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Liu B, Huang W, Zhang F, Wang J, Guo J, Huang X, Lei G, Wang J, Ye X, Wang R, Gai B, Hu X, Li M, Li C, Xiao Y, Lin Z, Niu L, Zhu G, Gao F, Niu H, Zhang H, Wu Q, Yang J, Zhao H, Zhang K, Chen Z, Chen T, Zhang H, Wang Z, Li Y. Guidelines for permanent iodine-125 seed interstitial brachytherapy for pancreatic cancer (2023 edition): The Chinese expert consensus workshop report. J Cancer Res Ther 2024; 20:1124-1129. [PMID: 39206973 DOI: 10.4103/jcrt.jcrt_2368_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 04/01/2024] [Indexed: 09/04/2024]
Abstract
ABSTRACT The incidence of pancreatic cancer is increasing worldwide. Approximately, 60% of patients with pancreatic cancer have distant metastases at the time of diagnosis, of which only 10% can be removed using standard resection. Further, patients derive limited benefits from chemotherapy or radiotherapy. As such, alternative methods to achieve local control have emerged, including permanent iodine-125 seed interstitial brachytherapy. In 2023, the Chinese College of Interventionalists, affiliated with the Chinese Medical Doctor Association, organized a group of multi-disciplinary experts to compose guidelines for this treatment modality. The aim of this conference was to standardize the procedure for permanent iodine-125 seed interstitial brachytherapy, including indications, contraindications, pre-procedural preparation, procedural operations, complications, efficacy evaluation, and follow-up.
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Affiliation(s)
- Bin Liu
- Department of Interventional and Minimal Invasive Oncology, The Second Hospital of Shandong University, Jinan, China
- The Institute of Interventional Oncology, Shandong University, Jinan, China
| | - Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fujun Zhang
- Imaging and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Junjie Wang
- Department of Radiation Oncology, Cancer Centre, Peking University Third Hospital, Beijing, China
| | - Jinhe Guo
- Department of Radiology, Southeast University, Zhongda Hospital, Nanjing, China
| | - Xuequan Huang
- Department of Interventional Medicine, The First Hospital Affiliated to AMU (Southeast Hospital), Chongqing, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shaanxi Provincial Cancer Hospital, Xi'an, China
| | - Juan Wang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ruoyu Wang
- Department of Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Baodong Gai
- Department of Gastrointestinal and Colorectal Surgery, The Third Hospital of Jilin University, Changjun, China
| | - Xiaokun Hu
- Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Maoquan Li
- Department of Interventional and Vascular Surgery, Affiliated Tenth People's Hospital of Tongji University, Interventional Vascular Institute of Tongji University, Shanghai, China
| | - Chengli Li
- Department of Radiology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Yueyong Xiao
- Department of Radiology, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhengyu Lin
- Department of Interventional Therapy, The First Affiliated Hospital of Fujian Medical University, Guang Zhou, Guangzhou, China
| | - Lizhi Niu
- Department of Surgical Oncology, Fuda Cancer Hospital, Guang Zhou, Guangzhou, China
| | - Guangyu Zhu
- Department of Radiology, Southeast University, Zhongda Hospital, Nanjing, China
| | - Fei Gao
- Imaging and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hongxin Niu
- Department of Interventional Radiology, Shandong Cancer Hospital, Jinan, China
| | - Hongtao Zhang
- Department of Oncology, Hebei General Hospital, Shijiazhuang, China
| | - Qing Wu
- Department of Oncology, Affiliated Longhua Hospital of Shanghai Traditional Chinese Medicine University, Shanghai, China
| | - Jijin Yang
- Department of Interventional Radiology, Shanghai Changhai Hospital, Shanghai, China
| | - Hong Zhao
- Department of Oncology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Zhijin Chen
- Department of Interventional Radiology, Luwan Branch of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingsong Chen
- Department of Interventional Radiology, Shanghai Seventh People's Hospital, Shanghai, China
| | - Haoren Zhang
- Present Office, True Health Medical Technology CO., LTD., Zhuhai, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuliang Li
- Department of Interventional and Minimal Invasive Oncology, The Second Hospital of Shandong University, Jinan, China
- The Institute of Interventional Oncology, Shandong University, Jinan, China
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Zhong L, Liu J, Xia M, Zhang Y, Liu S, Tan G. Effect of sarcopenia on survival in patients after pancreatic surgery: a systematic review and meta-analysis. Front Nutr 2024; 10:1315097. [PMID: 38260056 PMCID: PMC10800600 DOI: 10.3389/fnut.2023.1315097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Numerous studies have reported sarcopenia to be associated with unfavorable outcomes in patients who have undergone pancreatectomy. Therefore, in this meta-analysis, we examined the relationship between sarcopenia and survival after pancreatic surgery. Methods PubMed, Embase, and Cochrane Library were searched for studies that examined the association between sarcopenia and survival after pancreatic surgery from the inception of the database until June 1, 2023. Hazard ratio (HR) for overall survival (OS) and/or progression-free survival (PFS) of sarcopenia and pancreatic surgery were extracted from the selected studies and random or fixed-effect models were used to summarize the data according to the heterogeneity. Publication bias was assessed using Egger's linear regression test and a funnel plot. Results Sixteen studies met the inclusion criteria. For 13 aggregated univariate and 16 multivariate estimates, sarcopenia was associated with decreased OS (univariate analysis: HR 1.69, 95% CI 1.48-1.93; multivariate analysis: HR 1.69; 95% CI 1.39-2.05, I2 = 77.4%). Furthermore, sarcopenia was significantly associated with poor PFS of pancreatic resection (Change to univariate analysis: HR 1.74, 95% CI 1.47-2.05; multivariate analysis: HR 1.54; 95% CI 1.23-1.93, I2 = 63%). Conclusion Sarcopenia may be a significant prognostic factor for a shortened survival following pancreatectomy since it is linked to an elevated risk of mortality. Further studies are required to understand how sarcopenia affects long-term results after pancreatic resection.Systematic review registrationRegistration ID: CRD42023438208 https://www.crd.york.ac.uk/PROSPERO/#recordDetails.
