Publications by authors named "Lafaro K"
Unlabelled: Pancreatic ductal adenocarcinoma (PDAC) carries an extremely poor prognosis, in part resulting from cellular heterogeneity that supports overall tumorigenicity. Cancer associated fibroblasts (CAF) are key determinants of PDAC biology and response to systemic therapy. While CAF subtypes have been defined, the effects of patient-specific CAF heterogeneity and plasticity on tumor cell behavior remain unclear.
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- This study investigates early recurrence in patients with pancreatic ductal adenocarcinoma (PDAC) derived from intraductal papillary mucinous neoplasm (IPMN), aiming to identify predictors to help guide patient management.
- The research found that early recurrence is defined as occurring within 10.5 months post-surgery, affecting 38% of patients who experienced recurrence, with CA19-9 levels and N2 disease being significant predictors.
- Adjuvant chemotherapy showed a survival advantage only for high-risk patients, highlighting the importance of risk stratification for better treatment outcomes.
Current Endoscopic and Surgical Management of Pancreatic Cystic Lesions: A Comprehensive Review.
Turk J Gastroenterol
November 2024
Article Synopsis
- Pancreatic cystic lesions (PCLs) are commonly found during medical imaging, with their occurrence increasing as people age, making accurate identification of their type and cancer risk vital for treatment.
- Advanced endoscopic techniques, such as ultrasound and biopsy methods, allow for more precise diagnosis and management of PCLs, guiding clinicians on whether to monitor or operate.
- This review aims to summarize existing research on the endoscopic and surgical approaches to PCLs, examining their advantages, challenges, and future developments to assist healthcare professionals in their decision-making process.
Article Synopsis
- The study focuses on pancreatic acinar cell carcinoma (pACC), a rare type of pancreatic cancer, highlighting its clinical characteristics, genetic mutations, and patient survival outcomes.
- A total of 61 patients who underwent surgery between 1999 and 2022 were analyzed, showing a median overall survival of 73 months and a recurrence-free survival of 22 months; those with oligometastatic disease had even better outcomes.
- Significant genetic findings included mutations in core genes related to DNA repair pathways in 26% of patients, indicating potential avenues for targeted treatment.
Purpose: Dynamics of carbohydrate antigen 19-9 (CA19-9) often inform treatment decisions during and after neoadjuvant chemotherapy (NAT) of patients with pancreatic ductal adenocarcinoma (PDAC). However, considerable dispute persists regarding the clinical relevance of specific CA19-9 thresholds and dynamics. Therefore, we aimed to define optimal thresholds for CA19-9 values and create a biochemically driven composite score to predict survival in CA19-9-producing patients with PDAC after NAT.
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- Improved surgical techniques and therapy have enabled more patients with oligometastatic colorectal cancer to qualify for surgery, but many still experience recurrence, which varies by site and outcome.
- A study of 195 patients who had liver metastasis resection revealed that the one-year recurrence-free survival was 46%, while overall survival rates were high at 95% for the same period; several prognostic factors for worse outcomes were identified.
- The findings highlight the need for further research to pinpoint patients at increased risk of recurrence, potentially guiding additional preventive treatment strategies.
Article Synopsis
- The study investigates whether total pancreatectomy (TP) provides better oncological outcomes than partial pancreatectomy (PP) for patients with high-risk IPMN-associated cancer, focusing on local recurrence and secondary progression.
- It compares data from 359 patients, showing that while TP offers improved local disease-free survival (local-DFS), there is no significant difference in overall survival (OS) between TP and PP.
- The findings suggest that TP could be more beneficial for younger patients who are likely to benefit from reduced recurrence risk, while elderly patients may not see the same advantage in OS.
Objective: To measure the rate of LTS in resected PDAC and determine the association between predictors of OS and LTS.
Summary Background Data: Long-term survival (>5 y, LTS) remains rare in pancreatic ductal adenocarcinoma (PDAC). Multiple predictors of overall survival (OS) are known but their association with LTS remains unclear.
Article Synopsis
- This study investigates the effectiveness of adjuvant chemotherapy for patients with pancreatic ductal adenocarcinoma (PDAC) derived from intraductal papillary mucinous neoplasm (IPMN), highlighting the need for tailored treatment approaches due to limited evidence on this specific type of cancer.
- In a cohort of 1,031 patients, factors like nodal disease and elevated levels of carbohydrate antigen 19-9 (CA19-9) were linked to worse overall survival, with high-risk patients showing significant survival benefits from adjuvant chemotherapy.
- The findings suggest that a significant portion of patients (approximately 79.3%) are either overtreated or undertreated, emphasizing the
Article Synopsis
- Researchers developed a new method for matching chemotherapy regimens to pancreatic cancer patients based on chemosensitivity data from patient-derived organoids (PDOs).
- In a study involving PDOs from 95 patients, the method successfully matched 91% of the organoids to standard chemotherapeutics and showed that well-matched patients had significantly better clinical outcomes, such as reduced tumor markers and improved survival rates.
- The findings suggest that using PDO pharmacotyping to customize chemotherapy could lead to better treatment strategies and outcomes for patients with pancreatic ductal adenocarcinoma.
