Predictors of early recurrence following neoadjuvant chemotherapy and surgical resection for localized pancreatic adenocarcinoma.

BACKGROUND AND OBJECTIVES: Neoadjuvant chemotherapy (NAT) for pancreatic adenocarcinoma (PDAC) is increasingly being utilized. However, a significant number of patients will experience early recurrence, possibly negating the benefit of surgery. We aimed to identify factors implicated in early disease recurrence. METHODS: A retrospective review of pancreaticoduodenectomies performed between 2005 and 2017 at our institution for PDAC following NAT was performed. A 6-month cut-off was used to stratify patients into early/late recurrence groups. Multivariate analysis was performed to identify predictors of recurrence. RESULTS: Of 273 patients, 64 (23%) developed early recurrence or died within 90 days of surgery. The median time to recurrence was 4 months (95% confidence interval [CI]: 2.2-4.3) in the early group versus 16 months (95% CI: 13.7-19.9) in the late group. The former had higher baseline and post-NAT Ca19-9 levels than the latter (472 vs. 153 IU/ml, p = 0.001 and 71 vs. 39 IU/ml, p = 0.005, respectively). A higher positive lymph node ratio significantly increased the risk of early recurrence (hazard ratio [HR]: 15.9, p < 0.001) while adjuvant chemotherapy was protective (HR: 0.4, p < 0.001). CONCLUSION: Our findings acknowledge the limitations of clinically measured factors used to ascertain response to NAT and underline the need for individualized molecular markers that take into consideration the specific tumor biology.

Disturbed Sleep as a Mechanism of Race Differences in Nocturnal Blood Pressure Non-Dipping.

PURPOSE OF REVIEW: Disturbed sleep may be a mechanism of race differences in nocturnal blood pressure non-dipping. In support of this proposal, we summarize recent research from three literatures: (1) race differences (Black compared with White individuals) in nocturnal blood pressure non-dipping, (2) the association between disturbed sleep and nocturnal blood pressure non-dipping, and (3) race differences in disturbed sleep. RECENT FINDINGS: Black individuals are nearly twice as likely to have blood pressure non-dipping profiles compared with White individuals. This may be explained, in part, by sleep; shorter sleep duration, greater sleep fragmentation, less slow-wave sleep, and obstructive sleep apnea have each been associated with nocturnal blood pressure non-dipping. These sleep disturbances, in turn, are more common in Black compared with White individuals. Studies focused on nocturnal blood pressure non-dipping rarely assess sleep, and experimental evidence linking disturbed sleep with nocturnal blood pressure non-dipping in Black individuals is lacking. While mounting evidence from independent literatures suggests that disturbed sleep is a plausible, modifiable mechanism of race differences in nocturnal blood pressure non-dipping, definitive conclusions are premature given the current state of science.