Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma

Baekelandt, Bart Maria Gilbert; Hjermstad, Marianne Jensen; Nordby, Tom; Fagerland, Morten Wang; Kure, Elin H.; Heiberg, Turid; Buanes, Trond; Labori, Knut Jørgen

doi:10.1016/j.hpb.2015.09.004

Cited by 15 publications

(11 citation statements)

References 39 publications

(53 reference statements)

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“…After removal of 690 duplicates, a further 2588 articles were excluded after title and abstract screening because they did not meet the prespecified inclusion criteria. The full texts of the remaining 468 studies were evaluated in more detail, and 89 studies were found to meet the eligibility criteria for this systematic review. Among them, 22 studies containing information on clinical factors relevant to recurrence sites were selected for the meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The Cochrane Collaboration tool for assessing risk of bias showed that one study had no domain with a high risk of bias and three studies had one of seven domains with a high risk of bias ( Table S3 , supporting information). The overall risk of bias in non‐randomized studies, according to ROBINS‐I, was moderate in 48 studies and serious in 37 studies ( Table S4 , supporting information).…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

142

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Background: Initial recurrence mapping of resected pancreatic ductal adenocarcinoma (PDAC) could help in stratifying patient subpopulations for optimal postoperative follow-up. The aim of this systematic review and meta-analysis was to investigate the initial recurrence patterns of PDAC and to correlate them with clinicopathological factors.Methods: MEDLINE and Web of Science databases were searched systematically for studies reporting first recurrence patterns after PDAC resection. Data were extracted from the studies selected for inclusion. Pooled odds ratios (ORs) and 95 per cent confidence intervals were calculated to determine the clinicopathological factors related to the recurrence sites. The weighted average of median overall survival was calculated.Results: Eighty-nine studies with 17 313 patients undergoing PDAC resection were included. The weighted median rates of initial recurrence were 20⋅8 per cent for locoregional sites, 26⋅5 per cent for liver, 11⋅4 per cent for lung and 13⋅5 per cent for peritoneal dissemination. The weighted median overall survival times were 19⋅8 months for locoregional recurrence, 15⋅0 months for liver recurrence, 30⋅4 months for lung recurrence and 14⋅1 months for peritoneal dissemination. Meta-analysis revealed that R1 (direct) resection (OR 2⋅21, 95 per cent c.i. 1⋅12 to 4⋅35), perineural invasion (OR 5⋅19, 2⋅79 to 9⋅64) and positive peritoneal lavage cytology (OR 5⋅29, 3⋅03 to 9⋅25) were significantly associated with peritoneal dissemination as initial recurrence site. Low grade of tumour differentiation was significantly associated with liver recurrence (OR 4⋅15, 1⋅71 to 10⋅07).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Meta-analysis of recurrence pattern after resection for pancreatic cancer

Tanaka

Mihaljevic

Probst

et al. 2019

British Journal of Surgery

142

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“…The notion that pre-treatment cancer patients experience neurocognitive decline more readily than age-matched controls is gaining attention. Furthermore, recent clinical studies demonstrate that cognitive decline prior to cancer treatment is a significant independent predictor of survival [21,22]. Taken together, the clinical studies to date suggest that peripheral tumors and blood cancers affect several domains of cognitive function and modulate white matter neuroanatomy.…”

Section: Epidemiology Of Pre-treatment Crci and Recent Clinical Stmentioning

confidence: 99%

“…However, less was known about the prognostic utility of CRCI until recently. Cognitive impairment (deficits in working memory) prior to cancer treatment is an important predictor of survival in hematologic cancers [21] and pancreatic cancer [22]. Furthermore, CRCI is not limited to older patients, as it is also observed in younger patients with Hodgkin lymphoma [23].…”

