Pub Date : 2024-07-16DOI: 10.1097/jp9.0000000000000188
Xiuli Zhang, Zhigao Chen, Xiong Zhao, Jiachun Pan, Stephen J. Pandol, Li Wen
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignancies, accounting for 95% of pancreatic cancer cases, with a 5-year survival rate of around 10%. The relationship between pancreatitis and pancreatic cancer has been noted within the medical community. Recent epidemiological data and findings from experimental mouse models have underscored pancreatitis as a critical risk factor for pancreatic cancer. Therefore, exploring the mechanisms underlying the transition from pancreatitis to pancreatic cancer is crucial for improving early detection and treatment strategies for pancreatic cancer. In this review, we conducted a comprehensive search of the PubMed database and discussed relevant original studies, focusing on three key areas: findings from population- and animal-based studies, the role of pancreatic epithelial cell-intrinsic factors, and the impact of immune cells and cytokines. Additionally, we offered our prospectives on possible future research directions.
{"title":"Relationship of pancreatitis to pancreatic cancer: from population-based observations to preclinical and mechanistic insights","authors":"Xiuli Zhang, Zhigao Chen, Xiong Zhao, Jiachun Pan, Stephen J. Pandol, Li Wen","doi":"10.1097/jp9.0000000000000188","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000188","url":null,"abstract":"Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest malignancies, accounting for 95% of pancreatic cancer cases, with a 5-year survival rate of around 10%. The relationship between pancreatitis and pancreatic cancer has been noted within the medical community. Recent epidemiological data and findings from experimental mouse models have underscored pancreatitis as a critical risk factor for pancreatic cancer. Therefore, exploring the mechanisms underlying the transition from pancreatitis to pancreatic cancer is crucial for improving early detection and treatment strategies for pancreatic cancer. In this review, we conducted a comprehensive search of the PubMed database and discussed relevant original studies, focusing on three key areas: findings from population- and animal-based studies, the role of pancreatic epithelial cell-intrinsic factors, and the impact of immune cells and cytokines. Additionally, we offered our prospectives on possible future research directions.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1097/jp9.0000000000000189
Li Xiao, Haoqi Zhang, Chunlu Tan, Xubao Liu, Zhenjiang Zheng
Pancreatic cancer (PC) is a lethal tumor, and overall survival (OS) is poor, especially for patients with liver metastases. Herein, we report a 55-year-old female who presented with right upper quadrant pain. Computed tomography (CT) of the upper abdomen revealed a large space-occupying lesion (5.5×5.2 cm) in the pancreatic neck with multiple liver metastases. After biopsy confirmation, the patient underwent conversion therapy consisting of doublet chemotherapy (gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2) and toripalimab (a novel PD-1 inhibitor, 240 mg). After six and a half cycles, radical pancreaticoduodenectomy combined with resection of liver metastases and portal vein replacement were performed successfully. The patient died from hemorrhage of the pancreaticojejunostomy anastomotic stoma four months after surgery. No recurrence or metastases were detected by CT until the patient died. This is the first study to report the results of conversion surgery in patients with metastatic PC limited to the liver after preoperative chemotherapy plus a PD-1 inhibitor. Stage IV PC should not be considered a general contraindication for surgical resection in well-selected patients. A multicenter randomized controlled study should be performed to investigate the efficacy and safety of this controversial treatment strategy.
