The Effect of Wait Times on Oncological Outcomes From Periampullary Adenocarcinomas

McLean, Spencer R.; Karsanji, Divya J.; Wilson, Jennifer N.; Dixon, Elijah; Sutherland, Francis; Pasieka, Janice L.; Ball, Chad G.; Bathe, Oliver F.

doi:10.1002/jso.23338

Cited by 30 publications

(28 citation statements)

References 17 publications

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“…There have only been three previous studies that have investigated a component of the diagnostic interval and patient outcomes in PDAC. Two of these studies identified a positive association between shorter intervals and improved patient outcomes (13,14), and one found no association (15). Gobbi et al (13) found a positive association between the “time to diagnosis” (symptom onset–diagnosis) and survival and Raptis et al (14) found a shorter “pre-hospital” delay (symptom onset–referral to a specialist) to be positively associated with survival.…”

Section: Discussionmentioning

confidence: 99%

“…Gobbi et al (13) found a positive association between the “time to diagnosis” (symptom onset–diagnosis) and survival and Raptis et al (14) found a shorter “pre-hospital” delay (symptom onset–referral to a specialist) to be positively associated with survival. McLean et al (15) found no association between “wait times” (symptoms–surgical consultation and surgical consultation–procedure) on resectability or survival. However, directly comparing these studies to each other, or to the present investigation has some challenges.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

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Background Pancreatic ductal adenocarcinoma (PDAC) often presents with nonspecific symptoms and the workup is not standardized. To study the impact of delays in diagnosis and in the initiation of treatment, we investigated the relationship between length of diagnostic intervals and surgical resectability. Methods We performed a retrospective chart review of patients evaluated for PDAC at Johns Hopkins in 2014. Data were collected on the patient (date of first symptoms—first medical appointment), diagnostic (first medical appointment—diagnosis of PDAC), and treatment (diagnosis of PDAC—1st day of treatment) time intervals, and the upfront treatment received. Asymptomatic patients diagnosed incidentally, or for whom records were incomplete, were excluded from analysis. Results Of 453 charts reviewed, 116 patients met inclusion criteria. The median patient interval was 14 days [interquartile range (IQR): 6–30 days], the median diagnostic interval was 22 days (IQR: 8–46 days), and the median treatment interval was 26 days (IQR: 15–35 days). Thirty-eight patients (33%) received upfront surgery and 78 (67%) received nonsurgical treatment. After adjusting for multiple factors, the odds of receiving surgery significantly increased for individuals with a patient interval of 30 days or less [adjusted odds ratio (aOR): 3.41; 95% confidence interval (CI): 1.08–13.20; P=0.050] and with a diagnostic interval of 60 days or less (aOR: 15.68; 95% CI: 2.95–291.00, P=0.009). Conclusions A patient interval less than 1 month and a diagnostic interval less than 2 months for symptomatic PDAC are associated with increased odds of upfront surgical resection. These data provide initial evidence that reducing diagnostic delays may lead to improved outcomes in PDAC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Deshwar¹,

Sugar²,

Torto³

et al. 2018

Ann Pancreat Cancer

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“…This may lead to treatment delays, perhaps even resulting in growth of the tumor beyond resectability. In our center, 26% of patients who have major pancreatic resections ultimately are found to have benign disease [93]. This is not a trivial decision, as pancreatic resections are extensive operations associated with high morbidity and mortality rates [84][85][86].…”

Section: Development Of Metabolomics-based Diagnostic Testingmentioning

confidence: 99%

Characterizing the Metabolomic Effects of Pancreatic Cancer

Bathe

2014

Molecular Diagnostics and Treatment of Pancreatic Cancer

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“…In addition, a large proportion of patients undergo major surgery without a definitive diagnosis. This results in a finding of benign pathology in 7%–31% of pancreatic surgical resection specimens [5,6,7,8]. Given that pancreatic surgery is associated with substantial morbidity and a significant risk of perioperative mortality [9,10], a reduction in the need for such “diagnostic” resections would be beneficial.…”

Section: Introductionmentioning

confidence: 99%

Distinguishing Benign from Malignant Pancreatic and Periampullary Lesions Using Combined Use of 1H-NMR Spectroscopy and Gas Chromatography–Mass Spectrometry

et al. 2017

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Previous work demonstrated that serum metabolomics can distinguish pancreatic cancer from benign disease. However, in the clinic, non-pancreatic periampullary cancers are difficult to distinguish from pancreatic cancer. Therefore, to test the clinical utility of this technology, we determined whether any pancreatic and periampullary adenocarcinoma could be distinguished from benign masses and biliary strictures. Sera from 157 patients with malignant and benign pancreatic and periampullary lesions were analyzed using proton nuclear magnetic resonance (1H-NMR) spectroscopy and gas chromatography–mass spectrometry (GC-MS). Multivariate projection modeling using SIMCA-P+ software in training datasets (n = 80) was used to generate the best models to differentiate disease states. Models were validated in test datasets (n = 77). The final 1H-NMR spectroscopy and GC-MS metabolomic profiles consisted of 14 and 18 compounds, with AUROC values of 0.74 (SE 0.06) and 0.62 (SE 0.08), respectively. The combination of 1H-NMR spectroscopy and GC-MS metabolites did not substantially improve this performance (AUROC 0.66, SE 0.08). In patients with adenocarcinoma, glutamate levels were consistently higher, while glutamine and alanine levels were consistently lower. Pancreatic and periampullary adenocarcinomas can be distinguished from benign lesions. To further enhance the discriminatory power of metabolomics in this setting, it will be important to identify the metabolomic changes that characterize each of the subclasses of this heterogeneous group of cancers.

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The Effect of Wait Times on Oncological Outcomes From Periampullary Adenocarcinomas

Abstract: This series does not demonstrate an advantage for rapid diagnosis and surgery, in terms of resection rate and survival. However, further study is required in a larger cohort of patients, to confirm these findings.

Cited by 30 publications

References 17 publications

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Diagnostic intervals and pancreatic ductal adenocarcinoma (PDAC) resectability: a single-center retrospective analysis

Characterizing the Metabolomic Effects of Pancreatic Cancer

Distinguishing Benign from Malignant Pancreatic and Periampullary Lesions Using Combined Use of 1H-NMR Spectroscopy and Gas Chromatography–Mass Spectrometry

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