Short-term Recurrence-free Survival Research Articles

The impact of using Elsevier ClinicalPath oncology treatment pathways on survival and cost of care.

6620 Background: Cone Health is a 921 bed hospital system in North Carolina with a comprehensive cancer center. Our aim was to determine the value of using Elsevier’s ClinicalPath oncology pathways on short-term survival and cost of care from the patient and health system perspectives. Cancer treatment has become more complex as it progresses more toward precision medicine modalities. As such, clinical decision support tools, such as ClinicalPath, have gained traction. Health systems struggle to survive after the COVID pandemic, with residual financial impacts lingering into 2023. It is more important than ever before that health systems focus on value where the patient benefits and financial sustainability are improved. Methods: We used a retrospective cohort study design with matching. Exposure was the use of the ClinicalPath decision support tool in Epic (exposed) versus no use of the tool (not exposed). We matched on cancer body site, AJCC clinical stage, the goal of treatment, Elixhauser comorbidity score, and year of a cancer diagnosis. We were able to match 509 exposed to 509 unexposed. Our primary outcomes were 12-month survival from the time of the first treatment and contribution margin. We used a log-rank calculation based on our hazard ratios (Freedman method) to determine the sample size required for each group, assuming a power of 80%. We used a Weibull parametric model to assess 12-month survival with additional covariates. An OLS model was used to evaluate the contribution margin. Results: Results demonstrate that when ClinicalPath is used to guide treatment, patients are half as likely to die within 12 months from treatment compared to the unexposed (HR 0.50; 95% CI 0.37-0.68). The OLS contribution model found, on average, that margin has an associated 74.0% (0.74; 95% CI 0.58-0.90) increase when ClinicalPath is used to guide treatment compared to the unexposed. This equates to a crude increase in contribution margin for cancer treatment of $58,362, on average per case, when ClinicalPath is used. Variable direct costs are higher when using ClinicalPath. This means, on average, it costs more to treat patients on pathway using best available evidence. Still, they have better short-term survival and payers are covering the additional costs given the increase in contribution margin for our system. Conclusions: Short-term recurrence free survival is significantly improved when providers utilize ClinicalPath compared to not using the tool consistent with the primary aim of the CDS solution. Newer, more efficacious treatments may have higher initial costs, as expected. Still, the effectiveness of these treatments on survival in the real-world setting is born out in the current study. The higher initial direct costs are counterbalanced by a higher contribution margin per patient providing evidence that improved outcomes in cancer therapy can also provide a positive ROI for provider organizations.

Genome-Wide Profiling Reveals the Landscape of Prognostic Alternative Splicing Signatures in Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive lethal malignancy. Identification of potential alternative splicing (AS) prognostic indicators and related splicing pathways for the prediction of PDAC outcomes is lacking but urgently needed. A combined strategy of prognostic assessment and computational biology was performed to investigate survival-related AS signatures and their correlation with splicing factors. The prognostic signatures of each type were conducted according to the top 10 prognosis-related AS events, which were filtered through univariate Cox regression analysis. A time-dependent receiver operating characteristic curve was constructed to access the predictive accuracy of prognostic signatures. The independent predictors were identified using multivariate Cox regression analysis. Potential regulation mechanisms between splicing factors and splicing events were investigated through regulatory networks and correlation analyses. A total of 915 overall survival (OS) and 480 recurrence-free survival (RFS)-related AS events were identified in 120 patients with PDAC. The independent prognostic signatures for each type displayed favorable accuracy for the prediction of OS and short-term RFS [area under the curves were >0.6] except for the Exclusive Exons type. The splicing regulatory networks showed potential interactions between splicing factors and AS parent genes. Moreover, a positive relationship was detected among each splicing factor and Percent Spliced In values of prognostic signatures. Our results provide a view of the landscape of prognosis-related AS events and reveal the potential correlation between splicing factors and prognostic signatures, which may represent novel outcome-predictor markers and opportunities for targeted therapy for PDAC.

