surg Oncol 2022; 126:1413-1422. [PMID: 36063148 PMCID: PMC9649870 DOI: 10.1002/jso.27084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Germline mutation of CDH1 is rare and leads to hereditary diffuse gastric cancer (DGC). METHODS Patients (pts) with CDH1 mutation who underwent multidisciplinary counseling followed by open prophylactic total gastrectomy (PTG) by a single surgeon were reviewed. RESULTS Fifty-four pts with a median age of 41 years (16-70 years) underwent PTG between 2006 and 2021. Median operative time was 161 min, and median hospital stay was 7 days (range 6-12). There were 5 complications (9.2%) within 30 days, and two complications (pulmonary embolism and pancreatitis) required readmission. There were no anastomotic leaks. The pathologic analysis of the first 10 pts included the entire gastric mucosa, revealing a median of 15 foci of DGC (range 5-136). The subsequent 44 pts with more limited analysis had a median of 2 foci (range 0-5), and two pts (3.7%) had no foci identified. Median maximum weight loss was 19%. In long-term follow-up (median 4.6 years) of 20 pts, median global QOL was 2.0 (very good), the majority had persistent difficulty with certain foods or liquids, and all stated they would again elect PTG over surveillance endoscopy. CONCLUSIONS PTG can be performed safely at high-volume referral centers with very good QOL but nutritional sequelae persist.
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Affiliation(s)
- Mason D. Stillman
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole Kusche
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Sabrina Toledano
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kimberly J. Hilfrank
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Changhwan Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Joel T. Gabre
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Sheila D. Rustgi
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Chin Hur
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Sandra W. Ryeom
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Sam S. Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
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Oh A, Truong H, Kim J, Rustgi SD, Abrams JA, Hur C. Cost-effectiveness of screening with polymerase chain reaction for Helicobacter pylori to prevent gastric cancer and peptic ulcers. J Gastrointest Oncol 2022; 13:2186-2196. [PMID: 36388653 PMCID: PMC9660075 DOI: 10.21037/jgo-21-911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 06/16/2022] [Indexed: 01/21/2023] Open
Abstract
Background Helicobacter pylori (H. pylori) is a major risk factor for gastric cancer. Screening and treatment of H. pylori may reduce the risk of gastric cancer and peptic ulcer disease (PUD). Polymerase chain reaction (PCR) of gastric biopsies provides superior sensitivity and specificity for the detection of H. pylori. This study explores whether population-based H. pylori screening with PCR is cost-effective in the US. Methods A Markov cohort state-transition model was developed to compare three strategies: no screening with opportunistic eradication, 13C-UBT population screening and treating of H. pylori, and PCR population screening and treating of H. pylori. Estimates of risks and costs were obtained from published literature. Since the efficacy of H. pylori therapy in gastric cancer prevention is not certain, we broadly varied the benefit 30-100% in sensitivity analysis. Results PCR screening was cost-effective and had an incremental-cost effectiveness ratio per quality adjusted life-year (QALY) of $38,591.89 when compared to 13C-UBT strategy with an ICER of $2,373.43 per QALY. When compared to no screening, PCR population screening reduced cumulative gastric cancer incidence from 0.84% to 0.74% and reduced PUD risk from 14.8% to 6.0%. The cost-effectiveness of PCR screening was robust to most parameters in the model. Conclusions Our modeling study finds PCR screening and treating of H. pylori to be cost-effective in the prevention of gastric cancer and PUD. However, the potential negative consequences of H. pylori eradication such as antibiotic resistance could change the balance of benefits of population screening.
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Affiliation(s)
- Aaron Oh
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Judith Kim
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Sheila D. Rustgi
- Department of Medicine, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Julian A. Abrams
- Department of Medicine, New York Presbyterian, Columbia University Medical Center, New York, NY, USA;,Herbert Irving Columbia Cancer Center, New York, NY, USA
| | - Chin Hur
- Department of Medicine, New York Presbyterian, Columbia University Medical Center, New York, NY, USA;,Herbert Irving Columbia Cancer Center, New York, NY, USA
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Rustgi SD, Zylberberg HM, Hur C. Databases for Gastrointestinal Clinical and Public Health Research: Have Database, Will Research. Gastroenterology 2022; 163:31-34. [PMID: 35489433 DOI: 10.1053/j.gastro.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Sheila D Rustgi
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York; Vagelos College of Physicians and Surgeons, New York, New York
| | - Haley M Zylberberg
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York
| | - Chin Hur
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Cancer, New York, New York; Vagelos College of Physicians and Surgeons, New York, New York.