{"title":"Preoperative Chemotherapy plus Immune Checkpoint Inhibitors as Conversion Therapy in Pancreatic Cancer Patients with Initially Unresectable Liver-limited Metastases: A Case Report","authors":"Li Xiao, Haoqi Zhang, Chunlu Tan, Xubao Liu, Zhenjiang Zheng","doi":"10.1097/jp9.0000000000000189","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000189","url":null,"abstract":"Pancreatic cancer (PC) is a lethal tumor, and overall survival (OS) is poor, especially for patients with liver metastases. Herein, we report a 55-year-old female who presented with right upper quadrant pain. Computed tomography (CT) of the upper abdomen revealed a large space-occupying lesion (5.5×5.2 cm) in the pancreatic neck with multiple liver metastases. After biopsy confirmation, the patient underwent conversion therapy consisting of doublet chemotherapy (gemcitabine 1,000 mg/m2 and nab-paclitaxel 125 mg/m2) and toripalimab (a novel PD-1 inhibitor, 240 mg). After six and a half cycles, radical pancreaticoduodenectomy combined with resection of liver metastases and portal vein replacement were performed successfully. The patient died from hemorrhage of the pancreaticojejunostomy anastomotic stoma four months after surgery. No recurrence or metastases were detected by CT until the patient died. This is the first study to report the results of conversion surgery in patients with metastatic PC limited to the liver after preoperative chemotherapy plus a PD-1 inhibitor. Stage IV PC should not be considered a general contraindication for surgical resection in well-selected patients. A multicenter randomized controlled study should be performed to investigate the efficacy and safety of this controversial treatment strategy.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"5 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1097/jp9.0000000000000178
Qiaofei Liu, Yuze Hua, Jishu Wei, Qi Zhang, Zheng Wang, Xiaodong Tian, Feng Cao, Hanxiang Zhan, Song Gao, Shixiang Guo, Rongui Lin, Jinyong Xu, S. Gou, Chunlu Tan, Yuan Ding, Shi Si, Jiabin Jin, Zipeng Lu, Lei Cai, Min Wang, Chen Hua, Bin Zhou, Lei Zhang, Xiaohong Ning, Wenming Wu
To investigate the perceptions of pancreatic surgeons regarding palliative care for pancreatic cancer and the current status of palliative care for pancreatic cancer patients in China. An online questionnaire consisting of thirty-five questions in five domains, including basic information of the respondents, personal interest, training and experiences of palliative care, recognition of the importance of palliative care, palliative care in the hospital of the respondents, and advice to improve the service of palliative care for pancreatic cancer, was distributed to pancreatic surgeons by the WeChat APP. All the data were automatically recorded and can be downloaded. The respondents' perceptions of palliative care and the current status of palliative care were depicted, and the factors influencing the perceptions of the respondents and palliative care in hospitals were further analyzed. Responses from 429 pancreatic surgeons were validated. 81.4% were from tertiary hospitals, and 18.6% were from secondary hospitals. 94.2% were from general hospitals, and 5.8% were from cancer hospitals. Most surgeons have worked for over five years (93%), 72% had senior titles, and 54.5% held administrative positions. 49% have not read papers on palliative care before. 73.4% of the hospitals did not have a palliative care team, 77.9% did not have specific ward or bed for palliative care, 76.2% of the surgeons thought palliative care needed more attention in their hospitals. 97.4% of the surgeons thought palliative care was important for pancreatic cancer patients, and 94.9% were willing to join the palliative team. 46.6% of the surgeons thought palliative care should be conducted once pancreatic cancer was diagnosed. Most surgeons thought palliative care was helpful and should be involved in the multidisciplinary team. Regarding the geographical differences, surgeons and hospitals in North China performed better than in other regions. Surgeons with experience in clinical trials of pancreatic cancer performed better. The top three advice from the surgeons to promote palliative care were more education and training, seminars, and public broadcasting. 69.9% of the surgeons have concerns about the legal issue of implementation of palliative care. In general, the majority of pancreatic surgeons in China lack training and experience in palliative care for pancreatic cancer, and the current status of palliative care in most hospitals needs to be further improved. Prevalence of the participants think that palliative care is very important for pancreatic cancer patients. Palliative care should be provided once pancreatic cancer is diagnosed, and palliative care should be involved in the multidisciplinary team. More seminars, education and training, and public broadcasting are practical ways to improve palliative care for pancreatic cancer patients.
