Our aim was to determine the effect of metformin exposure on survival in patients with advanced pancreatic adenocarcinoma (PAC).
A retrospective cohort study was conducted using The Health ...Improvement Network, a primary care electronic medical record database from the United Kingdom (2003-2010). The study cohort included all subjects with a diagnostic code for incident PAC and a preexisting diagnosis of type 2 diabetes mellitus. Subjects were classified as exposed if they were prescribed metformin around the time of PAC diagnosis (between 6 months prior and 1 month after). A secondary analysis was performed only on exposed subjects without prior (ie, 6 months before PAC diagnosis) exposure to metformin. The primary outcome was overall survival. The analysis was performed using univariate and multivariable Cox proportional hazards models.
The study included 516 subjects with preexisting type 2 diabetes mellitus and PAC, 247 of which were exposed to metformin. In univariate and multivariable analysis, there was no difference in survival between those exposed and those unexposed to metformin in the primary analysis (hazards ratio, 1.11 0.89-1.38, P = 0.367) or the secondary analysis (hazards ratio, 1.09 0.80-1.47, P = 0.585).
Metformin use is not associated with improved survival in subjects with advanced PAC.
Background and Aim
To improve diagnostic yield of endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) in solid pancreatic lesions, on‐site cytology review has been recommended. Because this ...is not widely available throughout the world, the aim of the present study was to compare the diagnostic yield of EUS‐FNA carried out with rapid on‐site evaluation (ROSE) versus seven FNA passes without ROSE in pancreatic masses.
Methods
In this multicenter randomized non‐inferiority trial, patients were randomized to ROSE versus seven passes into a solid pancreatic mass. On the basis of the absolute difference in diagnostic yield with seven passes versus cytopathologist guidance, the non‐inferiority margin for the difference in diagnostic yield was defined as −15%. Definite diagnosis was defined to include positivity for malignancy, presence of neoplastic cells, and negativity for malignancy.
Results
Total of 142 patients were randomized with 73 in the cytopathologist arm and 69 in the seven‐passes arm. Diagnostic yield for definite diagnosis was 78.3% with seven passes and 78.1% with cytopathology guidance. With an absolute difference 0.2%, 95% CI –14.4 to 14.6, carrying out seven passes was non‐inferior to cytopathologist‐guided EUS‐FNA. There was no significant difference in complications or time to carry out FNA. A median of five passes were done with ROSE. Median cost with onsite cytopathology was significantly higher than carrying out seven passes ($1058 958, 1445 vs $375 275, 460, P < 0.001).
Conclusions
Diagnostic yield for carrying out seven passes during EUS‐FNA into solid pancreatic masses is non‐inferior with lower charge compared to cytopathologist guidance.
To test whether caffeine administered in coffee increases postprandial hyperglycemia in patients with type 2 diabetes who are habitual coffee drinkers.
The study used a within-subject, double-blind, ...placebo-controlled experimental design. Twenty adult coffee drinkers (11 women and 9 men) with type 2 diabetes treated with diet, exercise, orally administered antidiabetic agents, or some combination of these factors completed two mixed-meal tolerance tests (MMTT) after an overnight fast. Before the MMTT, each study participant received 250 mg of caffeine in 16 oz (475 mL) of decaffeinated coffee or decaffeinated coffee alone, with the treatment order counterbalanced in the group. Fasting and 1-hour and 2-hour postprandial blood samples were collected for measurement of plasma glucose and insulin concentrations.
Glucose and insulin responses to the MMTT were quantified by the incremental areas under the 2-hour concentration-time curves (AUC2h). Administration of caffeine in decaffeinated coffee increased postprandial glucose and insulin responses (both P = 0.02). The mean plasma glucose AUC2h was 28% larger and the mean plasma insulin AUC2h was 19% larger after administration of caffeine than after administration of placebo.
Other constituents in coffee did not prevent the exaggeration of postprandial hyperglycemia by caffeine in these patients with type 2 diabetes, who were habitual coffee drinkers. Repeated on a daily basis, such effects could impair long-term glucose control in those patients with type 2 diabetes who habitually drink coffee or other caffeinated beverages.
Recent evidence has identified pre-existing type 2 diabetes mellitus (T2DM) as a risk factor for the development of PAC, but relatively little is known about its effects on survival. Our aim was to ...determine the effect of varying durations of pre-existing T2DM on survival in patients with PAC.
We conducted a retrospective cohort study using The Health Improvement Network (THIN), a primary care electronic medical record database from the UK (2003-2010). The study cohort included all subjects with a diagnostic code for PAC. Subjects with a diagnostic code for T2DM before their PAC diagnosis were classified as exposed; otherwise, subjects were classified as unexposed. The primary outcome was overall survival. The analysis was performed using univariate and multivariable Cox proportional-hazards models. Additional analysis was performed to assess the effect of increasing duration of pre-existing T2DM i.e., <90 days, 90 days to <1 year, 1 to <3 years, 3 to 5 years, >5 years on survival.