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Zylberberg HM, Woodrell C, Rustgi SD, Aronson A, Kessel E, Amin S, Lucas AL. Opioid Prescription Is Associated With Increased Survival in Older Adult Patients With Pancreatic Cancer in the United States: A Propensity Score Analysis. JCO Oncol Pract 2022; 18:e659-e668. [PMID: 34990289 DOI: 10.1200/op.21.00488] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/12/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Few studies have assessed the interaction between pain treatment and mortality in pancreatic cancer. The aim of this study was to investigate the association between receipt of opioid prescriptions and survival in adults with pancreatic cancer. METHODS The SEER-Medicare linked database was used to identify patients diagnosed with late-stage pancreatic cancer between 2007 and 2015. Kaplan-Meier models were used to assess the association between opioid prescriptions in the year after cancer diagnosis and survival. Cox proportional hazard models were used to determine the association between opioid receipt and survival, adjusting for propensity score and other relevant confounders including cancer-directed therapies and palliative care referral. RESULTS A total of 5,770 older adults with pancreatic cancer were identified; 1,678 (29.1%) were prescribed opioids for at least 60 days. Median survival was increased in those with opioid prescriptions (6.0 months) compared with those without (4.0 months, P < .0001). After adjustment for confounders, opioid prescriptions were still associated with improved survival (hazard ratio 0.80; 95% CI, 0.75 to 0.86). On multivariable analysis, opioid prescriptions were associated with older age, female sex, residing in nonmetro areas, and treatment with celiac plexus neurolysis, chemotherapy, and radiation. CONCLUSION Receipt of opioid prescriptions is associated with longer survival in patients with pancreatic cancer. This may be due to the impact of cancer-related pain, although further studies are needed to better understand the interaction between pain management, cancer-directed therapies, and systemic factors, such as palliative care, availability of opioids, and clinical practice culture.
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Affiliation(s)
- Haley M Zylberberg
- Division of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher Woodrell
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
- Geriatric Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Sheila D Rustgi
- Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Anne Aronson
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth Kessel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil Amin
- Division of Gastroenterology, University of Miami Leonard Miller School of Medicine, Miami, FL
| | - Aimee L Lucas
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
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Zylberberg HM, Nagula S, Rustgi SD, Aronson A, Kessel E, Kumta NA, DiMaio CJ, Lucas AL. Celiac Plexus Neurolysis Is Associated With Decreased Survival in Patients With Pancreatic Cancer: A Propensity Score Analysis. Pancreas 2022; 51:153-158. [PMID: 35404890 DOI: 10.1097/mpa.0000000000001992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate survival in patients who received celiac plexus neurolysis (CPN) compared with patients who received opioids. METHODS The Surveillance, Epidemiology and End Results-Medicare database was used to identify patients older than 65 years diagnosed with pancreatic cancer between 2007 and 2015. We used claims data to identify patients with a history of CPN and opioid use within 1 year of diagnosis, and other demographic, clinical, and treatment variables. Kaplan-Meier analyses and inverse propensity-weighted adjusted Cox proportional hazard ratios were used to evaluate survival. RESULTS We identified 648 patients who underwent CPN (19.0%) compared with 2769 patients who received opioids (81.0%). The median survival and interquartile range for patients who received CPN was 4.0 months (2.0-8.0 months) compared with 7.0 months (3.0-12.0 months) for opioid users (P < 0.0001). After adjusting for confounders and propensity score, the patients who received CPN showed worsened survival (hazard ratio, 1.69; 95% confidence interval, 1.59-1.79). CONCLUSIONS Pancreatic cancer patients who underwent CPN had decreased survival compared with opioid users. This suggests that opioid sparing methods to reduce pancreatic cancer pain may actually be harmful. Future prospective studies should investigate whether other opioid sparing therapies impact pancreatic cancer survival.
