Chin Hur

Purpose: Pancreatic ductal adenocarcinoma (PDAC) has high rates of early recurrence (ER), occult metastasis, and poor survival despite curative-intent therapy. Predictive factors and models span clinical, biomarker, imaging, radiomics, pathologic, and molecular domains, but clinical readiness remains uncertain. Methods: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Five databases were searched for studies evaluating predictors or models of PDAC recurrence, metastasis, lymph node metastasis (LNM), occult metastatic disease, disease-free survival (DFS) or recurrence-free survival, or recurrence patterns. Studies were screened and coded for end point, modality, model type, validation, discrimination, calibration, clinical utility, and predictor timing. Results: Of 234 full-text records, 208 studies were included, comprising 144 prediction models and 64 predictor/prognostic factor studies. Computed tomography/radiomics (141/208), clinical/electronic health record variables (104/208), and serum/urine biomarkers (46/208) were the most common modalities. External validation, calibration, and decision-curve analyses were reported in 52, 36, and 38 model studies, respectively. AUCs ranged from 0.70 to 0.92 for ER, 0.75-0.95 for LNM, and 0.71-0.88 for liver or occult metastasis; DFS/relapse-free survival models had C-indices of 0.62-0.82. One externally validated occult-metastasis model had a C-statistic of 0.56. Model maturity was limited by retrospective design, heterogeneous end points, incomplete calibration reporting, and postoperative variables in preoperative models. Conclusion: Prediction models for PDAC recurrence and metastatic progression are rapidly expanding, particularly through radiomics, machine learning, and multimodal modeling. Clinical translation requires decision-aligned design, transparent reporting, external validation, calibration, interpretability, and prospective evaluation of clinical utility.

Background: Despite the frequent late-stage diagnosis of gastric cancer (GC), the United States lacks a routine GC screening program. Liquid biopsy (LB), specifically blood-based tests, has emerged as a potential screening approach, but it is unclear whether such a strategy is cost-effective. We, therefore, evaluated the cost-effectiveness of LB screening for GC in the United States. Methods: A Markov model was developed to compare no screening (current standard-of-care) and 2 LB-screening strategies. The study used a simulated cohort of 45-year-old individuals with average risk of GC. Primary model outcomes included life expectancy, quality-adjusted life-years (QALYs), total cost, and incremental cost-effectiveness ratios (ICERs). A strategy was considered cost-effective if the ICER was < the US willingness-to-pay threshold of $100 000 per quality-adjusted-life-year gained. Results: In the base-case analysis, LB screening strategies were not cost-effective, with an ICER of $917 826 per QALY gained. Screening became cost-effective for high-risk subpopulations or when the per-test cost was approximately $89. Conclusions: This economic evaluation of LB for GC screening found that while LB strategies are effective in reducing cancer incidence and mortality, they are not cost-effective due to high test costs. Our findings could help inform the potential planning of future clinical validation studies for LB tests used for GC screening.

AIM: To compare rural and urban trends in esophageal cancer (EC) incidence and mortality, including adenocarcinoma (EAC), squamous cell carcinoma (ESCC), and esophagogastric junction adenocarcinoma (EGJAC). METHODS: Joinpoint analysis of Surveillance, Epidemiology, and End Results (SEER) registries from 1992 through 2022. RESULTS: EAC incidence and mortality were greater in rural areas, with trends diverging around 1999. EGJAC incidence and mortality and ESCC incidence decreased in urban areas and had no significant trend in rural areas. CONCLUSION: There are substantial disparities in EC incidence and mortality trends by rurality. Understanding the cause of these trends could support cancer control efforts.

Electronic health record (EHR) prediction models often summarize longitudinal histories as static patient-level features, which may omit potentially informative event ordering. We developed a simplified spike-timing-dependent plasticity (STDP)-inspired framework that represents asynchronous EHR data as sparse, directional transition features. The approach encodes whether one clinical event precedes another within prespecified temporal windows, preserving event identity, directionality, and approximate timing while retaining feature-level interpretability. We evaluated this framework in two retrospective prediction tasks with different temporal scales: incident acute kidney injury (AKI) prediction in 17,351 MIMIC-IV ICU stays and early postoperative recurrence prediction in 713 CUMC patients with pancreatic ductal adenocarcinoma (PDAC). Models were compared with static burden features (demographics, comorbidities, raw lab measurements) and in addition with STDP transitional feature sets using patient-level cross-validation and rolling prediction horizons. In AKI, a calibrated STDP ensemble model showed higher discrimination than static burden alone at the 24-hour decision snapshot for AKI by 72 hours, with AUROC 0.838 versus 0.800, and at 48 hours for near-term AKI prediction, with AUROC 0.868 versus 0.827. In PDAC, STDP transition features modestly improved Day –30 preoperative recurrence prediction, with AUROC 0.611 versus 0.587 and AUPRC 0.323 versus 0.318 for static burden and showed similar performance at Day 0 (7 days before recorded surgery date), with AUROC 0.681 and AUPRC 0.363. Decision-curve and feature analyses suggested that selected temporal transitions were clinically interpretable across renal, inflammatory, hepatobiliary, hematologic, glycemic, and nutritional trajectories. These findings suggest that STDP-inspired transition features may provide a practical, interpretable way to incorporate temporal ordering into EHR-based risk prediction across both acute and longitudinal settings.

