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Article ; Online: Ablative Therapies for Locally Advanced Pancreatic Cancer.

Shah, Rupen / Ostapoff, Katherine T / Kuvshinoff, Boris / Hochwald, Steven N

2017 Volume 47, Issue 1, Page(s) 6–11

Abstract: The vast majority of patients who present with pancreatic adenocarcinoma have locally advanced or metastatic disease at the time of presentation without possibility of cure. Although in recent years there have been some new promising chemotherapy ... ...

Abstract	The vast majority of patients who present with pancreatic adenocarcinoma have locally advanced or metastatic disease at the time of presentation without possibility of cure. Although in recent years there have been some new promising chemotherapy regimens that improve overall survival by a few months, the prognosis remains dismal. There is, however, a subset of patients who experience durable stable disease or partial responses after initial courses of chemotherapy with locally advanced disease. In these select patients, there remains interest in local ablative therapy with or without resection as a means for local control, palliation of symptoms, and possible improved survival. This review describes the techniques, complications, and expected benefits of several ablative techniques as a treatment modality for locally advanced pancreatic cancer.
MeSH term(s)	Ablation Techniques/methods ; Adenocarcinoma/surgery ; Catheter Ablation/methods ; Electroporation/methods ; Humans ; Pancreas/pathology ; Pancreas/surgery ; Pancreatic Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2017-12-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632831-3
ISSN	1536-4828 ; 0885-3177
ISSN (online)	1536-4828
ISSN	0885-3177
DOI	10.1097/MPA.0000000000000948
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Article ; Online: Risk-stratified analysis of pasireotide for patients undergoing pancreatectomy.

Peng, June S / Joyce, Daniel / Brady, Maureen / Groman, Adrienne / Attwood, Kristopher / Kuvshinoff, Boris / Hochwald, Steven N / Kukar, Moshim

Journal of surgical oncology

2020 Volume 122, Issue 2, Page(s) 195–203

Abstract: Background and objectives: Pasireotide was shown in a randomized trial to decrease the rate of postoperative pancreatic fistula (POPF). However, retrospective series from other centers have failed to confirm these results.: Methods: Patients who ... ...

Abstract	Background and objectives: Pasireotide was shown in a randomized trial to decrease the rate of postoperative pancreatic fistula (POPF). However, retrospective series from other centers have failed to confirm these results. Methods: Patients who underwent pancreatoduodenectomy or distal pancreatectomy between January 2014 and February 2019 were included. Patients treated after November 2016 routinely received pasireotide and were compared to a retrospective cohort. Multivariate analysis was performed for the outcome of clinically relevant POPF (CR-POPF), with stratification by fistula risk score (FRS). Results: Ninety-nine of 300 patients received pasireotide. The distribution of high, intermediate, low, and negligible risk patients by FRS was comparable (P = .487). There were similar rates of CR-POPF (19.2% pasireotide vs 14.9% control, P = .347) and percutaneous drainage (12.1% vs 10.0%, P = .567), with greater median number of drain days in the pasireotide group (6 vs 4 days, P < .001). Multivariate modeling for CR-POPF showed no correlation with operation or pasireotide use. Adjustment with propensity weighted models for high (OR, 1.02, 95% CI, 0.45-2.29) and intermediate (OR, 1.02, CI, 0.57-1.81) risk groups showed no correlation of pasireotide with reduction in CR-POPF. Conclusions: Pasireotide administration after pancreatectomy was not associated with a decrease in CR-POPF, even when patients were stratified by FRS.
MeSH term(s)	Aged ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreatectomy/statistics & numerical data ; Pancreatic Fistula/epidemiology ; Pancreatic Fistula/etiology ; Pancreatic Fistula/prevention & control ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Pancreaticoduodenectomy/statistics & numerical data ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Precancerous Conditions/surgery ; Randomized Controlled Trials as Topic ; Retrospective Studies ; Risk ; Somatostatin/administration & dosage ; Somatostatin/analogs & derivatives
Chemical Substances	Somatostatin (51110-01-1) ; pasireotide (98H1T17066)
Language	English
Publishing date	2020-05-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.25949
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Article ; Online: Evolving ablative therapies for hepatic malignancy.