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Affiliation(s)
| | - Satish Nagula
- Gastroenterology, Icahn School of Medicine at Mount Sinai
| | - Sheila D Rustgi
- Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York, NY
| | - Anne Aronson
- Gastroenterology, Icahn School of Medicine at Mount Sinai
| | | | - Nikhil A Kumta
- Gastroenterology, Icahn School of Medicine at Mount Sinai
| | | | - Aimee L Lucas
- Gastroenterology, Icahn School of Medicine at Mount Sinai
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Rustgi SD, Zylberberg HM, Amin S, Aronson A, Nagula S, DiMaio CJ, Kumta NA, Lucas AL. Use of endoscopic ultrasound for pancreatic cancer from 2000 to 2016. Endosc Int Open 2022; 10:E19-E29. [PMID: 35047331 PMCID: PMC8759943 DOI: 10.1055/a-1608-0856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Pancreatic cancer (PC) is the fourth most common cause of cancer death in the United States. Previous studies have suggested a survival benefit for endoscopic ultrasound (EUS), an important tool for diagnosis and staging of PC. This study aims to describe EUS use over time and identify factors associated with EUS use and its impact on survival. Patients and methods This was a retrospective review of the Surveillance, Epidemiology and End Results (SEER) database linked with Medicare claims. EUS use, clinical and demographic characteristics were evaluated. Chi-squared analysis, Cochran-Armitage test for trend, and logistic regression were used to identify associations between sociodemographic and clinical factors and EUS. Kaplan-Meier and Cox proportional hazard ratios were used for survival analysis. Results EUS use rose during the time period, from 7.4 % of patients in 2000 to 32.4 % in 2015. Patient diversity increased, with a rising share of older, non-White patients with higher Charlson comorbidity scores. Both clinical (receipt of other therapies, PC stage) and nonclinical factors (region of country, year of diagnosis) were associated with receipt of EUS. While EUS was associated with a survival improvement early in the study period, this effect did not persist for PC patients diagnosed in 2012 to 2015 (median survival 3 month ± standard deviation [SD] 9.8 months without vs. 4 months ± SD 8 months with EUS). Conclusions Our data support previous studies, which suggest a survival benefit for EUS when it was infrequently used, but finds that benefit was attenuated as EUS became more widely available.
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Affiliation(s)
- Sheila D. Rustgi
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, United States
| | - Haley M. Zylberberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil Amin
- Division of Gastroenterology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, United States
| | - Anne Aronson
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Satish Nagula
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Christopher J. DiMaio
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Nikhil A. Kumta
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Aimee L. Lucas
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY,Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Abstract
Pancreatic cancer (PC) is a highly lethal cancer and projected to be the second leading cause of cancer death by 2030. Multigene panel testing has facilitated the identification of germline variants associated with an increased risk of PC. Precision treatment has led to improved outcomes for patients with these findings. Because of these improved outcomes as well as the implications for at-risk family members who may benefit from additional cancer screening, the NCCN recommends universal genetic testing for newly diagnosed PC patients. This review describes the most common heritable conditions associated with PC and those who may benefit from screening.
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Affiliation(s)
- Sheila D Rustgi
- Division of Digestive & Liver Diseases, Columbia University Irving Medical Center, 630 West 168th Street, Box 83, Room P&S 3-401, New York, NY 10032, USA
| | - Kimberly J Hilfrank
- Division of Digestive & Liver Diseases, Columbia University Irving Medical Center, 630 West 168th Street, Box 83, Room P&S 3-401, New York, NY 10032, USA
| | - Fay Kastrinos
- Division of Digestive & Liver Diseases, Columbia University Irving Medical Center, 630 West 168th Street, Box 83, Room P&S 3-401, New York, NY 10032, USA.
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Rustgi SD, Oh A, Hur C. Testing and Treating Helicobacter pylori Infection in Individuals With Family History of Gastric Cancer is Cost-effective. Gastroenterology 2021; 161:2051-2052.e4. [PMID: 34461053 DOI: 10.1053/j.gastro.2021.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Sheila D Rustgi
- Department of Medicine, Vagelos College of Physician and Surgeons, Columbia University, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Aaron Oh
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Chin Hur
- Department of Medicine, Vagelos College of Physician and Surgeons, Columbia University, New York, New York; Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Healthcare Innovations Research and Evaluation, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
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Rustgi SD, Bijlani P, Shah SC. Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management. Therap Adv Gastroenterol 2021; 14:17562848211038771. [PMID: 34484423 PMCID: PMC8414617 DOI: 10.1177/17562848211038771] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 02/04/2023] Open
Abstract
Autoimmune gastritis (AIG) is a chronic immune-mediated, inflammatory condition that involves the destruction of the gastric oxyntic mucosa through the autoimmune-mediated loss of parietal cells, with replacement by atrophic and metaplastic tissue. Diagnosing AIG is important, given the need for ongoing clinical management and vigilance with respect to downstream complications, the most serious of which is gastric adenocarcinoma. Other clinical consequences include gastric neuroendocrine tumors, consequences related to decreased gastric acid and decreased intrinsic factor due to parietal cell destruction and antibodies against intrinsic factor (e.g. micronutrient deficiencies), as well as concomitant autoimmune disorders. Considering the prevalence of AIG and the potential for severe clinical outcomes, it is important to engage in efforts to reduce practice pattern variability related to diagnosis and management. Accordingly, herein, we review of the epidemiology, pathogenesis, clinical presentation of AIG, including both gastric and extragastric manifestations, and provide an overview of clinical management.