{"title":"Perceptions of Pancreatic Surgeons and the Current Status of Palliative Care for Pancreatic Cancer in China: A Multi-Center Online Questionnaire Survey","authors":"Qiaofei Liu, Yuze Hua, Jishu Wei, Qi Zhang, Zheng Wang, Xiaodong Tian, Feng Cao, Hanxiang Zhan, Song Gao, Shixiang Guo, Rongui Lin, Jinyong Xu, S. Gou, Chunlu Tan, Yuan Ding, Shi Si, Jiabin Jin, Zipeng Lu, Lei Cai, Min Wang, Chen Hua, Bin Zhou, Lei Zhang, Xiaohong Ning, Wenming Wu","doi":"10.1097/jp9.0000000000000178","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000178","url":null,"abstract":"\u0000 \u0000 To investigate the perceptions of pancreatic surgeons regarding palliative care for pancreatic cancer and the current status of palliative care for pancreatic cancer patients in China.\u0000 \u0000 \u0000 \u0000 An online questionnaire consisting of thirty-five questions in five domains, including basic information of the respondents, personal interest, training and experiences of palliative care, recognition of the importance of palliative care, palliative care in the hospital of the respondents, and advice to improve the service of palliative care for pancreatic cancer, was distributed to pancreatic surgeons by the WeChat APP. All the data were automatically recorded and can be downloaded. The respondents' perceptions of palliative care and the current status of palliative care were depicted, and the factors influencing the perceptions of the respondents and palliative care in hospitals were further analyzed.\u0000 \u0000 \u0000 \u0000 Responses from 429 pancreatic surgeons were validated. 81.4% were from tertiary hospitals, and 18.6% were from secondary hospitals. 94.2% were from general hospitals, and 5.8% were from cancer hospitals. Most surgeons have worked for over five years (93%), 72% had senior titles, and 54.5% held administrative positions. 49% have not read papers on palliative care before. 73.4% of the hospitals did not have a palliative care team, 77.9% did not have specific ward or bed for palliative care, 76.2% of the surgeons thought palliative care needed more attention in their hospitals. 97.4% of the surgeons thought palliative care was important for pancreatic cancer patients, and 94.9% were willing to join the palliative team. 46.6% of the surgeons thought palliative care should be conducted once pancreatic cancer was diagnosed. Most surgeons thought palliative care was helpful and should be involved in the multidisciplinary team. Regarding the geographical differences, surgeons and hospitals in North China performed better than in other regions. Surgeons with experience in clinical trials of pancreatic cancer performed better. The top three advice from the surgeons to promote palliative care were more education and training, seminars, and public broadcasting. 69.9% of the surgeons have concerns about the legal issue of implementation of palliative care.\u0000 \u0000 \u0000 \u0000 In general, the majority of pancreatic surgeons in China lack training and experience in palliative care for pancreatic cancer, and the current status of palliative care in most hospitals needs to be further improved. Prevalence of the participants think that palliative care is very important for pancreatic cancer patients. Palliative care should be provided once pancreatic cancer is diagnosed, and palliative care should be involved in the multidisciplinary team. More seminars, education and training, and public broadcasting are practical ways to improve palliative care for pancreatic cancer patients.\u0000","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"28 s83","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-12DOI: 10.1097/jp9.0000000000000177
Hai-Chao Li, Huan He, Bo-Han Huang, Lei Yang, Yi-Xuan Dıng, Feng Cao, Fei Li
Acute pancreatitis is one of the most common gastrointestinal diseases with significant morbidity and mortality, especially in the moderate to severe types. Splanchnic vein thrombosis(SVT) is related to acute pancreatitis but the pathogenesis of SVT in patients with AP is incompletely understood. To investigate the risk factors of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) complicated by splanchnic venous thrombosis. The clinical data of 290 patients with MSAP and SAP admitted to Xuanwu Hospital of Capital Medical University between December 2015 and December 2020 were retrospectively analyzed. Patients were divided into two groups: 1) with thrombosis and 2) without thrombosis. Sex, age, etiology, severity of acute pancreatitis, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), prothrombin time (PT), activated partial thrombin time (APTT), D-dimer (D-D) levels, type of pancreatic necrosis, proportion and location of pancreatic parenchymal necrosis (PPN), location of local complications, computed tomography severity index (CTSI) and modified CTSI(mCTSI) were recorded. Univariate, logistic multivariate regression analyses and nomogram were used to determine the risk factors for splanchnic venous thrombosis complicated by acute pancreatitis (AP). A receiver operating characteristic (ROC) curve, decision curve and calibration curve were drawn. Among 290 patients with AP, 71 (24.5%) had SAP, and 219 (75.5%) had MSAP. The median age of all the patients was 49 years; 172 patients (59.3%) had biliary disease, 91 patients (31.4%) had hypertriglyceridemia, 13 patients (4.5%) had alcohol disease, and 14 patients (4.8%) had other diseases. Of the 290 patients, SVT was detected in 35 (12.1%). Univariate analysis showed that the severity of acute pancreatitis, PLT, CRP, PCT, IL-6, PT, D-D, proportion of pancreatic parenchyma necrosis (PPN), necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space, CTSI and mCTSI in the thrombus group were all statistically significant (P < 0.05). The results of multivariate analysis showed that PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space were independent risk factors for AP complicated with splanchnic venous thrombosis. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.845. PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space are independent risk factors for splanchnic vein thrombosis. A simple nomogram tool helps in the early, accurate prediction of AP. Early and relevant clinical intervention should be provided.
