Pancreatic cancer

摘要： BACKGROUND Pancreatic cancer is a malignancy with one of the poorest prognoses amongst all cancers.Patients with unresectable tumours either receive palliative care or undergo various chemoradiotherapy regimens.Conventional techniques are often associated with acute gastrointestinal toxicities,as adjacent critical structures such as the duodenum ultimately limits delivered doses.Stereotactic body radiotherapy(SBRT)is an advanced radiation technique that delivers highly ablative radiation split into several fractions,with a steep dose fall-off outside target volumes.AIM To discuss the latest data on SBRT and whether there is a role for magnetic resonance-guided techniques in multimodal management of locally advanced,unresectable pancreatic cancer.METHODS We conducted a search on multiple large databases to collate the latest records on radiotherapy techniques used to treat pancreatic cancer.Out of 1229 total records retrieved from our search,36 studies were included in this review.RESULTS Studies indicate that SBRT is associated with improved clinical efficacy and toxicity profiles compared to conventional radiotherapy techniques.Further dose escalation to the tumour with SBRT is limited by the poor soft-tissue visualisation of computed tomography imaging during radiation planning and treatment delivery.Magnetic resonance-guided techniques have been introduced to improve imaging quality,enabling treatment plan adaptation and re-optimisation before delivering each fraction.CONCLUSION Therefore,SBRT may lead to improved survival outcomes and safer toxicity profiles compared to conventional techniques,and the addition of magnetic resonance-guided techniques potentially allows dose escalation and conversion of unresectable tumours to operable cases.

摘要： There has been a growing interest in developing endoscopic ultrasound(EUS)-guided interventions for pancreatic cancer,some of which have become standard of care.There are two main factors that drive these advancements to facilitate treatment of patients with pancreatic cancer,ranging from direct locoregional therapy to palliation of symptoms related to inoperable pancreatic cancer.Firstly,an upper EUS has the capability to access the entire pancreas–lesions in the pancreatic head and uncinate process can be accessed from the duodenum,and lesions in the pancreatic body and tail can be accessed from the stomach.Secondly,there has been a robust development of devices that allow through-theneedle interventions,such as placement of fiducial markers,brachytherapy,intratumoral injection,gastroenterostomy creation,and ablation.While these techniques are rapidly emerging,data from a multicenter randomized controlled trial for some procedures are awaited prior to their adoption in clinical settings.

摘要： BACKGROUND Multiple primary malignancies(MPMs)refer to more than one primary malignancy in the same or separate organs of the same patient,and MPMs are considered when different histological characteristics are detected in epidemiological studies.Herein,we report a case presumed to be primary pancreatic cancer with multiple liver metastases by positron-emission tomography/computed tomography(PET/CT)and confirmed to be synchronous liver and pancreatic MPMs by endoscopic ultrasound-guided fine-needle aspiration(EUSFNA).CASE SUMMARY A 50-year-old man was referred to our hospital due to abdominal discomfort for 2 mo.Abdominal CT at a local hospital revealed a pancreatic mass with multiple liver nodules.After being transferred to our hospital,PET/CT confirmed all these lesions to have elevated metabolic activity,and therefore primary pancreatic cancer with multiple liver metastases was considered.EUS-guided liver aspiration unexpectedly found signet-ring cells with a high Ki-67 positive rate(20%),while EUS-guided pancreatic aspiration detected pancreatic neuroendocrine cells with a relatively low Ki-67 positive rate(1%).The final diagnosis from the multidisciplinary team was simultaneous liver and pancreatic MPMs.The patient returned to his local hospital for neoadjuvant chemotherapy and surgery,and he is still alive during the 6-mo postoperative follow-up.CONCLUSION Although rare,MPMs should be considered when treating pancreatic mass with suspected metastatic lesions,and EUS-FNA has proved minimally invasive and accurate.