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Affiliation(s)
- Sheila D Rustgi
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Priyesha Bijlani
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Shailja C Shah
- Section of Gastroenterology, VA San Diego Healthcare System, 3350 La Jolla Villa Drive, San Diego, CA 92161, USA
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Zylberberg HM, Rustgi SD, Yang A, Aronson A, Kessel E, Amin S, Lucas AL. Bisphosphonate Use Does Not Impact Survival in Patients with Pancreatic Cancer: A Propensity Score Matching Analysis. Gut Liver 2021; 15:782-790. [PMID: 34158422 PMCID: PMC8444100 DOI: 10.5009/gnl20297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/08/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background/Aims Bisphosphonates are increasingly recognized for their anti-neoplastic properties, which are the result of their action on the mevalonate pathway. Our primary aim was to investigate the association between bisphosphonate use and survival in patients with pancreatic cancer. Since statins also act on the mevalonate pathway, we also investigated the effect of the combined use of bisphosphonates and statins on survival. Methods The Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database was used to identify patients with pancreatic ductal adenocarcinoma (PDAC) between 2007 and 2015. Kaplan-Meier models were used to examine the association between survival with bisphosphonate use alone and in combination with statins within 1 year prior to the diagnosis of PDAC. Propensity score matching analysis and Cox-proportional hazard models were used to determine the association between overall survival with bisphosphonate use alone and combined with statins, after adjusting for relevant confounders, such as the Charlson comorbidity index score, stage, treatment, sociodemographic characteristics, and propensity score. Results In total, 13,639 patients with PDAC were identified, and 1,203 (8.82%) used bisphosphonates. There was no difference in the mean survival duration between bisphosphonate users (7.27 months) and nonusers (7.25 months, p=0.61). After adjustment for confounders, bisphosphonate use was still not associated with improved survival (hazard ratio, 1.00; 95% confidence interval, 0.93 to 1.08; p=0.96). Combined bisphosphonate and statin use was also not associated with improved survival (hazard ratio, 0.97; 95% confidence interval, 0.87 to 1.07; p=0.48) after adjustment for confounders. Conclusions Our findings suggest that the use of bisphosphonates, whether alone or in combination with statins, does not confer a survival advantage in patients with PDAC. (Gut Liver 2021;15-790)
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Affiliation(s)
- Haley M Zylberberg
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sheila D Rustgi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anthony Yang
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Anne Aronson
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Elizabeth Kessel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sunil Amin
- Division of Gastroenterology, University of Miami Leonard Miller School of Medicine, Miami, FL, USA
| | - Aimee L Lucas
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
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15
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Rustgi SD, Oh A, Yang JY, Kang D, Wolin E, Kong CY, Hur C, Kim MK. Initiation of Somatostatin analogues for neuroendocrine tumor patients: a cost-effectiveness analysis. BMC Cancer 2021; 21:597. [PMID: 34030646 PMCID: PMC8146685 DOI: 10.1186/s12885-021-08306-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/05/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND & AIMS Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are heterogeneous neoplasms. Although some have a relatively benign and indolent natural history, others can be aggressive and ultimately fatal. Somatostatin analogues (SSAs) improve both quality of life and survival for these patients once they develop metastatic disease. However, these drugs are costly and their cost-effectiveness is not known. METHODS A decision-analytic model was developed and analyzed to compare two treatment strategies for patients with Stage IV GEP-NETs. The first strategy had all patients start SSA immediately while the second strategy waited, reserving SSA initiation until the patient showed signs of progression. Sensitivity analysis was performed to explore model parameter uncertainty. RESULTS Our model of patients age 60 with metastatic GEP-NETs suggests empiric initiation of SSA led to an increase 0.62 unadjusted life-years and incremental increase in quality-adjusted life years (QALYs) of 0.44. The incremental costs were $388,966 per QALY and not cost-effective at a willingness-to-pay threshold of $100,000. Death was attributed to GEP-NETs for 94.1% of patients in the SSA arm vs. 94.9% of patients in the DELAY SSA arm. Sensitivity analysis found that the model was most sensitive to costs of SSAs. Using probabilistic sensitivity analysis, the SSA strategy was only cost-effective 1.4% of the time at a WTP threshold of $100,000 per QALY. CONCLUSIONS Our modeling study finds it is not cost-effective to initiate SSAs at time of presentation for patients with metastatic GEP-NETs. Further clinical studies are needed to identify the optimal timing to initiate these drugs.
