Jimin Lee

Background/Objectives: Cardiovascular diseases (CVDs) frequently limit the feasibility and effectiveness of cancer treatment. However, CVD burden has not been comprehensively described in pancreatic cancer. In our systematic review and meta-analysis, we evaluated the prevalence and incidence of CVDs in pancreatic ductal adenocarcinoma (PDAC). Methods: We conducted the systematic search in PubMed, EMBASE, and CENTRAL on 5 February 2024. Studies reporting the prevalence or incidence of CVDs in PDAC were included. Subgroup analyses were performed based on cancer stage and treatment type. Pooled proportions with the 95% confidence interval (CI) were calculated using a random-effects model. (PROSPERO: CRD42023482295). Results: We included 197 articles. At PDAC diagnosis, non-thrombotic cardiovascular diseases (NT-CVDs) were as prevalent as in the general population: hypertension in 33% (CI: 27–40%), ischemic heart disease in 6% (CI: 3–12%), and heart failure, arrhythmia, and stroke each in 2–3%. Their incidence during treatment remained low (1–10%). Thrombotic events, excluding pulmonary embolism, were present in 11% (CI: 7–15%) at diagnosis, with an incidence of 8–10% regardless of stage or treatment. Pulmonary embolism affected 3% at diagnosis and occurred at a similar rate during treatment. Conclusions: Thromboembolic events are common in PDAC and occur both at diagnosis and during follow-up. Their incidence remains stable across treatment modalities and disease stages, suggesting that the tumor itself is the primary driver of thrombotic risk. The prevalence of NT-CVDs in PDAC is comparable to that in the general population and shows minimal variation across cancer stages or treatment modalities.

INTRODUCTION: The magnitude and modifiers of the association between acute pancreatitis (AP) and pancreatic cancer (PC) are unclear. This systematic review and meta-analysis aimed to quantify the occurrence of PC in AP, the association of PC after AP, and the impact of specific risk factors on PC diagnosis. METHODS: The systematic search was conducted in PubMed, EMBASE, and Central Register of Controlled Trial from inception until July 14, 2025 (PROSPERO: CRD42023470350). Eligible studies included adult populations reporting on the association between AP and PC. Primary outcomes included prevalence, incidence, and diagnosis of PC in individuals with AP, including subset analyses of specific clinical and demographic factors. Meta-analyses were performed using random-effects models to calculate pooled outcome measures and corresponding 95% confidence intervals (CI). RESULTS: A total of 61 studies were included. The prevalence of PC among AP patients was 2% (CI: 2%–4%). The time-dependent analysis revealed an increased hazard of PC in AP vs no AP: 60 months (HR: 1.71, CI: 1.22–2.40). AP patients with subsequently diagnosed chronic pancreatitis (OR: 3.71, CI: 2.00–6.90), new-onset diabetes mellitus (OR: 2.22, CI: 1.02–4.84), idiopathic AP (OR: 2.97, CI: 1.44–6.13), and older than 50 years (OR: 4.04, CI: 2.73–5.97) showed significantly increased odds of having PC. We found no evidence for increased odds for PC with AP severity, smoking, and alcoholic and gallstone etiologies. DISCUSSION: Patients with AP have a higher likelihood of PC diagnosis, especially within the first 2 years. Although the association decreases with time, it remains significant long term. Newly diagnosed chronic pancreatitis, new-onset diabetes mellitus, idiopathic AP may further elevate the likelihood of PC diagnosis. PC diagnosed after AP tends to occur at a younger age, more often at an earlier stage, typically in the pancreatic head.

In experiments on product lifetime and reliability testing, there are many practical situations in which researchers terminate the experiment and report the results before all items of the experiment fail because of time or cost consideration. The most common and popular censoring schemes are type-I and type-II censoring. In type-I censoring scheme, the termination time is pre-fixed, but the number of observed failures is a random variable. However, if the mean lifetime of experimental units is somewhat larger than the pre-fixed termination time, then far fewer failures would be observed and this is a significant disadvantage on the efficiency of inferential procedures. In type-II censoring scheme, however, the number of observed failures is pre-fixed, but the experiment time is a random variable. In this case, at least pre-specified number of failure are obtained, but the termination time is clearly a disadvantage from the experimenter’s point of view. To overcome some of the drawbacks in those schemes, the hybrid censoring scheme, which is a mixture of the conventional type-I and type-II censoring schemes, has received much attention in recent years. In this paper, we consider the analysis of type-I and type-II hybrid censored data where the lifetimes of items follow two-parameter log-logistic distribution. We present the maximum likelihood estimators of unknown parameters and asymptotic confidence intervals, and a simulation study is conducted to evaluate the proposed methods.