{"title":"Risk factors and Nomogram Prediction for Splanchnic Venous Thrombosis in Moderate and Severe Acute Pancreatitis","authors":"Hai-Chao Li, Huan He, Bo-Han Huang, Lei Yang, Yi-Xuan Dıng, Feng Cao, Fei Li","doi":"10.1097/jp9.0000000000000177","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000177","url":null,"abstract":"\u0000 \u0000 Acute pancreatitis is one of the most common gastrointestinal diseases with significant morbidity and mortality, especially in the moderate to severe types. Splanchnic vein thrombosis(SVT) is related to acute pancreatitis but the pathogenesis of SVT in patients with AP is incompletely understood.\u0000 \u0000 \u0000 \u0000 To investigate the risk factors of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) complicated by splanchnic venous thrombosis.\u0000 \u0000 \u0000 \u0000 The clinical data of 290 patients with MSAP and SAP admitted to Xuanwu Hospital of Capital Medical University between December 2015 and December 2020 were retrospectively analyzed. Patients were divided into two groups: 1) with thrombosis and 2) without thrombosis. Sex, age, etiology, severity of acute pancreatitis, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), prothrombin time (PT), activated partial thrombin time (APTT), D-dimer (D-D) levels, type of pancreatic necrosis, proportion and location of pancreatic parenchymal necrosis (PPN), location of local complications, computed tomography severity index (CTSI) and modified CTSI(mCTSI) were recorded. Univariate, logistic multivariate regression analyses and nomogram were used to determine the risk factors for splanchnic venous thrombosis complicated by acute pancreatitis (AP). A receiver operating characteristic (ROC) curve, decision curve and calibration curve were drawn.\u0000 \u0000 \u0000 \u0000 Among 290 patients with AP, 71 (24.5%) had SAP, and 219 (75.5%) had MSAP. The median age of all the patients was 49 years; 172 patients (59.3%) had biliary disease, 91 patients (31.4%) had hypertriglyceridemia, 13 patients (4.5%) had alcohol disease, and 14 patients (4.8%) had other diseases. Of the 290 patients, SVT was detected in 35 (12.1%). Univariate analysis showed that the severity of acute pancreatitis, PLT, CRP, PCT, IL-6, PT, D-D, proportion of pancreatic parenchyma necrosis (PPN), necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space, CTSI and mCTSI in the thrombus group were all statistically significant (P < 0.05). The results of multivariate analysis showed that PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space were independent risk factors for AP complicated with splanchnic venous thrombosis. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.845.\u0000 \u0000 \u0000 \u0000 PLT≧422 × 109/L, necrosis of body-tail, and necrosis involving perihepatic and right subphrenic space are independent risk factors for splanchnic vein thrombosis. A simple nomogram tool helps in the early, accurate prediction of AP. Early and relevant clinical intervention should be provided.\u0000","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"60 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140249365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-05DOI: 10.1097/jp9.0000000000000176
Chaobin He, Jun Wang, Y. Mao, Xiangming Lao, Yongliang Chen, Xiaoyong Li, Heshui Wu, Yudong Qiu, Shengping Li
Pancreatic cancer is one of the most lethal malignancies, with increasing morbidity and mortality. Only 20% of all cases are candidates for surgical resection. Most locally advanced pancreatic cancer (LAPC) is deemed to be an unresectable disease because of the invasion of major vessels. Irreversible electroporation (IRE) is now increasingly applicable to treat LAPC. For the establishment of precise eligibility and the standardization of the IRE technique, a guideline is expected, aiming to improve safety, lead to reproducible outcomes, and facilitate further research into IRE. This article aimed to provide a set of technical recommendations for the treatment of LAPC by open IRE.
