S198 Impact of Low Fecal Elastase Level on Pancreatic Adenocarcinoma Outcomes: A Mayo Clinic Study
Notice bibliographique
Résumé
Introduction: Exocrine pancreatic dysfunction leading to diabetes mellitus (DM) frequently occurs prior to diagnosis with pancreatic adenocarcinoma (PDAC). However, due to population prevalence of DM, it is impractical to use changes in glycemic indices as biomarkers for PDAC. We hypothesize that exocrine dysfunction leading to a low fecal elastase impacts PDAC outcomes. Methods: We performed a retrospective chart review of patients over 18 years diagnosed with PDAC with actual fecal elastase (FE) levels at all Mayo clinic sites. Patients with cystic fibrosis, celiac disease, Roux-en-Y bypass or pancreatic resection were excluded. Outcomes of patients with PDAC and FE-1 < 200 mcg/g were compared to those of patients with PDAC and FE-1 >200 mcg/g. Continuous variables were expressed as means and standard deviations and compared with the independent sample Students' T-test. Categorical variables were expressed as percentages and compared using Chi-squared testing. Two-tailed P-value of 0.05 was used to test for statistical significance. The primary outcome of overall survival and secondary outcomes of receipt of surgery, chemoradiation therapy and mortality were compared between groups using multivariable regression modeling. Results: Among 66 PDAC patients, 49 (74.2%) had fecal elastase < 200 μg/g while 17 (25.8%) had levels >200 μg/g. Average age at diagnosis was 64.8 years. Fecal elastase (FE) indications included diarrhea (59.1%), weight loss (31.8%), abdominal pain (9.1%), and bloating (1.5%). The mean FE was 151.8 μg/g and 51.5% were female. On univariate analysis, no difference was seen in average survival among patients with FE < 200 vs those with FE >200 (3.2 years vs 3.5 years, P=0.71). The same trend was seen in other secondary outcomes including receipt of surgery (44.9% vs 47.1%, P=0.88), chemotherapy/radiation therapy (83.7% vs 64.7%, P=0.16). Two-year survival and 5-year survival were comparable between both groups of patients P=0.52). On multivariable analysis, compared to those with FE< 200, patients with FE >200 had no increased odds of surgery (adjusted odds ratio [aOR]=1.49,P=0.774), hemotherapy/radiation (aOR 2.07, 95% confidence interval 0.23-18.37, P=0.5) or death (AOR 0.69, 95% CI 0.13-3.68, P=0.66). Survival curve is attached in Figure 1. Conclusion: Patients with PDAC and FE-1 >200 mcg/g may have longer survival compared with those with FE-1 < 200 mcg/g but this did not meet statistical significance. More research is needed to assess the impact of low FE-1 on PDAC outcomes (see Table 1).Figure 1.: Nonparametric survival analysis - Kaplan-Meier survival analysis. EPI 1: Fecal elastase < 200: 75% survival at 0.9 years (11 months), 50% survival at 2.25 years (27 months) and 25% survival at 4.0 years (48 months). EPI 2: Fecal elastase > 200: 75% survival at 1.25 years (15 months), 50% survival at 2.75 years (33 months) and 25% survival at 5.0 years (60 months). Table 1. - A. Adjusting for significant EPI covariates (location and tumor stage) B. Adjusting for significant survival covariates (age at diagnosis, PERT, tobacco, location, AJCC stage and surgery) Univariate Analysis Outcomes HeaderVariable All patients Fecal Elastase <200 Fecal elastase >200 P-value Surgery 30 (45.5%) 22 (44.9%) 8 (47.1%) 0.8775 Chemotherapy +/- RT 52 (78.8) 41 (83.7%) 11 (64.7%) 0.1651 Mortality 32 (50.0%) 23 (46.9%) 10 (58.8%) 0.3984 Survival, mean (SD) 3.2 (3.3) yrs 3.2 (3.4) yrs 3.5 (3.1) yrs 0.710 Survival categories 0.5281 2-year survival 37 (56.1%) 27 (55.1%) 10 (58.8%) 5-year survival 10 (15.2%) 6 (12.2%) 4 (23.5%) Multivariate Analysis Outcomes Variable Fecal Elastase <200 vs >200 adjusted OR (95% CI P-valuea Surgery 1.49 (0.1-22.5) 0.774 Chemotherapy +/- RT 2.07 (0.23 – 18.37) 0.514 Mortality 0.69 (0.13 – 3.68) 0.659 aMean (95% CI) P-valueb Survival 1.1 years (-0.6 – 2.8 years) 0.220
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».