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Affiliation(s)
- Lei Zhong
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jifeng Liu
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mingquan Xia
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunshu Zhang
- Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuo Liu
- Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Guang Tan
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Hong Y, Zhong L, Lv X, Liu Q, Fu L, Zhou D, Yu N. Application of spectral CT in diagnosis, classification and prognostic monitoring of gastrointestinal cancers: progress, limitations and prospects. Front Mol Biosci 2023; 10:1284549. [PMID: 37954980 PMCID: PMC10634296 DOI: 10.3389/fmolb.2023.1284549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023] Open
Abstract
Gastrointestinal (GI) cancer is the leading cause of cancer-related deaths worldwide. Computed tomography (CT) is an important auxiliary tool for the diagnosis, evaluation, and prognosis prediction of gastrointestinal tumors. Spectral CT is another major CT revolution after spiral CT and multidetector CT. Compared to traditional CT which only provides single-parameter anatomical diagnostic mode imaging, spectral CT can achieve multi-parameter imaging and provide a wealth of image information to optimize disease diagnosis. In recent years, with the rapid development and application of spectral CT, more and more studies on the application of spectral CT in the characterization of GI tumors have been published. For this review, we obtained a substantial volume of literature, focusing on spectral CT imaging of gastrointestinal cancers, including esophageal, stomach, colorectal, liver, and pancreatic cancers. We found that spectral CT can not only accurately stage gastrointestinal tumors before operation but also distinguish benign and malignant GI tumors with improved image quality, and effectively evaluate the therapeutic response and prognosis of the lesions. In addition, this paper also discusses the limitations and prospects of using spectral CT in GI cancer diagnosis and treatment.
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Affiliation(s)
- Yuqin Hong
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Lijuan Zhong
- Department of Radiology, The People’s Hospital of Leshan, Leshan, China
| | - Xue Lv
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Qiao Liu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Langzhou Fu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Daiquan Zhou
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Na Yu
- Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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Ramavath K, Subbiah Nagaraj S, Kumar M, Raypattanaik NM, Dahiya D, Savlania A, Tandup C, Kalra N, Behera A, Kaman L. Visceral Obesity as a Predictor of Postoperative Complications After Pancreaticoduodenectomy. Cureus 2023; 15:e35815. [PMID: 37033590 PMCID: PMC10075183 DOI: 10.7759/cureus.35815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Obesity is associated with increased morbidity and mortality post surgery. The measurement of visceral obesity can predict postoperative outcomes after pancreaticoduodenectomy. METHODS This is a prospective observational study. Visceral obesity was calculated by measuring the fat thickness in the retro-renal area by using a computed tomography scan. Visceral obesity was defined as retro-renal fat thickness (RRFT) of ≥ 2 cm. Patients were divided into two groups: Group-A (RRFT < 2 cm, non-obese) and Group-B (RRFT > 2 cm, obese). Demographic, clinical, and intraoperative variables were correlated with postoperative outcomes. RESULTS Fifty-six patients were included in the study. Thirty-two patients were included in Group-A, and 24 patients were included in Group-B. The two groups had comparable outcomes. A total of 21 patients in Group-A (65.62%) and 17 patients in Group-B (70.83%) had comorbidities, including diabetes mellitus, hypertension, and coronary disease (p=0.680). American Society of Anesthesiologists (ASA) grading was comparable (p=0.927). BMI was also comparable (p=0.354). Type of pancreaticoduodenectomy, pancreatic texture, pancreatic duct diameter, and technique of pancreaticojejunostomy anastomosis were comparable. The mean operative time was longer in Group-B (362 ± 36.2 min vs. 298 ± 45.2 min) (p=0.001). Intraoperative blood loss was more in Group-B (312 ± 36.8 ml vs. 267 ± 23.7 ml) (p=0.001). The rates of postoperative pancreatic fistula and delayed gastric emptying were comparable (p=0.402 and p=0.134, respectively). The length of hospital stay was longer in patients in Group-B (p=0.004). There was one death in Group-B (obese group). CONCLUSION Visceral obesity is a risk factor for postoperative complications after a pancreaticoduodenectomy.