A Confirmed Extrarenal Birt-Hogg-Dubé-Associated Oncocytic Neoplasm.
Am J Surg Pathol
September 2024
Article Synopsis
- * A case was reported involving an unusual tumor located between the duodenum and pancreas that couldn’t be classified with known cancers despite thorough testing.
- * This tumor showed characteristics suggesting it was caused by a loss of the FLCN gene, marking it as the first known extrarenal tumor linked to BHD associated with this genetic mutation.
Article Synopsis
- A study at Johns Hopkins Hospital compared outcomes of patients who received neoadjuvant immunotherapy before surgery with those who had upfront resection; 36 of the 92 patients received the immunotherapy.
- The results showed that patients who underwent neoadjuvant immunotherapy had similar resection margins and recurrence-free survival rates compared to those who had upfront surgery, suggesting that this approach might help high-risk patients achieve comparable outcomes.
Background: Minimally invasive pancreatic surgery (MIPS), when selectively utilized, has been shown to hasten recovery with outcomes comparable to open approaches, but access may not be equitable. This study explored variation in utilization of MIPS for pancreatic cancer.
Methods: The National Cancer Database was queried to identify patients diagnosed with a primary pancreatic neoplasm from 2010 to 2020.
Objectives: Although prevalent in 50%-90% of pancreatic ductal adenocarcinomas, the clinical relevance of "cancerization of ducts" (COD) remains unknown.
Methods: Pathologists retrospectively reviewed slides classifying prevalence of COD. Histopathological parameters, location of first recurrence, recurrence-free survival (RFS), and overall survival (OS) were collected from the institutional pancreatectomy registry.
Background: For open minor hepatectomy, morbidity and recovery are dominated by the incision. The robotic approach may transform this "incision dominant procedure" into a safe outpatient procedure.
Study Design: We audited outpatient (less than 2 midnights) robotic hepatectomy at 6 hepatobiliary centers in 2 nations to test the hypothesis that the robotic approach can be a safe and effective short-stay procedure.
Article Synopsis
- * This study features four patients who displayed specific non-cancerous conditions linked to stenosis of the duct, including unique fibrosis and chronic inflammation related to past injuries.
- * Notably, three out of the four patients had significant prior abdominal trauma from motor vehicle accidents, underscoring the long-term effects such injuries can have on the pancreas and the importance of correlating clinical history with pathology findings.
Background: Molecular profiling of intrahepatic cholangiocarcinoma (ICC) can detect actionable molecular alterations and guide targeted therapies. We explore the clinical use of molecular profiling of ICC in our comprehensive multidisciplinary clinic.
Study Design: Patients with a tissue diagnosis of ICC seen between 2019 and 2023 were identified.
Incidental pancreatic cysts are highly prevalent, with management dependent on the risk of malignant progression. Serous cystadenomas (SCAs) are the most common benign pancreatic cysts seen on imaging. They have typical morphological patterns but may also show atypical features that mimic precancerous and cancerous cysts.
View Article and Find Full Text PDFBackground: Main-duct (MD-) and mixed-type (MT-) IPMNs harbor an increased risk of pancreatic cancer and warrant surgical resection. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are important in the diagnosis of IPMNs. The aim of this study was to investigate whether endoscopic procedures manipulating the MD impact postoperative adverse events in patients with MD- and MT-IPMNs.
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- Health-related quality of life (HRQoL) is an important measure for patients with hepatocellular carcinoma (HCC) and serves as a prognostic indicator and clinical endpoint.
- This study explored the relationship between BCLC stage, Child-Pugh score, and ECOG performance status on HRQoL, using the FACT-Hep questionnaire for assessment.
- Findings revealed that while BCLC stages did not significantly correlate with HRQoL, patients with worse liver function (CP B) experienced a notable decline in quality of life, highlighting the need for further research on the effects of early supportive care interventions.
Background: Neoadjuvant therapy (NAT) is increasingly applied in pancreatic ductal adenocarcinoma (PDAC); however, accurate prediction of therapeutic response to NAT remains a pressing clinical challenge. Cancer-cell-derived sialylated immunoglobulin G (SIA-IgG) was previously identified as a prognostic biomarker in PDAC. This study aims to explore whether SIA-IgG expression in treatment-naïve fine needle aspirate (FNA) biopsy specimens could predict the pathological response (PR) to NAT for PDAC.
View Article and Find Full Text PDFUnlabelled: To compare liver cancer resectability rates before and during the COVID-19 pandemic.
Background: Liver cancers usually present with nonspecific symptoms or are diagnosed through screening programs for at-risk patients, and early detection can improve patient outcomes. In 2020, the COVID-19 pandemic upended medical care across all specialties, but whether the pandemic was associated with delays in liver cancer diagnosis is not known.
Background: T4 colon cancers have been underrepresented in randomized trials comparing minimally invasive colectomy (MC) versus open colectomy (OC). Retrospective studies suggest improved survival with MC versus OC, but have not addressed the impact of tumor extent.
Methods: Using the National Cancer Database (NCDB), we analyzed patients undergoing colectomy for T4 colon adenocarcinoma from 2010 to 2014.