{"title":"Chinese Expert Consensus on Open Irreversible Electroporation Ablation for Locally Advanced Pancreatic Cancer (Version 2023)","authors":"Chaobin He, Jun Wang, Y. Mao, Xiangming Lao, Yongliang Chen, Xiaoyong Li, Heshui Wu, Yudong Qiu, Shengping Li","doi":"10.1097/jp9.0000000000000176","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000176","url":null,"abstract":"Pancreatic cancer is one of the most lethal malignancies, with increasing morbidity and mortality. Only 20% of all cases are candidates for surgical resection. Most locally advanced pancreatic cancer (LAPC) is deemed to be an unresectable disease because of the invasion of major vessels. Irreversible electroporation (IRE) is now increasingly applicable to treat LAPC. For the establishment of precise eligibility and the standardization of the IRE technique, a guideline is expected, aiming to improve safety, lead to reproducible outcomes, and facilitate further research into IRE. This article aimed to provide a set of technical recommendations for the treatment of LAPC by open IRE.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"218 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140265147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma (PDAC) and construct models to provide decision support and treatment selection for the candidate patients. Retrospect PDAC patients who received preoperative chemotherapy from January 2016 to June 2023 at the Second Affiliated Hospital of Zhejiang University School of Medicine. Run a univariate and multivariate analysis of factors associated with recurrence-free survival (RFS) and overall survival (OS). Scoring systems were developed based on the hazard ratios (HR) of all significant predictors. Kaplan–Meier analyses and log-rank tests were used to calculate RFS and OS. A total of 72 PDAC patients with preoperative chemotherapy were analyzed. After preoperative chemotherapy, 21(29.17%) patients achieved any radiologic downstaging with 68(94.44%) patients achieving negative resection margin status (R0 margins). For carbohydrate antigen 19-9(CA19-9) non-secreting patients, shrinkage rate of length diameter of tumor≥20%(P=0.027), resection margin status(P=0.011) were independent predictors of OS. And for CA19-9 secreting patients, CA19-9 serum level at the end of chemotherapy≥1000(P=0.027) and resection margin status (P=0.012) were independent predictors of OS. Points according HR were allocated to these factors in the proposed scoring system, respectively. Recurrence curves and survival curves with statistically significant differences were also presented for patients grouped according to the scoring systems. For CA19-9 non-secreting patients, the OS of patients with a score from 2 to 2.97 was significantly shorter than that of patients with a score from 4.94 to 5.91 (P=0.009). And for CA19-9 secreting patients, the OS of patients with a score of 2 was significantly shorter than that of patients with a score from 3.75 to 4.99 (P<0.001). Simple scoring models for RFS and OS incorporating CA19-9 serum levels or the tumor shrinkage rate and postoperative pathology may assist clinicians in evaluating prognosis of PDAC patients with preoperative chemotherapy.
{"title":"Recurrence and Survival Prediction Models for Receiving Preoperative Chemotherapy Pancreatic Ductal Adenocarcinoma Cancer: A Single-center Retrospective Research","authors":"Yixin Zhang, Xin Han, Zhongquan Sun, Wanlu You, Haoze Cao, Xiaochang Wu, Weilin Wang, Yuan Ding","doi":"10.1097/jp9.0000000000000171","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000171","url":null,"abstract":"\u0000 \u0000 Regard preoperative chemotherapy as a holistic sequential treatment modality to identify predictive factors associated with recurrence and survival in pancreatic ductal adenocarcinoma (PDAC) and construct models to provide decision support and treatment selection for the candidate patients.\u0000 \u0000 \u0000 \u0000 Retrospect PDAC patients who received preoperative chemotherapy from January 2016 to June 2023 at the Second Affiliated Hospital of Zhejiang University School of Medicine. Run a univariate and multivariate analysis of factors associated with recurrence-free survival (RFS) and overall survival (OS). Scoring systems were developed based on the hazard ratios (HR) of all significant predictors. Kaplan–Meier analyses and log-rank tests were used to calculate RFS and OS.\u0000 \u0000 \u0000 \u0000 A total of 72 PDAC patients with preoperative chemotherapy were analyzed. After preoperative chemotherapy, 21(29.17%) patients achieved any radiologic downstaging with 68(94.44%) patients achieving negative resection margin status (R0 margins). For carbohydrate antigen 19-9(CA19-9) non-secreting patients, shrinkage rate of length diameter of tumor≥20%(P=0.027), resection margin status(P=0.011) were independent predictors of OS. And for CA19-9 secreting patients, CA19-9 serum level at the end of chemotherapy≥1000(P=0.027) and resection margin status (P=0.012) were independent predictors of OS. Points according HR were allocated to these factors in the proposed scoring system, respectively. Recurrence curves and survival curves with statistically significant differences were also presented for patients grouped according to the scoring systems. For CA19-9 non-secreting patients, the OS of patients with a score from 2 to 2.97 was significantly shorter than that of patients with a score from 4.94 to 5.91 (P=0.009). And for CA19-9 secreting patients, the OS of patients with a score of 2 was significantly shorter than that of patients with a score from 3.75 to 4.99 (P<0.001).\u0000 \u0000 \u0000 \u0000 Simple scoring models for RFS and OS incorporating CA19-9 serum levels or the tumor shrinkage rate and postoperative pathology may assist clinicians in evaluating prognosis of PDAC patients with preoperative chemotherapy.\u0000","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"130 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139605093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-02DOI: 10.1097/jp9.0000000000000169
André Y. Ortega-Caballero, Alexis Paz-Rojas, Antonio Calderón-Vieyra, M. L. Serrano-Arévalo, J. Alonso-Lárraga, J. G. de la Mora-Levy, Angélica Hernández-Guerrero, J. M. Jiménez-Gutiérrez
We present two cases of primary melanomas that during their surveillance developed metastasis to the pancreas. After an initial approach, tissue samples of the pancreatic lesions were obtained by endoscopic ultrasound guided-fine needle biopsy (EUS-FNB). The histopathological report was compatible, in both cases, with a metastatic melanoma.