Singla, Smit / Hochwald, Steven N / Kuvshinoff, Boris

BioMed research international

2014 Volume 2014, Page(s) 230174

Abstract: The liver is a common site for both primary and secondary malignancy. Hepatic resection and transplantation are the two treatment modalities that have been shown to achieve complete cure, but only 10 to 20% of patients are candidates for these treatments. ...

Abstract	The liver is a common site for both primary and secondary malignancy. Hepatic resection and transplantation are the two treatment modalities that have been shown to achieve complete cure, but only 10 to 20% of patients are candidates for these treatments. For the remaining patients, tumor ablation has emerged as the most promising alternative modality. In addition to providing local control and improving survival outcomes, tumor ablation also helps to down stage patients for potential curative treatments, both alone as well as in combination with other treatments. While tumor ablation can be achieved in multiple ways, the introduction of newer ablative techniques has shifted the focus from palliation to potentially curative treatment. Because the long-term safety and survival benefits are not substantive at present, it is important that we strive to evaluate the results from these studies using appropriate comparative outcome methodologies.
MeSH term(s)	Disease-Free Survival ; Humans ; Liver Neoplasms/mortality ; Liver Neoplasms/therapy ; Survival Rate
Keywords	covid19
Language	English
Publishing date	2014-04-29
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2698540-8
ISSN	2314-6141 ; 2314-6133
ISSN (online)	2314-6141
ISSN	2314-6133
DOI	10.1155/2014/230174
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Article: Immune profiling and immunotherapeutic targets in pancreatic cancer.

Lenzo, Felicia L / Kato, Shumei / Pabla, Sarabjot / DePietro, Paul / Nesline, Mary K / Conroy, Jeffrey M / Burgher, Blake / Glenn, Sean T / Kuvshinoff, Boris / Kurzrock, Razelle / Morrison, Carl

Annals of translational medicine

2021 Volume 9, Issue 2, Page(s) 119

Abstract: Background: Immunotherapeutic approaches for pancreatic ductal adenocarcinoma (PDAC) are less successful as compared to many other tumor types. In this study, comprehensive immune profiling was performed in order to identify novel, potentially ... ...

Abstract	Background: Immunotherapeutic approaches for pancreatic ductal adenocarcinoma (PDAC) are less successful as compared to many other tumor types. In this study, comprehensive immune profiling was performed in order to identify novel, potentially actionable targets for immunotherapy. Methods: Formalin-fixed paraffin embedded (FFPE) specimens from 68 patients were evaluated for expression of 395 immune-related markers (RNA-seq), mutational burden by complete exon sequencing of 409 genes, PD-L1 expression by immunohistochemistry (IHC), pattern of tumor infiltrating lymphocytes (TILs) infiltration by CD8 IHC, and PD-L1/L2 copy number by fluorescent in situ hybridization (FISH). Results: The seven classes of actionable genes capturing myeloid immunosuppression, metabolic immunosuppression, alternative checkpoint blockade, CTLA-4 immune checkpoint, immune infiltrate, and programmed cell death 1 (PD-1) axis immune checkpoint, discerned 5 unique clinically relevant immunosuppression expression profiles (from most to least common): (I) combined myeloid and metabolic immunosuppression [affecting 25 of 68 patients (36.8%)], (II) multiple immunosuppressive mechanisms (29.4%), (III) PD-L1 positive (20.6%), (IV) highly inflamed PD-L1 negative (10.3%); and (V) immune desert (2.9%). The Wilcoxon rank-sum test was used to compare the PDAC cohort with a comparison cohort (n=1,416 patients) for the mean expressions of the 409 genes evaluated. Multiple genes including TIM3, VISTA, CCL2, CCR2, TGFB1, CD73, and CD39 had significantly higher mean expression versus the comparison cohort, while three genes (LAG3, GITR, CD38) had significantly lower mean expression. Conclusions: This study demonstrates that a clinically relevant unique profile of immune markers can be identified in PDAC and be used as a roadmap for personalized immunotherapeutic decision-making strategies.
Language	English
Publishing date	2021-01-25
Publishing country	China
Document type	Journal Article
ZDB-ID	2893931-1
ISSN	2305-5847 ; 2305-5839
ISSN (online)	2305-5847
ISSN	2305-5839
DOI	10.21037/atm-20-1076
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Article: Gemcitabine and capecitabine for advanced biliary cancer.

