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Position emission tomography imaging in pancreatic cancer: recent progress and future directions 胰腺癌的位置发射断层成像:最新进展和未来方向
Pub Date : 2019-05-14 DOI: 10.21037/APC.2019.03.02
Xiaoli Zhang, Xue Meng, Hui Zhu, Qiuan Yang, K. Morris, Terence Herman, Jinming Yu, Min Li
Pancreatic cancer (PC) is one of the leading causes of cancer death worldwide. Limited therapeutic options are available. Therefore, how to detect early-stage tumors and how to monitor treatment efficacy and outcomes to allow timely salvage therapies are of crucial importance. Position emission tomography (PET) imaging provides more tumor-associated functional, biochemical and molecular information, without some of the intrinsic limitations of traditional imaging modalities. PET is highlighted as a potential tool to help better understand the mechanism of PC and personalize individual therapeutic regimens. In this review, we outline the available PET imaging modalities and their prospective applications in PC.
胰腺癌(PC)是全球癌症死亡的主要原因之一。可供选择的治疗方法有限。因此,如何发现早期肿瘤,如何监测治疗效果和结果,以便及时进行抢救治疗至关重要。位置发射断层扫描(PET)成像提供了更多的肿瘤相关功能,生化和分子信息,没有传统成像方式的一些固有局限性。PET被认为是一种潜在的工具,有助于更好地了解PC的机制和个性化的治疗方案。在这篇综述中,我们概述了可用的PET成像方式及其在PC中的应用前景。
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引用次数: 0
Impact of prior cholecystectomy on perioperative outcomes after resection for pancreatic cancer: a single-center, retrospective cohort study in a Chinese population 既往胆囊切除术对胰腺癌术后围手术期预后的影响:一项针对中国人群的单中心、回顾性队列研究
Pub Date : 2019-04-23 DOI: 10.21037/APC.2019.03.01
L. Yin, Xinchun Liu, Tongtai Liu, Yue Fu, Yunpeng Peng, D. Ding, Zipeng Lu, Wen-tao Gao, Junli Wu, K. Jiang, Jishu Wei, Y. Miao
Background: Cholecystectomy is carried out as one of the most extensive abdominal surgery. Patients with a long-term history of cholecystectomy may have an increased risk of pancreatic cancer. However, it’s uncertain whether prior cholecystectomy is associated with the outcome of patients with pancreatic cancer. This study was to demonstrate that prior cholecystectomy may lead to adverse perioperative outcomes in patients with pancreatic adenocarcinoma. Methods: Retrospective study comprising 755 consecutive patients with pathological diagnosis of pancreatic adenocarcinoma in Pancreas Center of the First Affiliated Hospital of Nanjing Medical University (January 2010 to December 2015) was conducted. Demographic details, surgery, tumor stage, pathology and complications were assessed. Patients were divided into NPC (no prior cholecystectomy) group and PC (prior cholecystectomy) group. PC group consist of three subgroups: RC (recent cholecystectomy), LTC (long term cholecystectomy), MTC (medium term cholecystectomy) group. Results: A total of 9.3% (70/755) of the patients underwent prior cholecystectomy, which was significantly more frequent than other operations. The rate is also abnormally higher than Chinese population (1.2%, 31/2,579). Five hundred and fifty-three patients with radical resection were selected. Compared to NPC group, PC group has more progressive tumor with relatively higher level of serum CA19-9 and possibly higher rate of lymph node metastasis. Further analysis showed that RC group had remarkably longer surgery time and more blood loss than NPC group. There was no significant difference of operative time and blood loss between LTC/MTC group and NPC group. Postoperatively, there was no statistical difference between LTC/MTC group and NPC group in complications as POPF (postoperative pancreatic fistula), DGE (delayed gastric emptying), hemorrhage and infection. There was also no notably difference in length of hospital stay these two groups. Conclusions: There is an abnormally high proportion of patients with cholecystectomy history in Chinese patients with pancreatic cancer. Patients with recent cholecystectomy history may have adverse perioperative outcome.