The study included 3,147 patients with PAC, with 745 patients having pre-existing T2DM and 2,402 patients without pre-existing T2DM. In the primary multivariate analysis, there was no difference in survival between those exposed and those unexposed to pre-existing T2DM (HR 1.02 0.93, 1.12, p = 0.620). In the secondary analysis, only those patients with T2DM > 5 years duration had a significantly increased mortality (HR 1.16 1.00, 1.33, p < 0.05).
Long-term pre-existing T2DM is associated with increased mortality in patients diagnosed with PAC.
Abstract
CRC incidence in patients <50 years of age has increased by 17% in the last decade predominantly rectal cancer in Whites (Siegel et al, 2009). This age group is rarely screened. We ...determined the rectal binding Adnab-9 antibody in patients <50 years and a >50 year control at high clinical CRC risk of cancer. Methods: Adnab-9 is an adenoma-carcinoma sequence marker. We performed Adnab-9 immunohistocemistry on colonoscopic rectal biopsies. Results: Our study found that of 25 patients age <50 years, 48% had rectal binding of Adnab-9 versus 21.8% in 220 patients ≥50yrs (p<0.01) and with BMI was confirmed as an independent risk factor by multivariate analysis. Demographics are summarized (Table) and significant differences were seen for gender, ASA intake and BMI, however female gender was equally distributed 58.3 in the positive and 61.5% in the negative group. Hematochezia tended (p=0.23) to associate with positive rectal binding (50 versus 23%) and the colonoscopic finding was more likely to reveal adenomatous tissue in the positive group (58.3 versus 23.1%, p=0.11). Older patients were significantly more likely to take ASA which may have reduced the polyp number in this group and they also have an decreased BMI (p<0.02). In the entire group Adnab-9 positivity correlated with BMI as a continuous variable (U=0.03; p<0.01). Conclusions: Adnab-9 is an independent CRC risk marker in patients <50 years of age suggesting that they are more prone to development of neoplasia. The mechanism appears to be that of an adenoma-carcinoma sequence. ASA may be a factor but was not an independent mitigating marker in this study. BMI is also greater in the younger group and may be the underlying cause of the observed increase in neoplasia in the young. Adnab-9 staining of sigmoidoscopic rectal biopsies may be a convenient way of identifying a high-risk population of patients <50 years of age for CRC surveillance in this population hithertofore not afforded screening.Parameter (n)Patients <50 (25)Patients >50 (220)Age(mean+st.deviationSD)44.8 (5.4)62.4 (9.3)% Non-Hispanic Whites4041.4% Female Gender60 (OR 11.0, CI 4.4-27.2; p<0.0001)10.9Any NSAID/Statin/ASA(%)30.4/44/41.18/4.6 (less ASA-p<0.02)37.6/46.6/30.5Symptom %/BMI(SD)60/31.6(6.1) (BMI p<0.02)*42.9/28.7(5.4)
Citation Format: {Authors}. {Abstract title} abstract. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2905.
To improve diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in solid pancreatic lesions, on-site cytology review has been recommended. Because this is not widely ...available throughout the world, the aim of this study was to compare the diagnostic yield of EUS-FNA performed with rapid on-site evaluation (ROSE) versus 7 FNA passes without ROSE in pancreatic masses.
In this multicenter randomized noninferiority trial, patients were randomized to ROSE versus 7 passes into a solid pancreatic mass. On the basis of the absolute difference in diagnostic yield with 7 passes versus cytopathologist-guidance, the noninferiority margin for the difference in diagnostic yield was defined as -15%. Definite diagnosis was defined to include positive for malignancy, neoplastic cells present, and negative for malignancy.
A total of 142 patients were randomized with 73 in the cytopathologist arm and 69 in the 7 passes arm. Diagnostic yield for definite diagnosis was 78.3% with 7 passes and 78.1% with cytopathology guidance. With an absolute difference 0.2%, 95% CI -14.4 to 14.6, performing 7 passes was noninferior to cytopathologist-guided EUS-FNA. There was no significant difference in complications or time to perform FNA. A median of 5 passes were performed with ROSE. The median charge with onsite cytopathology was significantly greater than performing 7 passes $1058 (958, 1445) versus $375 (275, 460), p<0.001.
The diagnostic yield for performing 7 passes during EUS-FNA into solid pancreatic masses is noninferior with lower charge compared to cytopathologist-guidance. This article is protected by copyright. All rights reserved.
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