Pancreaticoduodenectomy with irreversible electroporation (IRE) Margin enhancement for borderline resectable pancreatic cancer

Background: Borderline resectable pancreatic adenocarcinoma (BRPC) remains a challenging surgical problem. Recently, irreversible electroporation (IRE) has shown promise as a safe adjunct to surgical resection in attempts to improve local control. Here we present a case-matched cohort of patients with BRPC undergoing pancreaticoduodenectomy with and without IRE margin enhancement to evaluate local recurrence and survival. Methods: A retrospective cohort analysis was performed on patients with BRPC. Patients who underwent pancreaticoduodenectomy and concurrent IRE (S-IRE) for margin enhancement were compared to a case-matched cohort who underwent pancreaticoduodenectomy alone (SR) based on demographic, tumor staging and resection margin status. Primary outcome measures included disease recurrence and overall survival. Results: Forty-one patients were included from 2013 to 2018, with 21 in the S-IRE group and 20 case-matched in the SR group. Recurrence-free survival was numerically better for the S-IRE group between 6 and 12 months but overall survival equilibrated by two years (26% vs 34%). There was no statistical difference between S-IRE and SR for medial overall survival (17.5 months vs 19 months) or median recurrence-free survival (15 vs 14.1 months). There was, however, a trend towards a decrease in local recurrence in the S-IRE group (29% vs 54%). Conclusion: This study demonstrated trends towards improvements in short-term recurrence-free survival and decreased local recurrence following margin enhancement with IRE. Results demonstrating a difference in overall survival were limited by loss to follow-up and restricted case matching. Ongoing accruement and continued surveillance will build on the promising trends presented here.

Effects of fluorescent light‐guided transurethral resection on non‐muscle‐invasive bladder cancer: a systematic review and meta‐analysis

What's known on the subject? and What does the study add? It was well known that FL-guided TURBT could reduce the residual rate of NMIBC, but our systematic review suggested that it was not superior to conventional WL-guided TURBT in diagnostic accuracy and it had no significant effect on short-term RFS and PFS. To assess the diagnostic accuracy and therapeutic outcomes of fluorescent light (FL)-guided transurethral resection (TUR) in non-muscle-invasive bladder cancer (NMIBC). A systematic search of PUBMED, EMBASE and Cochrane Library was performed to identify randomized controlled trials comparing the outcomes of FL- and white-light (WL)-guided TUR of bladder tumours (TURBT). Outcomes included tumour detection rate, false-positive diagnosis rate, carcinoma in situ (CIS) detection rate, residual tumour rate, recurrence-free survival (RFS) and progression-free survival (PFS). RevMan 5.1 software was used for the meta-analysis. Data from 14 studies, involving 4078 patients with suspected or proven NMIBC, were pooled and included in the meta-analysis. There was no significant difference in tumour detection rate (relative risk [RR] 0.99; 95% confidence interval [CI] 0.96-1.03; P = 0.64) and CIS detection rate (RR 0.82; 95% CI 0.67-1.02; P = 0.07) between the FL and the WL groups. The false-positive diagnosis rate of the FL group was higher than that of the WL group (RR 0.69; 95% CI 0.49-0.97; P = 0.03). The tumour residual rate was higher in the WL group than in the FL group (RR 2.77; 95% CI 1.47-5.02; P = 0.002). No significant differences were found between groups at 3-month follow-up (RR 1.15; 95% CI 0.79-1.66; P = 0.46) or 12-month follow-up (RR 0.86; 95% CI 0.70-1.06; P = 0.16) or in terms of either RFS or PFS at 12-month (RR 0.99; 95% CI 0.94-1.04; P = 0.57) and 24-month follow-up (RR 1.02; 95% CI 0.98-1.06; P = 0.35). FL-guided TURBT was not superior to conventional WL in diagnostic accuracy. Although FL-guided TURBT had an advantage in reducing the residual tumour rate, it had no significant effect on short-term RFS and PFS.