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Affiliation(s)
- Sheila D Rustgi
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1118, New York, NY, 10029-6574, USA
- Columbia University Irving Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Aaron Oh
- Columbia University Irving Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Jeong Yun Yang
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dasol Kang
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Edward Wolin
- Division of Hematology and Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chung Y Kong
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chin Hur
- Columbia University Irving Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Michelle K Kim
- Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1118, New York, NY, 10029-6574, USA.
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16
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Rustgi SD, Yang JY, Luther S, David Y, Dixon RE, Simoes PK, Kumta NA. Anticoagulation does not increase risk of mortality or ICU admission in hospitalized COVID-19 patients with gastrointestinal bleeding: Results from a New York health system. Clin Res Hepatol Gastroenterol 2021; 45:101602. [PMID: 33607549 PMCID: PMC7834436 DOI: 10.1016/j.clinre.2020.101602] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Sheila D Rustgi
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeong Yun Yang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sanjana Luther
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Yakira David
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rebekah E Dixon
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Priya K Simoes
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nikhil A Kumta
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Hilfrank KJ, Rustgi SD, Kastrinos F. Inherited predisposition to pancreatic cancer. Semin Oncol 2021; 48:2-9. [PMID: 33773812 DOI: 10.1053/j.seminoncol.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 11/11/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is projected to be the second leading cause of cancer death in the US by 2030. There are multiple germline pathogenic variants and cancer syndromes associated with an increased risk of PDAC. Precision treatment, informed by germline genetic testing and molecular tumor analysis, can optimize therapeutic regimens and outcomes for those diagnosed with PDAC. As a result, the National Comprehensive Cancer Network currently recommends genetic testing for all newly diagnosed PDAC patients given the clinical implications for treatment but also for the identification of at-risk family members who can benefit from pancreatic cancer screening and other cancer prevention strategies. This article reviews inherited risk factors for the development of PDAC and current screening strategies for the early detection of PDAC in high-risk populations.
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Affiliation(s)
- Kimberly J Hilfrank
- Herbert Iriving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY; Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer, New York, NY
| | - Sheila D Rustgi
- Herbert Iriving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY; Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer, New York, NY; Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Fay Kastrinos
- Herbert Iriving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY; Division of Digestive and Liver Diseases, Columbia University Irving Medical Cancer, New York, NY; Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
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18
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Yang A, Zylberberg HM, Rustgi SD, Amin SP, Bar-Mashiah A, Boffetta P, Lucas AL. Beta-blockers have no impact on survival in pancreatic ductal adenocarcinoma prior to cancer diagnosis. Sci Rep 2021; 11:1038. [PMID: 33441781 PMCID: PMC7807087 DOI: 10.1038/s41598-020-79999-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Previous studies have suggested that β-adrenergic signaling may regulate the growth of various cancers. The aim of our study is to investigate the association between the incidental use of beta-blockers for various conditions on the overall survival of patients with pancreatic ductal adenocarcinoma (PDAC). Patients with histologically-confirmed PDAC between 2007 and 2011 were extracted from Surveillance, Epidemiology, and End Results registry (SEER)-Medicare linked database. Kaplan Meier and multivariable Cox Proportional-Hazard models were used to examine the association between beta-blocker usage before diagnosis and overall survival adjusting for appropriate confounders. As an additional analysis we also examined continuous beta-blocker use before and after diagnosis. From 2007 to 2011, 13,731 patients were diagnosed with PDAC. Of these, 7130 patients had Medicare Part D coverage in the 6-month period before diagnosis, with 2564 (36%) of these patients using beta-blockers in this period. Patients receiving beta-blockers had a mean survival time of 5.1 months compared to 6 months for non-users (p < 0.01). In multivariable analysis, beta-blockers usage was not associated with improved survival (Hazard Ratio (HR) 1.04, 95%, Confidence Interval (CI) 0.98–1.1, p = 0.2). When patients were stratified by conditions with indications for beta-blocker usage, such as hypertension, coronary artery disease and cardiac arrhythmia, differences in survival were insignificant compared to non-users in all groups (p > 0.05). After stratification by receptor selectivity, this lack of association with survival persisted (p > 0.05 for all). As a subgroup analysis, looking at patients with continuous Medicare Part D coverage who used beta-blockers in the 6-month period before and after cancer diagnosis, we identified 7085 patients, of which 1750 (24.7%) had continuous beta blocker use. In multivariable analysis, continuous beta-blockers usage was associated with improved survival (Hazard Ratio (HR) 0.86, 95%, Confidence Interval (CI) 0.8–0.9, p < 0.01). Beta-blocker usage before diagnosis does not confer a survival advantage in patients with PDAC, though continuous use before and after diagnosis did confer a survival advantage. Prospective studies into the mechanism for this advantage are needed.