Section: Introductionmentioning

confidence: 99%

Pretreatment Cancer-Related Cognitive Impairment—Mechanisms and Outlook

Olson

Marks

2019

Cancers

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Cognitive changes are common in patients with active cancer and during its remission. This has largely been blamed on therapy-related toxicities and diagnosis-related stress, with little attention paid to the biological impact of cancer itself. A plethora of clinical studies demonstrates that cancer patients experience cognitive impairment during and after treatment. However, recent studies show that a significant portion of patients with non-central nervous system (CNS) tumors experience cognitive decline prior to treatment, suggesting a role for tumor-derived factors in modulating cognition and behavior. Cancer-related cognitive impairment (CRCI) negatively impacts a patient’s quality of life, reduces occupational and social functioning, and increases morbidity and mortality. Furthermore, patients with cancer cachexia frequently experience a stark neurocognitive decline, suggesting peripheral tumors exert an enduring toll on the brain during this chronic paraneoplastic syndrome. However, the scarcity of research on cognitive impairment in non-CNS cancers makes it difficult to isolate psychosocial, genetic, behavioral, and pathophysiological factors in CRCI. Furthermore, clinical models of CRCI are frequently confounded by complicated drug regimens that inherently affect neurocognitive processes. The severity of CRCI varies considerably amongst patients and highlights its multifactorial nature. Untangling the biological aspects of CRCI from genetic, psychosocial, and behavioral factors is non-trivial, yet vital in understanding the pathogenesis of CRCI and discovering means for therapeutic intervention. Recent evidence demonstrating the ability of peripheral tumors to alter CNS pathways in murine models is compelling, and it allows researchers to isolate the underlying biological mechanisms from the confounding psychosocial stressors found in the clinic. This review summarizes the state of the science of CRCI independent of treatment and focuses on biological mechanisms in which peripheral cancers modulate the CNS.

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“…However, when patients are diagnosed with pancreatic cancer, more than half are at an unresectable stage and are given chemotherapy, radiation, palliative surgery or supportive care ( 8 , 9 ). Even if patients undergo curative resection, their 5-year survival rates are approximately 15–20%, with a median survival of 16 to 23 months ( 10 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

Photodynamic diagnosis of peritoneal metastasis in human pancreatic cancer using 5‑aminolevulinic acid during staging laparoscopy

et al. 2018

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Peritoneal metastasis is an important prognostic factor for pancreatic cancer. The present study evaluated the possibility of diagnosing peritoneal metastasis by a photodynamic diagnosis using 5-aminolevulinic acid (5-ALA-PDD). In vitro, protoporphyrin IX (PpIX) accumulation was examined in the AsPC-1-GFP cell line following 5-ALA hydrochloride administration. In vivo, AsPC-1-GFP cells were injected into the peritoneal cavities of mice. Three weeks later 5-ALA hydrochloride was intraperitoneally administered to the mice. The peritoneal nodules were observed under fluorescence excitation. A total of 34 patients were enrolled in the present study who were clinically diagnosed with pancreatic malignancy. 5-ALA hydrochloride was orally administered to the patients prior to surgery. During the operation the abdominal cavity was observed under white light and fluorescence. In vitro and in vivo, it was confirmed that PpIX-induced red fluorescence. In 9 patients peritoneal nodules suspected to be peritoneal metastasis were observed under white light. In 4 of the 9 patients nodules were detected on the basis of the fluorescence images. Fluorescent nodules were histopathologically diagnosed as metastatic. In the present study it was confirmed that 5-ALA-PDD holds promise for the rapid diagnosis of peritoneal metastasis in patients with pancreatic cancer.

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Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma

Abstract: Presurgery cognitive function is a significant independent predictor of survival in patients with resectable PDAC. Thus, presurgery patient reported outcomes may provide as strong prognostic information as clinicopathological factors.

Cited by 15 publications

References 39 publications

Meta-analysis of recurrence pattern after resection for pancreatic cancer

Meta-analysis of recurrence pattern after resection for pancreatic cancer

Pretreatment Cancer-Related Cognitive Impairment—Mechanisms and Outlook

Photodynamic diagnosis of peritoneal metastasis in human pancreatic cancer using 5‑aminolevulinic acid during staging laparoscopy

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