背景:胆囊切除术是最广泛的腹部外科手术之一。有长期胆囊切除术史的患者患胰腺癌的风险可能增加。然而,既往胆囊切除术是否与胰腺癌患者的预后相关尚不确定。本研究旨在证明既往胆囊切除术可能导致胰腺腺癌患者的不良围手术期预后。方法:选取2010年1月至2015年12月南京医科大学第一附属医院胰腺中心病理诊断为胰腺腺癌的连续755例患者进行回顾性研究。统计资料、手术、肿瘤分期、病理及并发症。将患者分为未切除胆囊组(NPC)和切除胆囊组(PC)。PC组分为三个亚组:近期胆囊切除术(RC)、长期胆囊切除术(LTC)、中期胆囊切除术(MTC)组。结果:9.3%(70/755)的患者既往行胆囊切除术,明显高于其他手术。这一比例也异常高于中国人口(1.2%,31/ 2579)。553例患者行根治性切除。与NPC组相比,PC组肿瘤进展更大,血清CA19-9水平相对较高,淋巴结转移率可能更高。进一步分析,RC组手术时间明显长于NPC组,出血量明显大于NPC组。LTC/MTC组与NPC组手术时间及出血量无显著差异。术后,LTC/MTC组与NPC组在术后胰瘘(POPF)、胃排空延迟(DGE)、出血、感染等并发症方面差异无统计学意义。两组患者的住院时间也无显著差异。结论:中国胰腺癌患者有胆囊切除术史的比例异常高。近期有胆囊切除术史的患者围手术期预后不良。
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引用次数: 0
Malnutrition, frailty, and sarcopenia in pancreatic cancer patients: assessments and interventions for the pancreatic surgeon. 胰腺癌患者的营养不良、虚弱和肌肉减少症:胰腺外科医生的评估和干预措施。
Pub Date : 2019-03-01 Epub Date: 2019-03-11 DOI: 10.21037/apc.2019.02.01
Noah S Rozich, Caitlin E Jones, Katherine T Morris

The objective of this article is to review the available literature examining the impact of malnutrition, frailty, and sarcopenia on surgical morbidity among pancreatic cancer patients. We examine definitions used to diagnose and quantify these conditions and review the differences between them with regards to preoperative assessment and postoperative outcomes. The most relevant scoring systems are summarized. Lastly, we summarize current knowledge regarding effectiveness of specific interventions aimed at malnutrition, frailty, and sarcopenia for patients undergoing pancreatic cancer surgery.

本文的目的是回顾现有的研究胰腺癌患者中营养不良、虚弱和肌肉减少症对手术发病率的影响的文献。我们检查用于诊断和量化这些条件的定义,并回顾它们之间在术前评估和术后结果方面的差异。总结了最相关的评分系统。最后,我们总结了针对胰腺癌手术患者营养不良、虚弱和肌肉减少症的具体干预措施的有效性。
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引用次数: 4
Eugene J. Koay: translating promising new radiation technologies to patients with gastrointestinal cancers Eugene J. Koay:将有前途的新放射技术转化为胃肠道癌症患者
Pub Date : 2019-01-01 DOI: 10.21037/apc.2018.12.01
Brad Li
Gastrointestinal (GI) cancer refers to the group of cancers that affect the digestive system. This includes cancers of the oesophagus, stomach, liver, pancreas, gallbladder and biliary tract, small intestine, colon, rectum and anus. GI cancers are regarded as a highly virulent neoplasm with both high morbidity and mortality. Collectively, they are a major cause of morbidity and mortality worldwide (1). Over the past half century, modern radiation therapy has been established and slowly evolved to treat different kinds of GI cancers. However, challenges remain in giving accurate and safe radiation delivery.
胃肠道(GI)癌症是指影响消化系统的一类癌症。这包括食道癌、胃癌、肝癌、胰腺癌、胆囊癌、胆道癌、小肠癌、结肠癌、直肠癌和肛门癌。胃肠道肿瘤被认为是一种高致死率和高发病率的恶性肿瘤。总的来说,它们是世界范围内发病率和死亡率的主要原因(1)。在过去的半个世纪里,现代放射治疗已经建立并慢慢发展到治疗不同类型的胃肠道癌症。然而,在提供准确和安全的辐射输送方面仍然存在挑战。
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引用次数: 0
Pitfalls of minimally invasive pancreatoduodenectomy. 微创胰十二指肠切除术的陷阱。
Pub Date : 2019-01-01 Epub Date: 2019-01-16 DOI: 10.21037/apc.2018.12.02
Patrick W Underwood, Michael H Gerber, Steven J Hughes

Minimally invasive approaches to abdominal surgical procedures have provided superior outcomes when compared to the open approach and thus have become the standard of care. However, minimally invasive pancreatoduodenectomy (MIPD) presents unique difficulties for both laparoscopic and robotic platforms and remains controversial. Ongoing concerns continue about the minimally invasive approach creating meaningful benefit when system-wide data may suggest MIPD results in increased morbidity and mortality during the learning curve. This treatise explores the current state of MIPD, reviewing the volume and quality of data that supports benefit while contrasting the benefits to the unique challenges associated with MIPD that may lead to unacceptable rates of complications and death. We conclude that in a handful of centers, MIPD confers an iterative but not transformative benefit. Significant barriers to the wide-spread acceptance of MIPD are apparent and persist, including: lack of high level data confirming clinical benefit, well defined patient selection criteria, formal education programs that address challenges of the learning curve, and ultimately value.