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Affiliation(s)
- Anthony Yang
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY, 10029, USA
| | - Haley M Zylberberg
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY, 10029, USA
| | - Sheila D Rustgi
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY, 10029, USA
| | - Sunil P Amin
- Division of Gastroenterology, University of Miami Leonard Miller School of Medicine, Miami, FL, USA
| | - Ariel Bar-Mashiah
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY, 10029, USA
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Aimee L Lucas
- Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1069, New York, NY, 10029, USA.
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Abstract
Sex-based differences in inflammatory bowel disease (IBD) pathogenesis, disease course, and response to therapy have been increasingly recognized, however, not fully understood. Experimental and translational models have been leveraged to investigate hypothesized mechanisms for these observed differences, including the potential modifying role of sex hormones and sex-dependent (epi)genetic and gut microbiome changes. The primary objective of this review is to comprehensively describe sex-based differences in IBD including epidemiology, pathogenesis, phenotypic differences, therapeutic response, and outcomes.
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Affiliation(s)
- Sheila D. Rustgi
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Maia Kayal
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
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20
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Rustgi SD, Amin S, Yang A, Kim MK, Nagula S, Kumta NA, DiMaio CJ, Boffetta P, Lucas AL. Preoperative Endoscopic Retrograde Cholangiopancreatography Is Not Associated With Increased Pancreatic Cancer Mortality. Clin Gastroenterol Hepatol 2019; 17:1580-1586.e4. [PMID: 30529734 DOI: 10.1016/j.cgh.2018.11.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/21/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic retrograde cholangiopancreatography (ERCP) before surgery for pancreatic cancer has been associated with infectious complications after surgery. Little is known about the effects of preoperative ERCP on the survival of patients with pancreatic cancer. We investigated whether ERCP before surgery affects overall survival, after controlling for confounding factors. METHODS We used Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims data to identify patients older than 65 years with cancer localized to the head of the pancreas, from 2000 through 2011. We used inverse propensity-weighted Cox proportional hazard models to assess the effects of ERCP on the survival of patients who underwent surgery for pancreatic cancer. RESULTS Among 16,670 patients with cancer of the head of the pancreas, 2890 (17.3%) underwent surgical resection; 1864 (64.5%) of these patients received preoperative ERCP. After we adjusted for confounders, we found that patients who received preoperative ERCP did not have an increased risk of death compared with patients who underwent resection alone (hazard ratio, 1.02; 95% CI, 0.96-1.08). CONCLUSIONS Patients with pancreatic cancer who underwent ERCP before surgery did not have an increased risk of death compared with patients who proceeded directly to surgery. Studies are needed to identify subsets of patients who may benefit from this procedure.
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Affiliation(s)
- Sheila D Rustgi
- Henry D Janowitz Division of Gastroenterology, New York, New York
| | - Sunil Amin
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington
| | - Anthony Yang
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle K Kim
- Henry D Janowitz Division of Gastroenterology, New York, New York
| | - Satish Nagula
- Henry D Janowitz Division of Gastroenterology, New York, New York
| | - Nikhil A Kumta
- Henry D Janowitz Division of Gastroenterology, New York, New York
| | | | - Paolo Boffetta
- Tisch Cancer Institute, New York, New York; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Aimee L Lucas
- Henry D Janowitz Division of Gastroenterology, New York, New York.
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Rustgi SD, Amin SP, Kim MK, Nagula S, Kumta NA, DiMaio CJ, Boffetta P, Lucas AL. Age, socioeconomic features, and clinical factors predict receipt of endoscopic retrograde cholangiopancreatography in pancreatic cancer. World J Gastrointest Endosc 2019; 11:133-144. [PMID: 30788032 PMCID: PMC6379750 DOI: 10.4253/wjge.v11.i2.133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended technique for biliary decompression in pancreatic cancer. Previous studies have suggested racial, socioeconomic and geographic differences in diagnosis, treatment and outcomes of pancreatic cancer patients.
AIM To examine geographic, racial, socioeconomic and clinical factors associated with utilization of ERCP.
METHODS Surveillance, Epidemiology and End Results and linked Medicare claims data were used to identify pancreatic cancer patients between 2000-2011. Claims data were used to identify patients who had ERCP and other treatments. The primary outcome was receipt of ERCP. Chi-squared analyses were used to compare demographic information. Trends in use of ERCP over time were assessed using Cochran Armitage test. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for receipt ERCP were calculated using logistic regression, controlling for other characteristics.