{"title":"Endoscopic Ultrasound Guided-Tissue Acquisition in Pancreatic Melanoma. Report of Two Cases and Literature Review.","authors":"André Y. Ortega-Caballero, Alexis Paz-Rojas, Antonio Calderón-Vieyra, M. L. Serrano-Arévalo, J. Alonso-Lárraga, J. G. de la Mora-Levy, Angélica Hernández-Guerrero, J. M. Jiménez-Gutiérrez","doi":"10.1097/jp9.0000000000000169","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000169","url":null,"abstract":"We present two cases of primary melanomas that during their surveillance developed metastasis to the pancreas. After an initial approach, tissue samples of the pancreatic lesions were obtained by endoscopic ultrasound guided-fine needle biopsy (EUS-FNB). The histopathological report was compatible, in both cases, with a metastatic melanoma.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139124716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-20DOI: 10.1097/jp9.0000000000000167
Mengyi Wang, Nan Huang, Qiaofei Liu, Quan Liao
Heparin-induced thrombocytopenia thrombosis (HITT) is a rare and potentially life-threatening complication after abdominal surgery, and it always occurs after the prophylactic or therapeutic use of heparin. HITT after pancreaticoduodenectomy (PD) has not been reported before. Herein, we reported a case of HITT after PD without prophylactic or therapeutic use of heparin. A 74-year-old female patient who suffered resectable pancreatic head cancer was transferred to our center for surgery. An open PD procedure was performed, and the operation was smooth. No heparin was used after surgery. Nine days after surgery, the platelet sharply declined to 48 × 10 9 /L (100-350), and the D-dimer soared up to 33.56 mg/L (0-0.55). Ultrasound examination showed vein thrombosis in both the lower limb and the right upper limb. HIT-antibody was 6.3 U/ml (0-0.6). The diagnosis of HITT was confirmed. Fondaparinux was used. On POD 23, the platelet recovered to the normal range. On POD 27, she was discharged without thromboembolism or active bleeding, and oral Rivaroxaban was prescribed. One month after discharge, the platelet remained normal, and she did not complain of discomfort.
{"title":"Heparin-induced thrombocytopenia thrombosis (HITT) after pancreaticoduodenectomy without definitive prophylactic or therapeutic use of heparin: a case report","authors":"Mengyi Wang, Nan Huang, Qiaofei Liu, Quan Liao","doi":"10.1097/jp9.0000000000000167","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000167","url":null,"abstract":"Heparin-induced thrombocytopenia thrombosis (HITT) is a rare and potentially life-threatening complication after abdominal surgery, and it always occurs after the prophylactic or therapeutic use of heparin. HITT after pancreaticoduodenectomy (PD) has not been reported before. Herein, we reported a case of HITT after PD without prophylactic or therapeutic use of heparin. A 74-year-old female patient who suffered resectable pancreatic head cancer was transferred to our center for surgery. An open PD procedure was performed, and the operation was smooth. No heparin was used after surgery. Nine days after surgery, the platelet sharply declined to 48 × 10 9 /L (100-350), and the D-dimer soared up to 33.56 mg/L (0-0.55). Ultrasound examination showed vein thrombosis in both the lower limb and the right upper limb. HIT-antibody was 6.3 U/ml (0-0.6). The diagnosis of HITT was confirmed. Fondaparinux was used. On POD 23, the platelet recovered to the normal range. On POD 27, she was discharged without thromboembolism or active bleeding, and oral Rivaroxaban was prescribed. One month after discharge, the platelet remained normal, and she did not complain of discomfort.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139168833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-28DOI: 10.1097/jp9.0000000000000155
Jiujie Cui, Qihan Fu, Xiaobing Chen, Yanling Wang, Qi Li, Fenghua Wang, Zhihua Li, Guanghai Dai, Yusheng Wang, Hongmei Zhang, Houjie Liang, Jun Zhou, Liu Yang, Fenghua Wang, Leizhen Zheng, Xiaofeng Chen, Ping Gong, Jiang Liu, Ying Yuan, Lin Wang, Yuejuan Cheng, Jun Zhang, Yuhong Zhou, Weijian Guo, Xianbao Zhan, Z. Zou, Da Li, Shan Zeng, Enxiao Li, Zhiwei Li, Zan Teng, Dan Cao, J. Kan, Jianping Xiong, M. Quan, Jiayu Yao, Hai-yan Yang, Liwei Wang