摘要： BACKGROUND Laparoscopic pancreaticoenteric anastomosis is one of the technically challenging steps of minimally invasive pancreaticoduodenectomy(PD),especially during the learning curve.Despite multiple randomized controlled trials and meta-analyses,the type of pancreatico-enteric anastomosis as a risk factor for post-pancreatectomy complications is debatable.Also,the ideal technique of pancreatic reconstruction during the learning curve of laparoscopic PD has not been well studied.AIM To compare the short-term outcomes of modified binding pancreaticogastrostomy(PG)and Blumgart pancreaticojejunostomy(PJ)during learning curve of laparoscopic PD.METHODS The first 25 patients with resectable pancreatic or periampullary tumors who underwent laparoscopic PD with modified binding PG or modified Blumgart PJ between January 2015 and May 2020 were retrospectively analyzed to compare perioperative outcomes during the same learning curve.A single layer of the fullthickness purse-string suture was placed around the posterior gastrotomy in the modified binding PG.In the modified Blumgart technique,only a single transpancreatic horizontal mattress suture was placed on either side of the pancreatic duct(total two sutures)to secure the pancreatic parenchyma to the jejunum.Also,on the ventral surface,the knot is tied on the jejunal wall without going through the pancreatic parenchyma.Post pancreatectomy complications are graded as per the RESULTS During the study period,modified binding PG was performed in 27 patients and modified Blumgart PJ in 29 patients.The demographic and clinical parameters of the first 25 patients included in both groups were comparable.Lower end cholangiocarcinoma and ampullary adenocarcinoma were the primary indications for laparoscopic PD in both groups(32/50,64%).The median operative time for pancreatic reconstruction was significantly lower in the binding PG group(42 vs 58 min,P=0.01).The clinically relevant(Grade B/C)postoperative pancreatic fistula(POPF)was significantly more in the modified PJ group(28%vs 4%,P=0.04).In contrast,intraluminal postpancreatectomy hemorrhage(PPH)was more in the binding PG group(32%vs 4%,P=0.02).There was no significant difference in the incidence of delayed gastric emptying between the two groups.CONCLUSION During the learning curve of laparoscopic PD,modified binding PG reduces POPF but is associated with increased intraluminal PPH compared to PJ using the modified Blumgart technique.

摘要： Pharmacological inhibitors of glutathione synthesis and circulation,such as buthionine-sulfoximine,inhibit glutathione metabolism.These drugs decrease the aggressiveness of pancreatic cancer,inhibit tumor stem cell survival,and reduce chemotherapy resistance.Nevertheless,buthionine-sulfoximine also decreases the content of glutathione in normal cells,disrupts the balance between reactive oxygen species and glutathione,and eventually induces cell apoptosis.Pancreatic cancer is usually diagnosed at an advanced stage and has a poor prognosis.Consequently,the use of biomarkers to screen high-risk patients can be an effective method.

摘要： BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is one of the most lethal malignancies with high mortality and short survival time.Computed tomography(CT)plays an important role in the diagnosis,staging and treatment of pancreatic tumour.Pancreatic cancer generally shows a low enhancement pattern compared with normal pancreatic tissue.AIM To analyse whether preoperative enhanced CT could be used to predict postoperative overall survival in patients with PDAC.METHODS Sixty-seven patients with PDAC undergoing pancreatic resection were enrolled retrospectively.All patients underwent preoperative unenhanced and enhanced CT examination,the CT values of which were measured.The ratio of the preoperative CT value increase from the nonenhancement phase to the portal venous phase between pancreatic tumour and normal pancreatic tissue was calculated.The cut-off value of ratios was obtained by the receiver operating characteristic(ROC)curve of the tumour relative enhancement ratio(TRER),according to which patients were divided into low-and high-enhancement groups.Univariate and multivariate analyses were performed using Cox regression based on TRER grouping.Finally,the correlation between TRER and clinicopathological characteristics was analysed.RESULTS The area under the curve of the ROC curve was 0.768(P0.7 was defined as the high-enhancement group.According to the TRER grouping,the Kaplan-Meier survival curve analysis results showed that the median survival(10.0 mo)with TRER≤0.7 was significantly shorter than that(22.0 mo)with TRER>0.7(P0.7(P<0.05).Our results demonstrated that patients in the low TRER group were more likely to have higher American Joint Committee on Cancer stage,tumour stage and lymph node stage(all P<0.05),and TRER was significantly negatively correlated with tumour size(P<0.05).CONCLUSION TRER≤0.7 in patients with PDAC may represent a tumour with higher clinical stage and result in a shorter overall survival.

摘要： BACKGROUND Laparoscopic duodenojejunostomy(LDJ) has become the standard surgical procedure for superior mesenteric artery syndrome due to its sufficient outcome in terms of safety and symptom relief. However, there are only a few reports about LDJ for malignant stenosis and its indication remains uncertain.CASE SUMMARY A 77-year-old woman with a history of pancreatic cancer(PC) treated with distal pancreatectomy with en bloc resection of the transverse colon 7 mo ago was admitted for recurrent vomiting. Imaging upon admission revealed marked distention of the duodenum and a tumor around the duodenojejunal flexure. She was diagnosed with malignant stenosis caused by local recurrence of PC. LDJ was performed with an uneventful postoperative course, followed by chemotherapy which gave her 10 mo overall survival.CONCLUSION We think that LDJ is a valuable method for unresectable malignant stenosis around the duodenojejunal flexure as a part of multimodal therapy.