Gabriel, Emmanuel / Gandhi, Shipra / Attwood, Kristopher / Kuvshinoff, Boris / Hochwald, Steven / Iyer, Renuka

Journal of gastrointestinal oncology

2017 Volume 8, Issue 4, Page(s) 728–736

Abstract: Background: Gemcitabine with capecitabine (gem-cap) is an established regimen for advanced biliary cancer (ABC) supported by our previously reported phase II trial. Here, we provide our updated experience.: Methods: Single institution, retrospective ... ...

Abstract	Background: Gemcitabine with capecitabine (gem-cap) is an established regimen for advanced biliary cancer (ABC) supported by our previously reported phase II trial. Here, we provide our updated experience. Methods: Single institution, retrospective study from 2005 to 2015 of ABC treated with gem-cap. Results: A total of 372 patients with ABC were identified, of whom 227 (61.0%) were treated with chemotherapy. 153 patients (67.4%) received gem-cap, of which 129 (56.8%) received it in the first line. Thirty two point six percent (42/129) were locally advanced, 67.4% (87/129) had metastatic disease, and 18.6% (24/129) received it as adjuvant therapy. Disease sites included 48.8% [63] intrahepatic cholangiocarcinoma (IHCC), 24.0% [31] extrahepatic cholangiocarcinoma (EHCC) and 27.1% [35] gallbladder carcinoma (GBC). Median follow-up was 49.7 months (mo). The median PFS and OS were 8.0 mo [95% confidence intervals (CI): 6.0-9.3] and 13.0 mo (95% CI: 10.7-17.4), respectively. Overall, 53.5% (69/129) experienced a grade 3/4 toxicity. The most common (35.7%) was a hematologic toxicity (neutropenia or thrombocytopenia) followed by infection (25.6%). Conclusions: Gem-cap provides similar survival outcomes to gemcitabine/cisplatin based on historical comparison to the ABC-2 trial (median PFS =8.0 mo and OS =11.7 mo). Gem-cap may offer the advantage of fewer adverse events compared to the levels reported in ABC-2 (grade 3/4 events 70.7%).
Language	English
Publishing date	2017-08-23
Publishing country	China
Document type	Journal Article
ZDB-ID	2594644-4
ISSN	2219-679X ; 2078-6891
ISSN (online)	2219-679X
ISSN	2078-6891
DOI	10.21037/jgo.2017.01.24
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Article ; Online: Does adjuvant therapy improve overall survival for stage IA/B pancreatic adenocarcinoma?

Ostapoff, Katherine T / Gabriel, Emmanuel / Attwood, Kristopher / Kuvshinoff, Boris W / Nurkin, Steven J / Hochwald, Steven N

HPB : the official journal of the International Hepato Pancreato Biliary Association

2017 Volume 19, Issue 7, Page(s) 587–594

Abstract: Background: Current guidelines recommend adjuvant chemotherapy for resected pancreatic adenocarcinoma (PDAC). However, no studies have addressed its survival benefit for stage I patients as they comprise <10% of PDAC.: Methods: Using the NCDB 2006- ... ...