RESULTS Among 32510 pancreatic cancer patients, 14704 (45.2%) underwent ERCP. Patients who had cancer located in the head of the pancreas (aOR 3.27, 95%CI: 2.99-3.57), had jaundice (aOR 7.59, 95%CI: 7.06-8.17), cholangitis (aOR 4.22, 95%CI: 3.71-4.81) or pruritus (aOR 1.42, 95%CI: 1.22-1.66) and lived in lower education zip codes (aOR 1.14, 95%CI: 1.04-1.24) were more likely to receive ERCP. In contrast, patients who were older (aOR 0.88, 95%CI: 0.83, 0.94), not married (aOR 0.92, 95%CI: 0.86, 0.98), and lived in a non-metropolitan area (aOR 0.89, 95%CI: 0.82, 0.98) were less likely to receive ERCP. Compared to white patients, non-white/non-black patients (aOR 0.83, 95%CI: 0.70-0.97) were less likely to receive ERCP. Patients diagnosed later in the study period were less likely to receive ERCP (aOR 2004-2007 0.85, 95%CI: 0.78-0.92; aOR 2008-2011 0.76, 95%CI: 0.70-0.83). After stratifying by indications for ERCP including jaundice, racial differences persisted (aOR black patients 0.80, 95%CI: 0.67-0.95, nonwhite/nonblack patients 0.73, 95%CI: 0.58-0.91). Among patients with jaundice, those who underwent surgery were less likely to undergo ERCP (aOR 0.60, 95%CI: 0.52, 0.69).
CONCLUSION ERCP utilization in pancreatic cancer varies based on patient age, marital status, and factors related to where the patient lives. Further studies are needed to guide appropriate biliary intervention for these patients.
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Affiliation(s)
- Sheila D Rustgi
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sunil P Amin
- Division of Gastroenterology, Virginia Mason Medical Center, Seattle, WA 98101, United States
| | - Michelle K Kim
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Satish Nagula
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Nikhil A Kumta
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Christopher J DiMaio
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Aimee L Lucas
- Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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22
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Collins SR, Rustgi SD, Doty MM. Women and the Affordable Care Act of 2010. Issue Brief (Commonw Fund) 2010; 93:1-18. [PMID: 20677409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This issue brief analyzes how, over the next decade, the Affordable Care Act (ACA) is likely to stabilize and reverse women's growing exposure to health care costs. Up to 15 million women who now are uninsured could gain subsidized coverage under the law. In addition, 14.5 million insured women will benefit from provisions that improve coverage or reduce premiums. Women who have coverage through the individual insurance market and are charged higher premiums than men, who have been unable to secure coverage for the cost of pregnancy, or who have a preexisting health condition excluded from their benefits will ultimately find themselves on a level playing field with men, enjoying a full range of comprehensive benefits.
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Doty MM, Collins SR, Rustgi SD, Nicholson JL. Out of options: why so many workers in small businesses lack affordable health insurance, and how health care reform can help. Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007. Issue Brief (Commonw Fund) 2009; 67:1-22. [PMID: 19757552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Although employer-sponsored health insurance forms the backbone of the health insurance system in the United States, small businesses are finding it increasingly difficult to provide their workers with comprehensive coverage. In 2007, only 25 percent of employees in small businesses had coverage through their own employers, compared with 74 percent of workers in large firms. Because there are few sources of affordable coverage outside the employer-based system, millions of employees in small businesses are uninsured or have inadequate health insurance. In 2007, 52 percent of workers in small businesses were uninsured or underinsured during the year, compared with half as many employees in large businesses. Congressional bills to reform the health system include provisions specifically aimed at helping small businesses and their employees gain access to affordable, comprehensive coverage.
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Nicholson JL, Collins SR, Mahato B, Gould E, Schoen C, Rustgi SD. Rite of passage? Why young adults become uninsured and how new policies can help, 2009 update. Issue Brief (Commonw Fund) 2009; 64:1-20. [PMID: 19658271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Young adults ages 19 to 29 are one of the largest segments of the U.S. population without health insurance: 13.2 million, or 29 percent, lacked coverage in 2007. They often lose coverage at age 19 or upon high school or college graduation: nearly two of five (38%) high school graduates who do not enroll in college and one-third of college graduates are uninsured for a time during the first year after graduation. Twenty-six states have passed laws to expand coverage of dependents to young adults under parents' insurance policies. Congressional proposals to reform the health system could help uninsured young adults gain coverage and prevent others from losing it. This is the seventh edition of Rite of Passage, first published by The Commonwealth Fund in 2003.