与开放入路相比,微创入路腹部外科手术提供了更好的结果,因此已成为标准的护理方法。然而,微创胰十二指肠切除术(MIPD)在腹腔镜和机器人平台上都存在独特的困难,并且仍然存在争议。当全系统数据表明在学习过程中,MIPD会导致发病率和死亡率增加时,人们对微创方法能否产生有意义的益处的关注仍在继续。这篇论文探讨了MIPD的现状,回顾了支持益处的数据的数量和质量,同时对比了与MIPD相关的独特挑战的益处,这些挑战可能导致不可接受的并发症和死亡率。我们得出的结论是,在少数中心,MIPD提供了迭代而不是变革性的好处。广泛接受MIPD的重大障碍是明显且持续存在的,包括:缺乏证实临床益处的高水平数据,明确定义的患者选择标准,解决学习曲线挑战的正规教育计划,以及最终的价值。
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引用次数: 5
Immune defects in pancreatic cancer. 胰腺癌的免疫缺陷。
Pub Date : 2018-12-01 Epub Date: 2018-12-06 DOI: 10.21037/apc.2018.11.01
Lei Zheng
Pancreatic cancer is resistant to the immunotherapy. This resistance is caused by any of the four immune "defects" that occur in pancreatic cancer, including lack of "high quality" T cells, stromal barriers to T cells getting access to tumor cells, immunosuppressive cells such as M2 macrophages, myeloid derivative suppressor cells, and T regulatory cells, in the tumor microenvironment of pancreatic cancer. One or more defects may occur in an individual pancreatic cancer. To overcome the resistance to the immunotherapy such as immune checkpoint inhibitors, a rational combination of agents that target multiple immune defects is highly demanded.
胰腺癌对免疫疗法有抗药性。这种抵抗是由胰腺癌中发生的四种免疫“缺陷”中的任何一种引起的,包括缺乏“高质量”T细胞,T细胞进入肿瘤细胞的基质屏障,胰腺癌肿瘤微环境中的免疫抑制细胞,如M2巨噬细胞,髓系衍生物抑制细胞和T调节细胞。个别胰腺癌中可能出现一种或多种缺陷。为了克服免疫检查点抑制剂等免疫疗法的耐药性,迫切需要针对多种免疫缺陷的药物合理组合。
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引用次数: 5
Pancreatic cystic neoplasms: usually incidental, rarely incident 胰腺囊性肿瘤:通常是偶发的,很少是偶然发生的
Pub Date : 2018-10-01 DOI: 10.21037/APC.2018.09.04
E. Duell
There are over 20 different types of cystic lesions of the pancreas, most of which are benign (1). The four most common pancreatic cysts with neoplastic potential are serous cystadenoma (SCA), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN).
