Citations

Background: Immersive technologies (ImTs), including virtual, augmented, or mixed reality, are increasingly used to support periprocedural pediatric patients, but clinical adoption varies widely across children’s hospitals and specialties. Multiple determinants for the adoption of ImT in health care have been identified; however, these have not been well characterized in pediatric perioperative settings. Aims: Among Society for Pediatric Anesthesia Improvement Network (SPAIN) member institutions, we describe the current state of pediatric perioperative ImT use, identify barriers and facilitators to ImT adoption, and report perceived implementation-related factors. Methods: We conducted a multi-institutional cross-sectional survey of pediatric perioperative practices via key contacts from SPAIN. Survey responses underwent mixed-methods analyses informed by the Consolidated Framework for Implementation Research. Results: Among 27 eligible institutions, 24 (89%) provided responses, 13 of which reported ImT use. Of these, 8 (62%) reported existing institutional infrastructure or governance to support ImT. Use patterns were highly heterogeneous, but use was commonly paired with the presence of champions, technology expertise, and available resource support. Use cases included anxiety reduction, distraction, and procedural support. Barriers, facilitators, and potential strategies for successful implementation were highlighted. Conclusions: ImT is used variably across pediatric anesthesia practices affiliated with SPAIN. These findings provide a descriptive snapshot of current practice and highlight factors commonly associated with adoption. Further work is needed to more rigorously characterize the implementation processes and evaluate strategies that may support integration of ImT into routine care in diverse clinical settings.

Through a Delphi process, all 33 panelists reached consensus on topics relating to MRI reporting of knee meniscus lesions, demonstrating that interdisciplinary and multi-institutional standardization is possible.

Vanishing bile duct syndrome is a rare complication of classical Hodgkin’s lymphoma (cHL) which may present with significant cholestasis and hepatic dysfunction. Management is primarily focused on chemotherapy and symptomatic management of cholestatic liver failure. We describe a case of a man in his 60s with relapsed cHL with significant cholestatic liver injury who was treated with brentuximab vedotin complicated by renal failure. The complex decision-making surrounding chemotherapeutic choice with the presence of multiorgan dysfunction is discussed with a review of literature describing regimens in similar clinical circumstances.

TPS160 Background: Up to 50% of patients with gastric cancer (GC) may develop peritoneal metastasis (PM) that is associated with resistance to systemic therapy and poor prognosis. Although cytoreductive surgery and intraperitoneal (IP) chemotherapy were shown to modestly improve the survival of patients with PM from gastric GC (PM-G), these clinical trials were performed in the pre-immunotherapy era. The significant heterogeneity in trial design and patient selection criteria further limit the applicability of these trial results to current clinical practice where anti-PD-1/L1 immunotherapy and/or targeted therapy in combination with chemotherapy have become a common, standard first-line therapy for the majority of patients with metastatic GC, raising the question of whether chemotherapy such as paclitaxel remains the most effective IP therapy. IP therapy using novel immunotherapy such as bispecific antibodies and chimeric antigen receptor T-cell therapy have demonstrated safety and promising antitumor activities in PM-G. We are conducting a phase 1b clinical trial that evaluates the efficacy of IP interleukin-2 (IL-2) in patients with PM-G with stable disease on first-line chemo-immunotherapy based on the hypothesis that IP IL-2 may synergize with intravenous (IV) chemo-immunotherapy to improve the treatment of PM-G. Multi-omics studies using patient blood, peritoneal fluid, and tissue specimens serially collected from this trial will be performed to characterize the changes in the tumor immune microenvironment of PM-G and identify new therapeutic targets. Methods: Patients with PM only from gastric adenocarcinoma are eligible for this phase 1b trial. All participants will continue IV fluorouracil-containing chemotherapy with nivolumab every 2 weeks and concurrently receive up to 16 doses of IP IL-2 (aldesleukin 6 × 10 5 IU/m2) weekly through an indwelling peritoneal catheter (Bard). Diagnostic laparoscopy (DL) will be performed before initiation of IP IL-2 and after 8 doses of IP therapy to assess treatment response based on the peritoneal cancer index (PCI), which is the primary endpoint of the trial. Patients with at least stable radiographic disease will continue to receive another 8 doses of IP IL-2 and undergo a third DL. Secondary endpoints include safety, peritoneal regression grading score, overall survival, and progression-free survival. Major inclusion criteria include mismatch repair-proficient or microsatellite-stable GC, PCI of 3-24, absence of distant metastasis other than PM, stable disease on first-line IV chemo-immunotherapy, tolerability of anti-PD-1 therapy, and adequate organ function. Enrollment began in 2024 and remains active. To date, seven of planned 15 patients have received study treatment without significant treatment-related adverse events and three of these patients underwent curative-intent cytoreductive surgery. Clinical trial information: NCT05802056 .