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Doty MM, Collins SR, Nicholson JL, Rustgi SD. Failure to protect: why the individual insurance market is not a viable option for most U.S. families: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2007. Issue Brief (Commonw Fund) 2009; 62:1-16. [PMID: 19621500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Between 2001 and 2007, an increasing share of adults with private insurance--whether employer-based coverage or individual market plans--spent a large amount of their income on premiums and out-of-pocket medical costs, were underinsured, and/or avoided needed health care because of costs. Those with coverage obtained in the individual market were the most affected. Over the last three years, nearly three-quarters of people who tried to buy coverage in this market never actually purchased a plan, either because they could not find one that fit their needs or that they could afford, or because they were turned down due to a preexisting condition. Even people enrolled in employer-based plans are spending larger amounts of their income on health care and curtailing their use of needed services to save money. The findings underscore the need for an expansion of affordable health insurance options, particularly during a time of mounting job losses.
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Collins SR, Nuzum R, Rustgi SD, Mika S, Schoen C, Davis K. How health care reform can lower the costs of insurance administration. Issue Brief (Commonw Fund) 2009; 61:1-19. [PMID: 19618542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The United States leads all industrialized countries in the share of national health care expenditures devoted to insurance administration. The U.S. share is over 30 percent greater than Germany's and more than three times that of Japan. This issue brief examines the sources of administrative costs and describes how a private-public approach to health care reform--with the central feature of a national insurance exchange (largely replacing the present individual and small-group markets)--could substantially lower such costs. In three variations on that approach, estimated administrative costs would fall from 12.7 percent of claims to an average of 9.4 percent. Savings--as much as $265 billion over 2010-2020--would be realized through less marketing and underwriting, reduced costs of claims administration, less time spent negotiating provider payment rates, and fewer or standardized commissions to insurance brokers.
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Rustgi SD, Doty MM, Collins SR. Women at risk: why many women are forgoing needed health care. An analysis of the Commonwealth Fund 2007 Biennial Health Insurance Survey. Issue Brief (Commonw Fund) 2009; 52:1-12. [PMID: 19434951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Rising health care costs coupled with eroding health care benefits are having a substantial effect on Americans' ability to get needed health care, with women particularly affected. Women experience cost-related access problems and medical bill problems more often than men. In 2007, more than half (52%) of women reported problems accessing needed care because of cost and 45 percent of women accrued medical debt or reported problems with medical bills. Since women use more health care services than men, they are more exposed to the fragmentation and failings of the current health care system-- underscoring the need for affordable and high-quality health insurance coverage that is available to all.
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Doty M, Rustgi SD, Schoen C, Collins SR. Maintaining health insurance during a recession: likely COBRA eligibility: an updated analysis using the Commonwealth Fund 2007 Biennial Health Insurance Survey. Issue Brief (Commonw Fund) 2009; 49:1-12. [PMID: 19288628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As the U.S. economic downturn continues and job losses mount, more working Americans are likely to lose access to affordable health benefits subsidized by their employers. Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds that two of three working adults would be eligible to extend job-based coverage, under the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) if they became unemployed. Under COBRA, however, unemployed workers would have to pay four to six times their current contribution at a time of sharply reduced income. In fact, the latest national figures indicate that, because of high premiums, only 9 percent of unemployed workers have COBRA coverage. Substantial financial assistance of 75 percent to 85 percent of premiums could help laid-off workers maintain coverage. In addition, expansion of Medicaid and the State Children's Health Insurance Program would benefit low-income, laid-off workers and their families who are ineligible for COBRA.
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Doty MM, Collins SR, Rustgi SD, Kriss JL. Seeing red: the growing burden of medical bills and debt faced by U.S. families. Issue Brief (Commonw Fund) 2008; 42:1-12. [PMID: 19798802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent, or 72 million people,between 2005 and 2007. In addition, 7 million adults age 65 and older had these problems,bringing the total to 79 million adults with medical debt or bill problems. All income groups reported an increase. Families with low or moderate incomes were particularly hard hit, as were adults who had gaps in health coverage or those underinsured. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. Sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.
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Rustgi SD, Marino G, Halpern MT, Umana WO, Tolleris C, Rustgi VK. Impact of donor age on graft survival among liver transplant recipients: analysis of the United Network for Organ Sharing database. Transplant Proc 2002; 34:3295-7. [PMID: 12493451 DOI: 10.1016/s0041-1345(02)03602-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S D Rustgi
- Metropolitan Liver Diseases/Gastroenterology Center, Fairfax, VA 22031, USA
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