S198 Impact of Low Fecal Elastase Level on Pancreatic Adenocarcinoma Outcomes: A Mayo Clinic Study
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".