Inconsistencies in domestic land use change study Alarcon Falconi, Tania M; Kazemiparkouhi, Fatemeh; Schwartz, Brittany ...
Proceedings of the National Academy of Sciences - PNAS,
12/2022, Letnik:
119, Številka:
51
Journal Article
Background
The incidence of asymptomatic, sporadic, small non‐functioning pancreatic neuroendocrine neoplasms (NF‐PNENs) has increased in recent decades. Conservative treatment has been advocated for ...these tumours. The aim of this study was systematically to evaluate the literature on active surveillance and to compare this with surgical management for asymptomatic sporadic small NF‐PNENs.
Methods
PubMed, Embase and the Cochrane Library were searched systematically for studies that compared the active surveillance of asymptomatic, sporadic, small NF‐PNENs with surgical management. PRISMA guidelines for systematic reviews were followed.
Results
After screening 3915 records, five retrospective studies with a total of 540 patients were included. Of these, 327 patients (60·6 per cent) underwent active surveillance and 213 (39·4 per cent) had surgery. There was wide variation in the tumour diameter threshold considered as inclusion criterion (2 cm to any size). The median length of follow‐up ranged from 28 to 45 months. Measurable tumour growth was observed in 0–51·0 per cent of patients. Overall, 46 patients (14·1 per cent) underwent pancreatic resection after initial conservative treatment. In most patients the reason was an increase in tumour size (19 of 46). There were no disease‐related deaths in the active surveillance group in any of the studies.
Conclusion
This systematic review suggests that active surveillance of patients affected by sporadic, small, asymptomatic NF‐PNENs may be a good alternative to surgical treatment.
Watch and wait is safe
Background
Despite evidence of different malignant potentials, postoperative follow-up assessment is similar for G1 and G2 pancreatic neuroendocrine tumors (panNETs) and adjuvant treatment currently ...is not indicated. This study investigated the role of Ki67 with regard to recurrence and survival after curative resection of panNET.
Methods
Patients with resected non-functioning panNET diagnosed between 1992 and 2016 from three institutions were retrospectively analyzed. Patients who had G1 or G2 tumor without distant metastases or hereditary syndromes were included in the study. The patients were re-categorized into Ki67 0–5 and Ki67 6–20%. Cox regression analysis with log-rank testing for recurrence and survival was performed.
Results
The study enrolled 241 patients (86%) with Ki67 0–5% and 39 patients (14%) with Ki67 6–20%. Recurrence was seen in 34 patients (14%) with Ki67 0–5% after a median period of 34 months and in 16 patients (41%) with Ki67 6–20% after a median period of 16 months (
p
< 0.001). The 5-year recurrence-free and 10-year disease-specific survival periods were respectively 90 and 91% for Ki67 0–5% and respectively 55 and 26% for Ki67 6–20% (
p
< 0.001). The overall survival period after recurrence was 44.9 months, which was comparable between the two groups (
p
= 0.283). In addition to a Ki67 rate higher than 5%, tumor larger than 4 cm and lymph node metastases were independently associated with recurrence.
Conclusions
Patients at high risk for recurrence after curative resection of G1 or G2 panNET can be identified by a Ki67 rate higher than 5%. These patients should be more closely monitored postoperatively to detect recurrence early and might benefit from adjuvant treatment. A clear postoperative follow-up regimen is proposed.
Patients with borderline (BL) or locally advanced (LA) pancreatic adenocarcinoma are usually treated with primary chemotherapy (CT), followed by resection when feasible. Scanty data are available ...about the criteria to candidate patients to resection after CT.
Between 2002 and 2016 overall 223 patients diagnosed with BL or LA pancreatic adenocarcinoma were primarily treated with Gemcitabine combination (4-drugs or nab-paclitaxel-gemcitabine) for 3–6months followed by surgery and/or chemoradiation. Resection was carried out when radical resection could be predicted by imaging studies and intraoperative findings. The prognostic value of both pre-treatment factors and treatment response was retrospectively evaluated, searching for criteria that could improve the selection of patients for surgery.
Median survival (MS) for the whole population was 18.3months. Surgical resection was carried out in 61 patients; MS in resected patients was significantly longer (30.0months) as compared with 162 non-resected patients (16.5months) (P<0.00001). According to response criteria, 48% had a radiological partial response, 47% a stable disease and 5% a disease progression); CA19.9 response (reduction>50%) was obtained in 77.8% of patients. Among resected patients, neither pre-treatment factors, including BL/LA distinction, nor radiological response, were able to prognosticate survival differences. Survival of resected patients having no CA19.9 response was significantly lower as compared with responders (MS 15.0 versus 31.5months,P=0.04), and was similar to non-responders patients that did not undergo resection (MS 10.9months,P=0.25). Multivariate analysis carried out on the overall population, showed that Karnofsky performance status, T3–T4 status, resection and CA19.9 response were independent prognostic factors, while radiological response, BL/LA distinction and baseline CA19.9 had not significant influence on survival.