摘要： BACKGROUND Due to dietary patterns,the aging population,and other high-risk factors,the occurrence of pancreatic cancer(PC)has been rapidly increasing in China.AIM To present the epidemiological trends of PC in China over the past decade and the estimated trend in 2025 and to compare the international differences in PC morbidity and mortality.METHODS This study used a series of nationally representative data from the National Central Cancer Registry of China(NCCR),the International Agency for Research on Cancer and the Institute for Health Metrics and Evaluation databases.Agestandardized data of the PC incidence and mortality from 2006 to 2015 in China were extracted from the NCCR database.Linear regression models were used to estimate the incidence and mortality rates of PC in 2025.RESULTS The age-standardized rates of PC in China increased from 3.65 per 100000 in 2006 to 4.31 per 100000 in 2015 and were estimated to reach up to 5.52 per 100000 in 2025.The mortality went from 3.35 per 100000 in 2006 to 3.78 per 100000 in 2015,estimated to reach up to 4.6 per 100000 in 2025.The number of new cases and deaths was low before 45 years and the peak age of onset was 85-89 years.The incidence and mortality rates in men were higher than those in women regardless of the region in China.In addition,the incidence and mortality rates in China were higher than the average level around the world.Likewise,disabilityadjusted life years attributed to PC in China were 197.22 years per 100000,above the average level around the world.CONCLUSION This study presented an increasing trend of PC in China and differences in morbidity,mortality and disability-adjusted life years between Chinese and global populations.Efforts need to be made to decrease the PC incidence and improve patient outcomes.

摘要： Pancreatic cancer is a disease with high unmet clinical need.Pancreatic cancer is also characterised by an intense fibrotic stroma,which harbours many immune cells.Studies in both human and animal models have demonstrated that the immune system plays a crucial role in modulating tumour onset and progression.In human pancreatic ductal adenocarcinoma,high B-cell infiltration correlates with better patient survival.Hence,B cells have received recent interest in pancreatic cancer as potential therapeutic targets.However,the data on the role of B cells in murine models is unclear as it is dependent on the pancreatic cancer model used to study.Nevertheless,it appears that B cells do organise along with other immune cells such as a network of follicular dendritic cells(DCs),surrounded by T cells and DCs to form tertiary lymphoid structures(TLS).TLS are increasingly recognised as sites for antigen presentation,T-cell activation,Bcell maturation and differentiation in plasma cells.In this review we dissect the role of B cells and provide directions for future studies to harness the role of B cells in treatment of human pancreatic cancer.

摘要： BACKGROUND The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.AIM To explore if pancreatic head cancer(PHC)and pancreatic body/tail cancer(PBTC)have different overall survival(OS),molecular signature and response to chemotherapy.METHODS We retrospectively queried patient records from July 2016 to June 2020 in our institution.Patient demographics,cancer stage on diagnosis,tumor location,somatic mutations,treatment,and survival are recorded and analyzed.A test is considered statistically significant if the P value was<0.05.RESULTS We reviewed 101 patients with complete records,among which 67(66.34%)were PHC and 34(33.66%)were PBTC.More PHC were diagnosed at younger age[61.49 vs 68.97,P=0.010],earlier stages(P=0.006)and underwent surgical resection(P=0.025).There were no significant differences among all mutations and pathways studied except for TP53 mutations(37.0%in PHC vs 70.0%in PBTC,P=0.03).OS was not statistically different between PHC and PBTC(P=0.636)in the overall population and in subgroups according to surgical resection status or stages.In terms of response to chemotherapy,chemotherapy regimens(FOLFIRINOX-based vs gemcitabine-based)didn’t impact disease free interval in those who had surgical resection in either PHC(P=0.546)or PBTC(P=0.654),or the duration of response to first line palliative treatment in those with advanced disease in PHC(P=0.915)or PBTC(P=0.524).CONCLUSION Even though PHC and PBTC have similar poor OS and response to chemotherapy,the different presentations and molecular profiles indicate they are different diseases.Utilization of molecular profiling to develop targeted therapy for individualization of treatment is needed.