S2030 The Prevalence of Low Fecal Elastase Among Patients With Pancreatic Adenocarcinoma
Notice bibliographique
Résumé
Introduction: Pancreatic adenocarcinoma (PDAC) accounts for approximately 3% of all cancers in the United States. PDAC is often diagnosed at an advanced stage, leading to poor prognosis and high mortality rates. About 1% of patients with diabetes mellitus (DM) aged >= 50 years will be diagnosed with PDAC within 3 years and this is believed to be due to exocrine dysfunction from PDAC. A low fecal elastase is associated with exocrine dysfunction of the pancreas. We hypothesize that a low fecal elastase, either alone or in combination with glycemic indices, could enrich the population at risk for PDAC, enabling earlier detection. Methods: We retrospectively analyzed the characteristics and outcomes of PDAC patients at all Mayo Clinic sites who had fecal elastase levels checked. The study population consisted of 66 PDAC patients, categorized based on their fecal elastase (FE) levels: < 200 μg/g (suggestive of EPI) and >200 μg/g. We assessed various demographic, clinical, and treatment-related variables. 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. Results: Among the 66 PDAC patients, 49 (74.2%) had fecal elastase < 200 μg/g while 17 (25.8%) had levels >200 μg/g. Mean age at diagnosis was 64.8 years, with females accounting for 51.5% of the study sample. About 91% of study participants were White. Mortality rate was 50.0%, with a mean survival of 3.2 years. Diabetes was present in 48.5% of patients, predominantly type 2 (90.0%). Mean hemoglobin A1C (HbA1C) and fasting blood glucose (FBG) were 8.0% and 161 mg/dl respectively. Pancreatic enzyme replacement therapy was used by 78.8% of patients. 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. Imaging confirmed a cancer mass in 97.0% of patients, with tumor locations primarily in the head (53.0%), body (24.2%), and tail (13.7%) of the pancreas. The majority of patients were diagnosed at AJCC stage 4 (37.9%) or with metastatic disease (42.4%). Surgery was performed in 45.5% of patients, while 78.8% received chemotherapy, with or without radiation therapy. Conclusion: The prevalence of a low fecal elastase in PDAC patients is high and could serve as a biomarker for early detection. More research is needed to explore the interactions between fecal elastase and glycemic indices in patients with PDAC (Table 1). Table 1. - Fecal elastase testing in patients with pancreatic adenocarcinoma Total number of PDAC patients 66 Fecal elastase < 200 49 (74.2%) Fecal elastase >200 17 (25.8%) Age at diagnosis, mean (sd) 64.8 (10.9) years Fecal elastase collection date After PDAC diagnosis 60 (90.9%) Mean PDAC diagnosis to FE level 21.1 months Female 34 (51.5%) Race White 60 (90.9%) Asian 3 (4.6%) Hispanic 2 (3.0%) Black 1 (1.5%) Mortality 32 (50.0%) Survival, mean (sd) 3.2 (3.3) years Survival categories 2-year survival 37 (56.1%) 5-year survival 10 (15.2%) BMI, mean (sd) 24.9 (5.9) Diabetes 32 (48.5%) Type 2 27 (90.0%) Type 1 3 (10.0%) Hemoglobin A1C, mean (sd) 8.0% (2.4%) Fasting glucose, mean (sd) 161 (49.4) mg/dl Receiving diabetes treatment 29 (90.6%) Acute pancreatitis 14 (21.2%) Chronic pancreatitis 4 (6.2%) Family history of pancreatic cancer 5 (7.6%) Tobacco use Never 38 (57.6%) Former 23 (34.8%) Active 5 (7.6%) Alcohol use Never 40 (60.6%) Former 8 (12.1%) Active 18 (27.3%) Fecal elastase, mean (sd) 151.8 (161.8) μg/g Fecal elastase indications Bloating 1 (1.5%) Diarrhea 39 (59.1%) Weight loss 21 (31.8%) Abdominal pain 6 (9.1%) Pancreatic enzyme replacement 52 (78.8%) Pancreas imaging CT scan 49 (74.2%) MRCP 9 (13.6%) MRI abdomen 14 (21.2%) EUS 48 (72.7%) Imaging findings Cancer mass 64 (97.0%) Acute pancreatitis 3 (4.6%) Chronic pancreatitis 2 (3.0%) Pancreatic cyst 5 (7.6%) IPMN 7 (10.6%) Main PD dilation 19 (28.8%) Tumor location Head 35 (53.0%) Body 16 (24.2%) Tail 9 (13.7%) Uncinate process 5 (7.6%) Multiple locations 1 (1.5%) FNA/biopsy confirmed 61 (92.4%) AJCC Stage Stage 1 10 (15.2%) Stage 2 10 (15.2%) Stage 3 16 (24.2%) Stage 4 25 (37.9%) Unspecified 5 (7.5%) Clinical stage Early 17 (25.8%) Locally advanced 21 (31.8%) Metastatic 28 (42.4%) Surgery 30 (45.5%) Chemo +/- RT 52 (78.8%)
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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 | 0,000 | 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 | 0,000 | 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) | 0,004 | 0,001 |
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 ».