胰腺有超过20种不同类型的囊性病变,其中大多数是良性的(1)。四种最常见的具有肿瘤潜力的胰腺囊肿是浆液性囊腺瘤(SCA)、实性假乳头状瘤(SPN)、粘液性囊性肿瘤(MCN)和导管内乳头状粘液性肿瘤(IPMN)。
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引用次数: 0
Case analysis of pancreatic cancer treated with FOLFIRINOX in China 国内FOLFIRINOX治疗胰腺癌病例分析
Pub Date : 2018-10-01 DOI: 10.21037/APC.2018.09.01
S. Si, T. Hieken, A. Degnim, Zhiying Yang, H. Tan, Yongliang Sun, Liguo Liu, Wenying Zhou, Jia Huang
Background: The FOLFIRINOX regimen recently became the new standard of care for patients with advanced pancreatic cancer. However, FOLFIRINOX hasn’t been widely used in China as the hesitance of oncologists to use FOLFIRINOX due to the toxicity of the regimen and the presumption that Chinese patients could not tolerate FOLFIRINOX. Methods: We retrospectively analyzed the clinical data of ten patients with pancreatic cancer who received the FOLFIRINOX regimen from July 2016 to July 2018. The two woman and eight men enrolled were aged 29 to 76 years. Three, three, and four patients were diagnosed with borderline resectable pancreatic cancer (BRPC), liver-metastatic pancreatic cancer (LMPC), and recurrent pancreatic cancer (RPC), respectively. Seven and three patients received a full or 80% initial dose, according to their Eastern Cooperative Oncology Group performance status. Results: One of the seven patients was administered an 80% dose after the second cycle because of febrile neutropenia (grade >3). The most common adverse event was neutropenia (grade 2). Four patients with BRPC or LMPC successfully underwent surgical resection. Two patients with LMPC achieved partial remission (PR). The levels of the serum carbohydrate antigen 19-9 of three patients with RPC significantly decreased (>60%). Conclusions: The FOLFIRINOX regimen is effective and is tolerated by certain Chinese patients with advanced pancreatic cancer. The dose of the FOLFIRINOX regimen should be individually adjusted to reduce toxicity.
背景:FOLFIRINOX方案最近成为晚期胰腺癌患者的新护理标准。然而,由于肿瘤学家对FOLFIRINOX方案的毒性以及假定中国患者对FOLFIRINOX不能耐受,因此FOLFIRINOX在中国并没有得到广泛的应用。方法:回顾性分析2016年7月至2018年7月接受FOLFIRINOX方案治疗的10例胰腺癌患者的临床资料。参与研究的两名女性和八名男性年龄在29岁至76岁之间。3例、3例和4例患者分别被诊断为交界性可切除胰腺癌(BRPC)、肝转移性胰腺癌(LMPC)和复发性胰腺癌(RPC)。根据东部肿瘤合作小组的表现状况,7名和3名患者接受了全额或80%的初始剂量。结果:7例患者中有1例因发热性中性粒细胞减少症(分级>3)在第二周期后给予80%剂量。最常见的不良事件是中性粒细胞减少(2级)。4例BRPC或LMPC患者成功接受了手术切除。2例LMPC患者获得部分缓解(PR)。3例RPC患者血清碳水化合物抗原19-9水平明显降低(>60%)。结论:FOLFIRINOX方案对部分中国晚期胰腺癌患者有效且耐受。FOLFIRINOX方案的剂量应单独调整以减少毒性。
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引用次数: 0
Stressing for sugar: a new role of serotonin for glycolysis in pancreatic cancer cells. 对糖的应激:血清素在胰腺癌细胞糖酵解中的新作用。
Pub Date : 2018-10-01 Epub Date: 2018-10-10 DOI: 10.21037/apc.2018.09.03
Gregory B Lesinski
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引用次数: 0
Depletion of tumor associated macrophages by anti-BAG3 treatment complements PD-1 blockade in pancreatic cancer 在胰腺癌中,抗bag3治疗对肿瘤相关巨噬细胞的消耗是对PD-1阻断的补充
Pub Date : 2018-10-01 DOI: 10.21037/APC.2018.10.01
Yi Sun, R. Torphy, Yuwen Zhu
New literature published in Gut has shown that combined treatment of anti-BAG3 mAb and anti-PD-1 mAb in pancreatic cancer can eliminate tumor-associated macrophages (TAMs), increase tumor infiltrating CD8+ T cells and result in tumor growth suppression (1). These findings highlight the potential of BAG3 (Bcl-2-associated athanogene 3) as a therapeutic target in conjunction with immune checkpoint blockade in the treatment of pancreatic cancer.
发表在Gut杂志上的新文献表明,联合使用抗BAG3单抗和抗pd -1单抗治疗胰腺癌可以消除肿瘤相关巨噬细胞(tam),增加肿瘤浸润CD8+ T细胞,并导致肿瘤生长抑制(1)。这些发现突出了BAG3 (bcl -2相关的thanogene 3)作为治疗靶点与免疫检查点阻断联合治疗胰腺癌的潜力。
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引用次数: 0
期刊
Annals of Pancreatic Cancer
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