CA19.9 response may allow a better selection of patients who will benefit from resection after primary CT for BL or LA pancreatic adenocarcinoma.
Abstract
The carbon intensity (CI) of corn ethanol, the primary renewable fuel used in transportation, has been actively researched and quantified over the last three decades. Reliable estimates of ...greenhouse gas (GHG) emissions for corn ethanol are important since these values help determine significant policy and market decisions on state, national, and international levels. We reviewed well-to-wheel GHG life cycle analyses (LCAs) for corn ethanol and evaluated models, input data, and results for farming, fuel production, co-product credit, land use change (LUC), transport of feedstock and fuel, tailpipe, and denaturant. Compared to earlier analyses, recent LCAs for corn ethanol contain updates to modeling systems and data that reflect: (a) market-driven changes in corn production that lowered the intensity of fertilizer and fossil fuel use on farms; (b) more efficient use of natural gas and recent electric generation mix data for energy consumed at ethanol refineries, and (c) LUC analyses based on hybrid economic-biophysical models that account for land conversion, land productivity, and land intensification. LCAs that include these latest developments yield a central best estimate of CI for corn ethanol of 51.4 gCO
2
e MJ
−1
(range of 37.6–65.1 gCO
2
e MJ
−1
) which is 46% lower than the average CI for neat gasoline. The largest components of total CI are ethanol production (29.6 gCO
2
e MJ
−1
, 58% of total) and farming practices net of co-product credit (13.2 gCO
2
e MJ
−1
, 26%), while LUC is a minor contributor (3.9 gCO
2
e MJ
−1
, 7%). Market conditions that favor greater adoption of precision agriculture systems, retention of soil organic carbon, and demand for co-products from ethanol production may lower the CI of corn ethanol further. Continued refinement of models to account for co-products, conservation of soil carbon, and direct and indirect LUC is expected to produce ever more accurate estimates in the future.
Both the European Neuroendocrine Tumor Society (ENETS) and the International Union for Cancer Control/American Joint Cancer Committee/World Health Organization (UICC/AJCC/WHO) have proposed TNM ...staging systems for pancreatic neuroendocrine neoplasms. This study aims to identify the most accurate and useful TNM system for pancreatic neuroendocrine neoplasms.
The study included 1072 patients who had undergone previous surgery for their cancer and for which at least 2 years of follow-up from 1990 to 2007 was available. Data on 28 variables were collected, and the performance of the two TNM staging systems was compared by Cox regression analysis and multivariable analyses. All statistical tests were two-sided.
Differences in distribution of sex and age were observed for the ENETS TNM staging system. At Cox regression analysis, only the ENETS TNM staging system perfectly allocated patients into four statistically significantly different and equally populated risk groups (with stage I as the reference; stage II hazard ratio HR of death = 16.23, 95% confidence interval CI = 2.14 to 123, P = .007; stage III HR of death = 51.81, 95% CI = 7.11 to 377, P < .001; and stage IV HR of death = 160, 95% CI = 22.30 to 1143, P < .001). However, the UICC/AJCC/WHO 2010 TNM staging system compressed the disease into three differently populated classes, with most patients in stage I, and with the patients being equally distributed into stages II-III (statistically similar) and IV (with stage I as the reference; stage II HR of death = 9.57, 95% CI = 4.62 to 19.88, P < .001; stage III HR of death = 9.32, 95% CI = 3.69 to 23.53, P = .94; and stage IV HR of death = 30.84, 95% CI = 15.62 to 60.87, P < .001). Multivariable modeling indicated curative surgery, TNM staging, and grading were effective predictors of death, and grading was the second most effective independent predictor of survival in the absence of staging information. Though both TNM staging systems were independent predictors of survival, the UICC/AJCC/WHO 2010 TNM stages showed very large 95% confidence intervals for each stage, indicating an inaccurate predictive ability.
Our data suggest the ENETS TNM staging system is superior to the UICC/AJCC/WHO 2010 TNM staging system and supports its use in clinical practice.
DNA methylation is an epigenetic mark that living beings have used in different environments. The MTases family catalyzes DNA methylation. This process is conserved from archaea to eukaryotes, from ...fertilization to every stage of development, and from the early stages of cancer to metastasis. The family of DNMTs has been classified into DNMT1, DNMT2, and DNMT3. Each DNMT has been duplicated or deleted, having consequences on DNMT structure and cellular function, resulting in a conserved evolutionary reaction of DNA methylation. DNMTs are conserved in the five kingdoms of life: bacteria, protists, fungi, plants, and animals. The importance of DNMTs in whether methylate or not has a historical adaptation that in mammals has been discovered in complex regulatory mechanisms to develop another padlock to genomic insurance stability. The regulatory mechanisms that control DNMTs expression are involved in a diversity of cell phenotypes and are associated with pathologies transcription deregulation. This work focused on DNA methyltransferases, their biology, functions, and new inhibitory mechanisms reported. We also discuss different approaches to inhibit DNMTs, the use of non-coding RNAs and nucleoside chemical compounds in recent studies, and their importance in biological, clinical, and industry research.
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