Background The prognosis and recurrence patterns of early-diagnosed pancreatic ductal adenocarcinoma (PDAC), particularly following surgical resection, remain unclear. Methods This multicenter retrospective study analyzed patients who underwent surgical resection for PDAC between 2005 and 2023. Patients were categorized according to pathological stages 0, I, and II. Recurrence patterns and survival outcomes were compared among the three groups. Multivariate analysis was performed to identify independent risk factors for remnant pancreatic recurrence, including early-stage disease, postoperative follow-up of more than 5 years, and receipt of adjuvant chemotherapy. Results A total of 349 patients were included: 51 with stage 0, 77 with stage I, and 221 with stage II PDAC. The 5-year overall survival rates were 87%, 71%, and 49% for patients with stage 0, I, and II PDAC, respectively. Remnant pancreatic recurrence was observed in 10% of patients with stage 0 PDAC and 18% of patients with stage I PDAC, compared with 5% of those with stage II PDAC. Recurrence was significantly more frequent in stage I (P < 0.001) and tended to be higher in stage 0 (P = 0.062) than in stage II. Multivariate analysis identified pathological stage 0-I and postoperative follow-up of > 5 years as independent risk factors for remnant pancreatic recurrence. Conclusions Patients with early-stage PDAC exhibit a higher risk of remnant pancreatic recurrence than those with stage II disease. These findings underscore the importance of long-term pancreas-focused surveillance in early-stage PDAC to enable timely detection of late recurrence and potentially improve patients outcomes.
Background Group 2 pulmonary hypertension (PH), defined as PH caused due to left heart disease, remains a challenging condition. However, its prognostic impact and implications for emerging therapies are unclear. We aimed to evaluate the real‐world relationship between pulmonary vascular resistance (PVR) and prognosis in Group 2 PH and assess the efficacy of emerging therapies. Methods Two prospective registries supported by Japanese PH societies were analyzed: a current (2018–2024; n=563) and a previous (2012–2016; n=425) registry. The composite end points were hospitalization for heart failure, all‐cause death, ventricular assist device implantation, or cardiac transplantation. Results Stratified analyses using propensity score–matched data demonstrated a significant association between PVR >3 Wood units and prognosis in patients with Group 2 PH (6‐year event‐free rates, PVR >3 Wood units versus PVR ≦3 Wood units, previous registry: 72.9% versus 61.4%; current registry: 75.2% versus 55.4%). Consistent patterns were observed in both heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. The use of SGLT2 (sodium‐glucose cotransporter‐2) inhibitors in the current registry was associated with improved outcomes in patients with elevated PVR, showing event‐free rates of 73.8% versus 35.5% in those without treatment. Among multivariate analyses including major treatment options, SGLT2 inhibitor treatment exhibited significant associations with improvement of composite end points. Conclusions Elevated PVR (>3 Wood units) identified a high‐risk subset of patients with Group 2 PH. The association between the use of SGLT2 inhibitors and better outcomes suggests a potential therapeutic role that warrants further investigation through controlled studies.
8099 Background: Combination therapy with anti-PD-L1 monoclonal antibodies and chemotherapy (ICI-chemotherapy) is the current standard treatment for patients(pts) with extensive-stage small cell lung cancer (ES-SCLC). However, its safety and efficacy in older pts (≥ 71 years) remain limited. Given the pivotal role of geriatric assessment (GA) in the older care, prospective data remain scarce. This study aimed to clarify the efficacy and safety of ICI-chemotherapy in older pts and to evaluate the association between GA and survival. Methods: This multicenter prospective study enrolled pts ≥ 71 years with ES-SCLC who received atezolizumab plus carboplatin and etoposide as first-line therapy. The primary endpoint was 1-year survival rate (SR). Based on existing results, the expected value was 60%, the threshold was 40% (α-error = 0.1 [two-sided], power = 0.75). The calculated sample size was 32 pts. A pre-treatment G8 assessment was mandatory for all pts. Secondary endpoints included safety, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Results: Between August 2022 and March 2024, a total of 32 pts were enrolled: median age 77 years (range 71–83); male/female = 27/5; PS 0/1 = 8/24, G8 scores ≥12 /＜12 /not collected were 19/12/1. The 1-year SR was 62.5% (95% confidence interval [CI]: 43.5–76.7). Median OS was 14.6 months (95% CI: 8.2–23.3), median PFS was 5.0 months (95% CI; 4.2–5.9), and ORR was 84.4% (95% CI; 66.3–93.7). Median OS by G8 (score ≥12 vs < 12) was 15.4 vs 12.3 months. Cox regression analysis including clinically important factors for survival (age, PS, G8, bone and brain metastasis at diagnosis) identified brain (HR; 3.1, 95% CI: 1.06 to 8.87; p = 0.039) and bone metastases (HR 3.5, 95% CI: 1.20 to 10.1; p = 0.022) as an independent factor. grade ≥ 3 adverse events (AEs) occurred in 87.5% of pts, and dose reduction was required in 45.1%. The most frequent AE was neutropenia (93.8%); one treatment-related death (stroke) was reported. Conclusions: ICI-combined chemotherapy demonstrated efficacy comparable to that in existing studies, but greater caution was required regarding safety in older pts. While G8 status did not affect survival in SCLC pts, the presence of bone or brain metastasis at diagnosis was identified as an independent prognostic factor. Clinical trial information: jRCT1061200024.
Background: Leonis Mova is a steerable microcatheter that enables adjustment of the tip angle through a proximal manual dial. Although predominantly utilized as a distal access catheter in specific clinical scenarios, we present a case in which Leonis Mova was employed as the microcatheter for coil embolization of a ruptured wide-neck aneurysm in combination with an adjunctive technique. Case Description: An 88-year-old woman presented with sudden-onset headache and vomiting and was diagnosed with subarachnoid hemorrhage. Head computed tomography angiography revealed a left posterior inferior cerebellar artery aneurysm with a wide neck. Coil embolization was planned using the microcatheter protective technique. Under general anesthesia, a 4-Fr guiding sheath was inserted into the right vertebral artery (VA), and a microcatheter was delivered distal to the aneurysm’s parent artery through the contralateral VA approach to prevent coil herniation from the aneurysm neck. Subsequently, a 6-Fr guiding sheath was inserted into the left VA and a Leonis Mova Selective microcatheter was guided into the aneurysm sac. Four coils were deployed inside the aneurysm by adjusting the tip angle of Leonis Mova. Adequate aneurysm obliteration was successfully achieved without any perioperative complications. Conclusion: Leonis Mova may serve as a highly maneuverable and effective microcatheter for coil embolization of wide-neck aneurysms requiring complex adjunctive techniques.