Purpose: The association between pre‐existing psychiatric disorders (PD) and gastric cancer outcomes has not been thoroughly investigated. This study evaluated whether PD, particularly serious pre‐existing psychiatric disorders (SPD), is associated with differences in gastric cancer stage at diagnosis, overall mortality, and cancer‐specific mortality. Methods: We conducted a retrospective cohort study using SEER‐Medicare data (2000–2017) to identify patients aged ≥ 68 years diagnosed with gastric cancer. PD was defined as a Medicare claim for depressive disorder, anxiety disorder, adjustment disorder, psychotic disorder, bipolar disorder, or schizophrenia occurring 6–36 months before cancer diagnosis. SPD included claims for psychotic disorder, bipolar disorder, schizophrenia, or major depressive disorder (MDD). Multinomial logistic regression was used to assess stage at diagnosis. Cox proportional hazards and Fine‐Gray subdistribution hazard models were used to assess overall and cancer‐specific mortality, respectively. Results: Among 15,882 patients, 1883 (12%) had PD. Patients with PD differed significantly from those with no pre‐existing psychiatric disorders (NPD) in terms of demographics, comorbidities, and cancer characteristics. Compared with NPD patients, those with PD were more likely to be diagnosed with early (in situ/local) stage cancer yet had higher overall mortality (aHR: 1.17, 95% CI [1.11, 1.23]) and cancer‐specific mortality (aSHR: 1.13, 95% CI [1.07, 1.21]). Patients with SPD also had higher risks of overall (aHR: 1.33, 95% CI [1.22, 1.45]) and cancer‐specific mortality (aSHR: 1.25, 95% CI [1.14, 1.38]). Conclusion: Our findings highlight critical differences in gastric cancer outcomes among patients with PD and SPD. Despite being more likely to be diagnosed with early‐stage cancer, these patients experienced worse survival.

INTRODUCTION: Potassium competitive acid blockers (PCABs) are superior to proton pump inhibitors (PPIs) for healing of Los Angeles (LA) class C/D erosive esophagitis and are approved for nonerosive gastroesophageal reflux disease (GERD) given their efficacy measured by heartburn-free days. However, they are more expensive than PPIs. We estimated the cost-effectiveness of PCABs compared with PPIs for the management of GERD. METHODS: A decision tree was constructed for the base case of a patient with GERD. We tested scenarios in which nonerosive reflux disease, LA A/B, or LA C/D esophagitis was present, comparing PCABs with PPIs as first-line therapy, including step up therapy and/or class switching if symptoms persisted. Using publicly available cost estimates, quality-adjusted life years (QALYs) were compared using a willingness-to-pay threshold of $100,000/QALY from a societal perspective at 6 months. RESULTS: The cost of PCABs for GERD was $3,240 more than PPIs, with an incremental cost-effectiveness ratio of $144,208/QALY. When evaluating GERD phenotypes separately, the incremental cost-effectiveness ratio was consistently over our willingness-to-pay threshold. One-way analyses showed the most influential parameters were PCAB cost and efficacy for heartburn-free days. Probabilistic sensitivity analysis favored PPIs 71.7% out of 100,000 iterations. Reducing one-week costs to below $91 would make PCABs a cost effective first-line strategy across all GERD phenotypes. DISCUSSION: Despite PCAB efficacy, PPIs are a cost-effective strategy for GERD treatment, and can be positioned ahead of PCAB escalation on this basis. Reducing PCAB costs or accepting a higher willingness-to-pay threshold would influence this finding, although PCABs may be favored in some current situations as evidenced by probabilistic sensitivity results.

Purpose Neoadjuvant chemotherapy (NACT) is often the preferred systemic treatment modality for advanced breast tumors. Delays in NACT initiation are associated with worse outcomes although it is unclear which patients are at the highest risk for delays and whether these delays impact pathologic complete response (pCR). We sought to determine the incidence, predictors, and cancer-related outcomes associated with delays in NACT initiation among patients with HER2-positive (HER2 +) breast cancer in the modern era. Methods We retrospectively analyzed a cohort of patients with stage II–III HER2 + breast cancer who were treated with NACT and surgery using the National Cancer Database. Multivariable logistic regression, adjusted for demographic, socioeconomic and tumor characteristics, was used to identify characteristics associated with and the likelihood of achieving a pCR with delays in NACT initiation. Results 56,868 patients were included in the analysis. Delays in NACT initiation of > 60 days from diagnosis was observed in 9% of patients. In a multivariable analysis, patients who were Black (OR 1.88 95%CI 1.74–2.04), Hispanic (OR 2.19, 95%CI 2.00–2.39), had Medicaid (2.14, 95%CI 1.97–2.32), or no insurance (2.39, 95%CI 2.09–2.72) were more likely to be delayed. Delay was associated with a lower likelihood of achieving pCR (OR 0.86 95% CI 0.81–0.92) and an increased risk of death (HR 1.15 95%CI 1.03–1.29). Conclusion There are racial, ethnic, and socioeconomic disparities in NACT initiation delays and an association with worse cancer-related outcomes. Future studies and interventions are needed to mitigate these delays.

Baseline advanced adenoma characteristics