21 Background: Large language models (LLMs) are becoming an increasing source of medical information for both patients and providers. Clinical decision making is occasionally complex and may use factors outside of traditional guidelines. We conducted a comparative performance evaluation of frontier models on standardized genitourinary (GU) oncology knowledge assessments derived from the American Society of Clinical Oncology Self-Evaluation Program 2025 (ASCO SEP 2025) in addition to challenging questions developed by GU oncology experts. Methods: Three frontier LLMs were selected: ChatGPT-5.2 (OpenAI, San Francisco, CA, USA), Claude Opus 4.6 (Anthropic, San Francisco, CA, USA), and Gemini 3 Pro (Google DeepMind, Mountain View, CA, USA). Model selection was based on publicly reported performance on “Humanity’s Last Exam,” a benchmark of advanced scientific reasoning (Scale AI leaderboard Jan-Feb 2026). The OpenEvidence (OpenEvidence Inc., MA, USA) search engine was also selected for evaluation. All models were asked 145 ASCO SEP 2025 GU oncology questions and 12 real world challenging scenarios using an uniform prompt. Subject matter experts peer reviewed LLM generated responses to challenging questions and credit was given only for correct rationale and option selection. Results: All models demonstrated high and comparable accuracy on Standardized knowledge assessment, with Gemini 3 Pro leading numerically at 97.24% (95% CI, 93.1% – 99.0%), OpenEvidence followed with an accuracy of 94.48% (95% CI, 89.5% – 97.3%), while Chat GPT -5.2 and Claude OPUS 4.6 scored 92.41% (95%, CI 86.9% – 95.7%) and 79.31% (95% CI, 71.9% – 85.1%) respectively. On challenging real world scenarios, ChatGPT-5.2 demonstrated the highest numerical accuracy at 100% (95% CI, 75.8% – 100%), Gemini 3 Pro and Open Evidence scored 75.0% (95% CI, 46.8%–91.1%) each, followed by Claude Opus 4.6 at 66.7% (39.1–86.3). Conclusions: All current frontier AI models appear to provide accurate medical information and rationale on a large majority of guideline based medical knowledge assessments for GU oncology. Frontier AI models also appear to have emerging competence in highly challenging real-world scenarios. AI based tools may become a valuable and reliable tool for patients and providers. Comparative LLM performance. Model ASCO SEP 2025 % (95% CI) Real World Scenarios % (95% CI) Gemini 3 Pro 97.24% (93.1–99.0) 75.0% (46.8–91.1) OpenEvidence 94.48% (89.5–97.3) 75.0% (46.8–91.1) ChatGPT-5.2 92.41% (86.9–95.7) 100% (75.8–100) Claude Opus 4.6 79.31% (71.9–85.1) 66.67% (39.1–86.3)

