Systematic review of peri-operative prognostic biomarkers in pancreatic ductal adenocarcinoma

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) continues to be associated with a poor prognosis. This systematic review aimed to summarize the literature regarding potential prognostic biomarkers to facilitate validation studies and clinical application. METHODS: A systematic review was performed (2004-2014) according to PRISMA guidelines. Studies were ranked using REMARK criteria and the following outcomes were examined: overall/disease free survival, nodal involvement, tumour characteristics, metastasis, recurrence and resectability. RESULTS: 256 biomarkers were identified in 158 studies. 171 biomarkers were assessed with respect to overall survival: urokinase-type plasminogen activator receptor, atypical protein kinase C and HSP27 ranked the highest. 33 biomarkers were assessed for disease free survival: CD24 and S100A4 were the highest ranking. 17 biomarkers were identified for lymph node involvement: Smad4/Dpc4 and FOXC1 ranked highest. 13 biomarkers were examined for tumour grade: mesothelin and EGFR were the highest ranking biomarkers. 10 biomarkers were identified for metastasis: p16 and sCD40L were the highest ranking. 4 biomarkers were assessed resectability: sCD40L, s100a2, Ca 19-9, CEA. CONCLUSION: This review has identified and ranked specific biomarkers that should be a primary focus of ongoing validation and clinical translational work in PDAC

Importance of the distinction between quality of methodology and quality of reporting Response

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The impact of fellowships on surgical resident training in a multispecialty cohort in Australia and New Zealand

Introduction: Fellowships in surgery are increasing in number, and concerns have been raised regarding their impact on resident training. Although fellows may contribute to resident education and training, they also compete for operative and other experience. This study aimed to quantify the impact of fellowships on resident training in a binational multispecialty cohort. Methods: The operative case volumes and primary operator rates of surgery trainees (residents) in Australia and New Zealand were compared between units with and without fellows. Trainees also were surveyed using Likert Scales to assess quality of operative and other experience in units with and without fellows. Results: Data from 911 trainees over 2 terms was analyzed; survey response rate 42%. Of all trainees, 42% worked with fellows. Trainees in units without fellows were involved in more major (P = 03) and minor (P<.0001) cases. Primary operator rates were comparable, but trainees in units without fellows were less often assistants, reported an increased quality of elective operating experience, and reported more favorable completion of learning objectives (all P<.05). These findings were consistent between tertiary and nontertiary hospitals. Thematic analysis showed positive benefits of fellows in teaching, training and mentorship, but negative impacts on case exposure, competition for operating, and clinical experience. Conclusion: Fellows may assist in the teaching and training of residents, but residents working with fellows experience a decreased quantity of operative experience that may impact several aspects of the quality of training. Surgical educators must actively balance the learning needs of fellows and residents