Real-world diagnostic and treatment data for pancreatic cancer in China are lacking. As such, the present study investigated the clinical characteristics, diagnosis, and treatment of advanced pancreatic cancer (including locally advanced and metastatic disease) in the Hospital-based Advanced Pancreatic Cancer Cohort in China of the China Pancreas Data Center database. A total of 5349 Chinese patients with advanced pancreatic cancer were identified from a database. The entire course of real-world pancreatic cancer management was analyzed. The proportion of patients with advanced pancreatic cancer was higher among males than females (62.4% versus [vs.] 37.6%, respectively). Patients typically had a history of hypertension (30.8%), diabetes (21.6%), and cholangitis (20.2%). Abdominal pain (51.6%), abdominal distension (27.1%), jaundice (20.1%), and weight loss (16.3%) were the main symptoms observed in patients with advanced pancreatic cancer in this cohort. Serum carbohydrate antigen (CA)19-9 is one of the most common tumor markers. In the present study, 2562 patients underwent first-line therapy. The median progression-free survival (PFS) for patients undergoing first-line therapy was 4.1 months. The major options for first-line therapy included gemcitabine (GEM) plus S-1 (GS/X) (23.4%), nab-paclitaxel plus GEM (AG) (18.1%), oxaliplatin, irinotecan, and leucovorin-modulated fluorouracil (FOLFIRINOX; 11.9%), nab-paclitaxel plus S-1 (AS) (8.9%), and GEM combined with oxaliplatin/cisplatin (GEMOX/GP) (7.6%). The AS and GS/X regimens were associated with the highest PFS rates. This is the first study to report multicenter, real-world data regarding advanced pancreatic cancer in China. Results revealed that real-world treatment options differed from guideline recommendations, and PFS was shorter than that in previously reported data. Improving intelligent follow-up systems and standardizing diagnosis and treatment of pancreatic cancer is recommended.
{"title":"The real-world study of the clinical characteristics, diagnosis, and treatment of advanced pancreatic cancer in China","authors":"Jiujie Cui, Qihan Fu, Xiaobing Chen, Yanling Wang, Qi Li, Fenghua Wang, Zhihua Li, Guanghai Dai, Yusheng Wang, Hongmei Zhang, Houjie Liang, Jun Zhou, Liu Yang, Fenghua Wang, Leizhen Zheng, Xiaofeng Chen, Ping Gong, Jiang Liu, Ying Yuan, Lin Wang, Yuejuan Cheng, Jun Zhang, Yuhong Zhou, Weijian Guo, Xianbao Zhan, Z. Zou, Da Li, Shan Zeng, Enxiao Li, Zhiwei Li, Zan Teng, Dan Cao, J. Kan, Jianping Xiong, M. Quan, Jiayu Yao, Hai-yan Yang, Liwei Wang","doi":"10.1097/jp9.0000000000000155","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000155","url":null,"abstract":"Real-world diagnostic and treatment data for pancreatic cancer in China are lacking. As such, the present study investigated the clinical characteristics, diagnosis, and treatment of advanced pancreatic cancer (including locally advanced and metastatic disease) in the Hospital-based Advanced Pancreatic Cancer Cohort in China of the China Pancreas Data Center database. A total of 5349 Chinese patients with advanced pancreatic cancer were identified from a database. The entire course of real-world pancreatic cancer management was analyzed. The proportion of patients with advanced pancreatic cancer was higher among males than females (62.4% versus [vs.] 37.6%, respectively). Patients typically had a history of hypertension (30.8%), diabetes (21.6%), and cholangitis (20.2%). Abdominal pain (51.6%), abdominal distension (27.1%), jaundice (20.1%), and weight loss (16.3%) were the main symptoms observed in patients with advanced pancreatic cancer in this cohort. Serum carbohydrate antigen (CA)19-9 is one of the most common tumor markers. In the present study, 2562 patients underwent first-line therapy. The median progression-free survival (PFS) for patients undergoing first-line therapy was 4.1 months. The major options for first-line therapy included gemcitabine (GEM) plus S-1 (GS/X) (23.4%), nab-paclitaxel plus GEM (AG) (18.1%), oxaliplatin, irinotecan, and leucovorin-modulated fluorouracil (FOLFIRINOX; 11.9%), nab-paclitaxel plus S-1 (AS) (8.9%), and GEM combined with oxaliplatin/cisplatin (GEMOX/GP) (7.6%). The AS and GS/X regimens were associated with the highest PFS rates. This is the first study to report multicenter, real-world data regarding advanced pancreatic cancer in China. Results revealed that real-world treatment options differed from guideline recommendations, and PFS was shorter than that in previously reported data. Improving intelligent follow-up systems and standardizing diagnosis and treatment of pancreatic cancer is recommended.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139216661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-21DOI: 10.1097/jp9.0000000000000154