139 Background: Statins have been shown to reduce the risk of HCC in high-risk populations with metabolic diseases. However, emerging data suggests that GLP-1 RA’s may also offer hepatoprotection by reversing metabolic and inflammatory drivers contributing to HCC development. Patients with T2DM are at an increased risk of metabolic associated steatotic liver disease (MASLD) and HCC. To our knowledge, no real-world studies have directly compared the effectiveness of GLP-1 RA’s and statins for prevention of HCC in patients with T2DM. In this study, we aim to compare the incidence of HCC and hepatic decompensation events in patients with T2DM treated with GLP-1 RA’s vs statins. Methods: We performed a retrospective cohort study using data from TriNetX, a healthcare database of over 150 million patients in the United States. Adult patients with T2DM were identified and stratified by use of GLP-1 RA (semaglutide, dulaglutide, tirzepatide, exenatide, liraglutide, and lixisenatide) or statin (pitavastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin or lovastatin). Exposure groups were mutually exclusive with no overlap in GLP-1 RA or statin use. Propensity score matching was conducted between cohorts, matching for age, sex, race, tobacco use, alcohol use, hypertension, hyperlipidemia, obesity, MASLD, aspirin use, non-steroidal anti-inflammatory analgesic drug use, and other T2DM medications. Five-year incidence of HCC was compared between the GLP-1 RA and statin cohorts. In a subsequent analysis, hepatic decompensation events of ascites, hepatic encephalopathy (HE), spontaneous bacterial peritonitis (SBP), and esophageal varices (EV) were compared. Results: We identified 1,411,022 patients with T2DM, including 254,832 GLP-1 RA users and 1,156,190 statin users. After PSM, 219,984 patients were included in the analysis. There was no significant difference in the five-year incidence of HCC between the GLP-1 RA and statin cohorts (0.14% vs 0.15%, odds ratio (OR) 0.95, 95% confidence interval (CI)0.81-1.11, p =0.5). In the subsequent analysis, GLP-1 RA use was associated with a lower incidence of ascites (0.98% vs 1.99%, OR 0.84, 95% CI 0.46-0.51, p <0.001), HE (0.18% vs 0.22%, OR 0.84, 95% CI 0.74-0.96, p =0.01), and SBP (0.05% vs 0.1%, OR 0.52, 95% CI 0.42-0.65, p <0.001). There was no difference in incidence of EV (0.33% vs 0.35%, OR 0.94, 95% CI 0.85-1.04, p =0.25). Conclusions: In patients with T2DM at elevated risk for MASLD and HCC, we found that GLP-1 RA use was associated with significantly lower incidence of hepatic decompensation events compared to statin use. However, there was no significant difference in HCC incidence between the cohorts. Prospective studies are warranted to confirm the hepatoprotective effect of GLP-1 RA medications and evaluate long-term oncologic outcomes.

138 Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RA’s) have advanced the treatment of type 2 diabetes mellitus (T2DM), yet their association with cancer risk remains subject of ongoing research. Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a well-established risk factor for colorectal cancer (CRC). Studies have shown a reduced risk of CRC with GLP-1 RA use however, the impact of GLP-1 RA therapy in the high-risk IBD population is unknown. In this study, we aim to evaluate the association between GLP-1 RA use and CRC incidence among patients with IBD, and among those with IBD and T2DM. Methods: We performed a retrospective cohort study using data from TriNetX, a healthcare database of over 150 million patients in the United States. In the first analysis, adult patients with pre-existing IBD were identified and stratified by use of a GLP-1 RA (semaglutide, dulaglutide, tirzepatide, exenatide, liraglutide, and lixisenatide) or not. Propensity score matching (PSM) was conducted between GLP1-RA users and non-users, matching for age, sex, race, tobacco use, alcohol use, hypertension, hyperlipidemia, obesity, IBD subtype (CD or UC), steroid use, immunosuppressive use including biologics, and other T2DM medications. Five-year incidence of CRC was compared between GLP-1 RA users and non-users in the matched cohort between 2015 and 2025. We then restricted the cohort to patients with IBD and T2DM and repeated this analysis. Results: We identified 1,137,300 patients with IBD, including 70,303 GLP-1 RA users and 1,066,997 non-users. After PSM with all variables adequately matched, 69,221 patients were included in the analyses. GLP-1 RA use was associated with a lower 5-year incidence of CRC (0.2% vs. 0.43%, odds ratio (OR) 0.49, 95% confidence interval (CI) 0.3-0.57, p <0.001). We then identified 209,649 patients with IBD and T2DM, including 38,567 GLP-1 RA users and 171,082 non-users. After matching for all variables, 37,740 patients were included in the analyses. Among patients with IBD and T2DM, GLP-1 RA use was associated with a lower 5-year incidence of CRC (0.31% vs. 0.57%, OR 0.54, 95% CI 0.43-0.68, p <0.001). Conclusions: GLP-1 RA use was associated with a significantly reduced incidence of CRC in all patients with IBD, as well as the subpopulation with both IBD and T2DM. Given the elevated CRC risk in IBD, these findings suggest a potential protective effect of GLP-1 RA use in this high-risk population. Prospective studies will be important to further analyze and confirm this potential benefit.