Abstract	Background: Current guidelines recommend adjuvant chemotherapy for resected pancreatic adenocarcinoma (PDAC). However, no studies have addressed its survival benefit for stage I patients as they comprise <10% of PDAC. Methods: Using the NCDB 2006-2012, resected PDAC patients with stage I disease who received adjuvant therapy (chemotherapy or chemoradiation) were analyzed. Factors associated with overall survival (OS) were identified. Results: 3909 patients with resected stage IA or IB PDAC were identified. Median OS was 60.3 months (mo) for stage IA and 36.9 mo for IB. 45.5% received adjuvant chemotherapy; 19.9% received adjuvant chemoradiation. There was OS benefit for both stage IA/IB patients with adjuvant chemotherapy (HR = 0.73 and 0.76 for IA and IB, respectively, p = 0.002 and <0.001). For patients with Stage IA disease (n = 1,477, 37.8%), age ≥70 (p < 0.001), higher grade (p < 0.001), ≤10 lymph nodes examined (p = 0.008), positive margins (p < 0.001), and receipt of adjuvant chemoradiation (p = 0.002) were associated with worse OS. For stage IB patients (n = 2,432, 62.2%), similar associations were observed with the exception of adjuvant chemoradiation whereby there was no significant association (p = 0.35). Conclusion: Adjuvant chemotherapy was associated with an OS benefit for patients with stage I PDAC; adjuvant chemoradiation was either of no benefit or associated with worse OS.
MeSH term(s)	Aged ; Antineoplastic Agents/adverse effects ; Antineoplastic Agents/therapeutic use ; Carcinoma, Pancreatic Ductal/drug therapy ; Carcinoma, Pancreatic Ductal/mortality ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/surgery ; Chemoradiotherapy, Adjuvant ; Chemotherapy, Adjuvant ; Chi-Square Distribution ; Databases, Factual ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Pancreatectomy ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Proportional Hazards Models ; Risk Factors ; Time Factors ; Treatment Outcome ; United States
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2017-04-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2017.03.002
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Article: The role of local excision in invasive adenocarcinoma of the ampulla of Vater.

Platz, Timothy / Bain, Andrew / Kuvshinoff, Boris

Journal of gastrointestinal oncology

2012 Volume 4, Issue 1, Page(s) 1–2

Language	English
Publishing date	2012-09-26
Publishing country	China
Document type	Journal Article
ZDB-ID	2594644-4
ISSN	2219-679X ; 2078-6891
ISSN (online)	2219-679X
ISSN	2078-6891
DOI	10.3978/j.issn.2078-6891.2013.004
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Article: Preoperative survival calculator for resectable hepatocellular carcinoma.

Gabriel, Emmanuel / Kim, Jin / Ostapoff, Katherine T / Attwood, Kristopher / Kurenov, Sergei / Kuvshinoff, Boris / Hochwald, Steven N / Nurkin, Steven J

Journal of gastrointestinal oncology

2018 Volume 9, Issue 2, Page(s) 316–325

Abstract: Background: Estimation of preoperative overall survival (OS) of hepatocellular carcinoma (HCC) may guide surgical decision-making.: Methods: OS was analyzed using the National Cancer Data Base from 1998-2012. Patients with HCC who underwent wedge ... ...

Abstract	Background: Estimation of preoperative overall survival (OS) of hepatocellular carcinoma (HCC) may guide surgical decision-making. Methods: OS was analyzed using the National Cancer Data Base from 1998-2012. Patients with HCC who underwent wedge resection, lobectomy or extended lobectomy were selected. Patients who had metastatic disease or previous treatment prior to surgery were excluded. Data was randomly allocated to model building (n Results: HCC patients (n=5,455) who underwent curative resection had a median OS of 36 months (95% CI, 34-38 months) with 1- and 3-year OS of 73% (95% CI, 72-74%) and 50% (95% CI, 49-51%), respectively. The patient median age was 65, 66% of patients were male, median tumor size was 60 mm; clinical stage 1 =25%, stage 2 =30% and stage 3 =45%. Alpha fetoprotein (AFP) was elevated in 63% of patients. Factors significant in the prediction model included degree of resection, age, race, tumor size, grade, and histologic subtype. Conclusions: A preoperative OS calculator was developed to assist in the treatment evaluation and OS prediction of HCC patients.
Language	English
Publishing date	2018-05-07
Publishing country	China
Document type	Journal Article
ZDB-ID	2594644-4
ISSN	2219-679X ; 2078-6891
ISSN (online)	2219-679X
ISSN	2078-6891
DOI	10.21037/jgo.2017.12.03
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Article ; Online: Clinicopathological characteristics and outcomes of rare histologic subtypes of gallbladder cancer over two decades: A population-based study.