M. Gong, Bo Zhang, Xueni Wang, Zeen Zhu, Wei Li, Liang Han, Zheng Wu, Qingyong Ma, Zheng Wang, Weikun Qian
Partly due to the limited effect of chemotherapy or other therapeutic strategies, which may due to the insufficient known of the tumor promotion markers and targets, pancreatic cancer (PC) holds the position of one of the most malignant tumors. This study aims to found a diagnosis/therapeutic molecule that can predicted the prognosis in pancreatic cancer with different gene background. TCGA PAAD based single nucleotide polymorphisms and gene expression data was used to find the different expression genes (DEGs) between KRAS/TP53 mutant samples and no gene mutation samples. GSEA based KEGG analysis and R based GO or immune cell invasion assay were used to explore above DEGs involved pathways. The single center pancreatic cancer cohort accompanied with next generation sequence testing was used to verified the TGCA PAAD based bioinformatic results. Firstly, we found pancreatic cancer patients harbored KRAS and/or TP53 gene mutation have a poor overall survival. Besides, the enrichment analysis showed that mutant KRAS/TP53 was correlated with pancreatic cancer tumor-promotion-related pathways and immune microenvironment. Next, we detected that prostate stem cell antigen (PSCA) was one of the most differential genes in KRAS/TP53 mutant pancreatic cancer tissues. Indeed, the bioinformatic analysis and our clinical data showed PSCA was a biomarker of poor prognosis in pancreatic cancer. PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant pancreatic cancer patients.
{"title":"PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant pancreatic cancer patients","authors":"M. Gong, Bo Zhang, Xueni Wang, Zeen Zhu, Wei Li, Liang Han, Zheng Wu, Qingyong Ma, Zheng Wang, Weikun Qian","doi":"10.1097/jp9.0000000000000154","DOIUrl":"https://doi.org/10.1097/jp9.0000000000000154","url":null,"abstract":"Partly due to the limited effect of chemotherapy or other therapeutic strategies, which may due to the insufficient known of the tumor promotion markers and targets, pancreatic cancer (PC) holds the position of one of the most malignant tumors. This study aims to found a diagnosis/therapeutic molecule that can predicted the prognosis in pancreatic cancer with different gene background. TCGA PAAD based single nucleotide polymorphisms and gene expression data was used to find the different expression genes (DEGs) between KRAS/TP53 mutant samples and no gene mutation samples. GSEA based KEGG analysis and R based GO or immune cell invasion assay were used to explore above DEGs involved pathways. The single center pancreatic cancer cohort accompanied with next generation sequence testing was used to verified the TGCA PAAD based bioinformatic results. Firstly, we found pancreatic cancer patients harbored KRAS and/or TP53 gene mutation have a poor overall survival. Besides, the enrichment analysis showed that mutant KRAS/TP53 was correlated with pancreatic cancer tumor-promotion-related pathways and immune microenvironment. Next, we detected that prostate stem cell antigen (PSCA) was one of the most differential genes in KRAS/TP53 mutant pancreatic cancer tissues. Indeed, the bioinformatic analysis and our clinical data showed PSCA was a biomarker of poor prognosis in pancreatic cancer. PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant pancreatic cancer patients.","PeriodicalId":506939,"journal":{"name":"Journal of Pancreatology","volume":"38 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139251677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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