130 Background: The COVID-19 pandemic markedly affected the U.S. health care system and may have altered the diagnosis and management of pancreatic cancer. We examined national trends in pancreatic cancer diagnoses before and throughout the first two years after the onset of COVID-19 in the United States, using the latest data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods: We queried the SEER database for cases of pancreatic cancer diagnosed between 2019 and 2021 using ICD-O-3 codes C25.0-C25.9. Disease stage was categorised as localised, regional, distant, or unknown according to the SEER combined summary staging system. Case counts and incidence rates were compared across 2019, 2020, and 2021, with year-to-year differences assessed for statistical significance using χ² tests. Results: The overall number of cases of PDAC diagnosed in 2019, 2020, and 2021 (including year-to-year changes) were 13,457, 13,153 (-2.3%, p<0.05), and 13,998 (+6.4%, p<0.001). Among the known SEER summary staging for PDAC, 52.3% of cases were categorised as “distant” at the time of diagnosis in 2019, compared to 53.6% (+2.4%, p<0.05) in 2020, and 52.0% (-2.8%, p<0.05) in 2021. This reflected an overall change of -0.5% in “distant” PDAC diagnoses from 2019 to 2021 (p>0.05). Conclusions: Significantly fewer cases of PDAC were diagnosed in 2020 compared with 2019, followed by a significant increase in 2021 to above pre-pandemic levels. The proportion diagnosed as distant was significantly higher in 2020 than in 2019 but did not differ significantly between 2019 and 2021. These findings suggest a transient shift toward more advanced-stage PDAC diagnoses during the first year of the COVID-19 pandemic with likely delays in diagnosis, which returned to baseline in 2021.

129 Background: Pancreatic ductal adenocarcinoma (PDAC) presents with significant morbidity and mortality. Five-year survival at 13% consistently remains among the lowest of all cancers. We undertook a population-level risk analysis of sociodemographic risk factors (sex, age, ethnic, and geographic) that may inform closer monitoring of those with increased likelihood of developing PDAC. Methods: PDAC incidence data from 2000 to 2022 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database, representing approximately 37% of the US population. Age-adjusted incidence rates (AAIRs) were calculated by race, sex, age group, and county-level rural–urban classification. Incidence is reported per 100,000 population. Temporal trends were assessed using annual percent change (APC) estimated via weighted least-squares regression. Results: Between 2000 and 2022, the overall AAIR of PDAC was 12.6. Incidence was highest among Black individuals (16.1), followed by White (12.7) and Hispanic (11.7) individuals, and was consistently higher in males (14.3) than in females (11.2). Temporal trends did not differ significantly by sex, with annual increases of +0.8% in males and +0.9% in females. Incidence increased progressively with age across all racial and ethnic groups in both sexes. While overall incidence was comparable between urban and rural counties, rural counties experienced a significantly faster rise in incidence (+1.3% vs. +0.8% APC; p<0.05). Conclusions: PDAC incidence has increased from 2000 to 2022 across both sexes at all ages and across all ethnicities. Those most at risk include males and Black individuals, with rates rising faster in rural counties. Better epidemiological understanding of developing trends of at-risk patients may inform screening strategies for patients at high risk of developing PDAC. Incidence rate (per 100,000 population) and annual change in PDAC (95% CI with Tiwari modification). Rate Trend Sex Male 14.3 (14.2-14.4) 0.8 (0.7-0.9) Female 11.2 (11.1-11.3) 0.9 (0.8-1.0) Age 40-44 years 2.7 (2.6-2.8) 1.3 (0.8-1.8) 45-49 years 5.6 (5.4-5.8) 0.8 (0.5-1.1) 50-54 years 10.9 (10.8-11.1) 0.6 (0.4-0.9) 55-59 years 19.2 (19.0-19.5) 1.0 (0.7-1.3) 60-64 years 30.8 (30.0-31.1) 0.8 (0.5-1.0) 65-69 years 45.9 (45.0-46.4) 0.9 (0.7-1.0) 70-74 years 62.2 (62.0-62.8) 0.8 (0.6-0.9) 75-79 years 79.7 (79.0-80.6) 1.0 (0.8-1.2) 80-84 years 94.7 (94.0-95.8) 0.9 (0.7-1.1) 85-89 years 104.6 (103-106.1) 0.8 (0.5-1.1) 90+ years 101.7 (100-103.6) 0.4 (0.1-0.8) Race White 12.7 (12.6-12.8) 1.1 (1.0-1.2) Black 16.1 (16-16.3) 0.3 (0.2-0.5) American Indian/Alaska Native 10.5 (10.0-11.1) 1.4 (0.4-2.4) Asian or Pacific Islander 10.2 (10.0-10.4) 0.6 (0.4-0.8) Hispanic 11.7 (11.5-11.8) 0.7 (0.4-0.9) Location Urban 12.6 (12.5-12.7) 0.8 (0.7-0.9) Rural 12.6 (12-12.7) 1.3 (1-1.5)