Samuel, Sandeep / Mukherjee, Sarbajit / Ammannagari, Nischala / Pokuri, Venkata K / Kuvshinoff, Boris / Groman, Adrienne / LeVea, Charles M / Iyer, Renuka

PloS one

2018 Volume 13, Issue 6, Page(s) e0198809

Abstract: Background: There is limited literature about the clinicopathological characteristics and outcomes of rare histologic variants of gallbladder cancer (GBC).: Methods: Using SEER database, surgically managed GBC patients with microscopically confirmed ... ...

Abstract	Background: There is limited literature about the clinicopathological characteristics and outcomes of rare histologic variants of gallbladder cancer (GBC). Methods: Using SEER database, surgically managed GBC patients with microscopically confirmed adenocarcinoma, adenosquamous/squamous cell carcinoma and papillary carcinoma were identified from 1988 to 2009. Patients with second primary cancer and distant metastasis at presentation were excluded. The effect of clinicopathological variables on overall survival (OS) and disease specific survival (DSS) were analyzed using univariate and multivariate proportional hazards modeling. All associations were considered statistically significant at an alpha error of 0.01. Results: Out of 4738 cases, 217 adenosquamous/squamous (4.6%), 367 papillary (7.7%), and 4154 adenocarcinomas (87.7%) were identified. Median age was 72 years. Higher tumor grade (grade 2, 3, 4 versus grade 1), higher T stage (T2, T3, T4 versus T1), lymph node positivity (N1 versus N0) and adenosquamous/squamous histology (versus adenocarcinoma) had worse OS and DSS (p < .001). Papillary GBC had better OS and DSS than adenocarcinoma (HR = 0.7; p < .001). Radical surgery (versus simple cholecystectomy) had better OS (HR = 0.83, p = 0.002) in multivariate analysis. OS rates at 3 and 5 years were 0.56 and 0.44 for papillary, 0.3 and 0.22 for adenocarcinoma, and 0.14 and 0.12 for adenosquamous/squamous histology, while DSS rates at 3 and 5 years were 0.67 and 0.61 for papillary, 0.38 and 0.31 for adenocarcinoma, and 0.17 and 0.16 for adenosquamous/squamous subtypes respectively. Conclusion: Papillary GBC had better survival outcomes while adenosquamous/squamous GBC had worse survival outcomes compared to gallbladder adenocarcinoma.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma, Papillary/pathology ; Aged ; Carcinoma, Squamous Cell/pathology ; Databases, Factual ; Female ; Gallbladder Neoplasms/mortality ; Gallbladder Neoplasms/pathology ; Humans ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Male ; Multivariate Analysis ; Neoplasm Staging ; Retrospective Studies
Language	English
Publishing date	2018-06-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0198809
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Article: Surgical therapy of liver metastases.

Kuvshinoff, Boris / Fong, Yuman

Seminars in oncology

2007 Volume 34, Issue 3, Page(s) 177–185

Abstract: The liver is the most common site of metastatic disease from both gastrointestinal and extra-intestinal malignancies. Historically, only a minority of patients with colorectal liver metastases were candidates for resection. However, over the past several ...

Abstract	The liver is the most common site of metastatic disease from both gastrointestinal and extra-intestinal malignancies. Historically, only a minority of patients with colorectal liver metastases were candidates for resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for hepatic colorectal metastases. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Selected patients with isolated liver metastases from neuroendocrine tumors, germ cell cancers, ocular melanoma, gastrointestinal stromal tumors (GIST), and breast cancer also may be considered for hepatic surgery.
MeSH term(s)	Antineoplastic Combined Chemotherapy Protocols/administration & dosage ; Carcinoma, Neuroendocrine/secondary ; Carcinoma, Neuroendocrine/surgery ; Carcinoma, Neuroendocrine/therapy ; Catheter Ablation ; Chemotherapy, Cancer, Regional Perfusion ; Colorectal Neoplasms/pathology ; Gastrointestinal Neoplasms/pathology ; Hepatectomy/methods ; Hepatectomy/trends ; Humans ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Liver Neoplasms/therapy ; Neoadjuvant Therapy ; Patient Selection
Language	English
Publishing date	2007-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	189220-4
ISSN	1532-8708 ; 0093-7754
ISSN (online)	1532-8708
ISSN	0093-7754
DOI	10.1053/j.seminoncol.2007.03.003
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