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Adhikari KM, Sharma D, Dahal R, Kandel BP, Lakhey PJ. Comparative Study of Perioperative Outcomes Between Modified Blumgart Duct to Mucosa and Dunking Pancreaticojejunostomy. Cureus 2023; 15:e34418. [PMID: 36874701 PMCID: PMC9978053 DOI: 10.7759/cureus.34418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Pancreaticojejunostomy (PJ) is the ''Achilles heel" of pancreaticoduodenectomy (PD) which affects perioperative as well as oncological outcomes. However, there is a lack of information about the superiority of the type of anastomosis in terms of overall morbidity and postoperative pancreatic fistula (POPF) after PD. Here, we compare the outcomes of modified Blumgart PJ with the dunking technique of PJ. METHODOLOGY A case-control study of a prospectively maintained database of 25 consecutive patients undergoing modified Blumgart PJ (study group) and 25 patients who underwent continuous dunking PJ (control group) between January 2018 to April 2021 was done. Between groups, comparisons were made for the duration of surgery, intraoperative blood loss, original fistula risk score, overall complications as graded by Clavien Dindo (CD), POPF, post pancreatectomy haemorrhage (PPH), delayed gastric emptying (DGE), and 30-day mortality at 95% confidence level. RESULTS Among 50 patients, 30 (60%) were male. The most common indication for PD was ampullary carcinoma (44% in the study group vs. 60% in the control group). The duration of surgery was approximately 41 minutes longer in the study group compared to the control (p = 0.02), while the intraoperative blood loss was similar between the two groups (496.00 ± 226.35 ml vs 508.00 ± 180.67 ml, p = 0.84). While there was no significant difference in mean fistula risk score between the two groups, the POPF (8% vs 32%, p = 0.03), PPH (0% vs 20%, p =0.02), and overall major complications (CD≥ III) according to CD Grading (12% vs 40%, p = 0.02) were significantly lower in the study group. Similarly, the duration of hospital stay in the study group was 4.64 days shorter than the control group (p = 0.001). However, there was no significant difference in the 30-day mortality between the two groups. CONCLUSIONS Modified Blumgart pancreaticojejunostomy has better perioperative outcomes in terms of procedure-specific complications like POPF, PPH, overall major postoperative complications, and duration of hospital stay.
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Affiliation(s)
- Krishna M Adhikari
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Deepak Sharma
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Romi Dahal
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Bishnu P Kandel
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
| | - Paleswan J Lakhey
- Department of Surgical Gastroenterology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
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Giannone F, Crippa S, Aleotti F, Palumbo D, Belfiori G, Partelli S, Schiavo Lena M, Capurso G, Petrone MC, De Cobelli F, Arcidiacono PG, Falconi M. Improving diagnostic accuracy and appropriate indications for surgery in pancreatic cystic neoplasms: the role of EUS. Gastrointest Endosc 2022; 96:648-656.e2. [PMID: 35618030 DOI: 10.1016/j.gie.2022.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/14/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Pancreatic cystic neoplasms (PCNs) represent a difficult preoperative diagnosis despite improvements in imaging. In this study, we compared preoperative and final pathologic diagnosis in a large cohort of resected PCNs, evaluating diagnostic accuracy with a specific focus on the value of EUS. METHODS A retrospective analysis of patients undergoing resection between 2009 and 2019 for presumed PCNs was performed. Preoperative workup was reviewed by analyzing the role of imaging and EUS. Patients with a benign histology who did not show absolute indication were categorized as "delayable surgery." RESULTS Of 585 patients who were retrospectively analyzed, in 108 (18.5%) final histology did not confirm preoperative diagnosis. EUS was associated with a lower rate of incorrect diagnosis (16%; P = .03), but the risk of overtreatment was similar regardless of instrumental diagnostic path (33/131 vs 68/328, P = .298). Dilatation of the main pancreatic duct and cytologic sampling were the only variables independently associated with a correct diagnosis (P < .001 and P = .041, respectively). Based on clinical presentation and final histology, pancreatic resection could have been spared or delayed in 101 of 459 patients (22%), and this was influenced by age (odds ratio [OR], .97; P = .002), cyst larger than 30 mm (OR, 1.89; P = .005), and type of operation (OR, 3.46 [P < .001] and 3.18 [P = .023] for distal pancreatectomies and other resections, respectively). CONCLUSIONS The overall risk of unnecessary immediate surgery for PCNs is about 22% in a high-volume referral center. EUS with cytologic sampling is a useful procedure in the diagnostic management of PCNs, improving their diagnostic accuracy.
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Affiliation(s)
- Fabio Giannone
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of General, Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Stefano Crippa
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Francesca Aleotti
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Pancreas Translational and Clinical Research Center, Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Belfiori
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Partelli
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Marco Schiavo Lena
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita Salute San Raffaele University, Milan, Italy; Pancreas Translational and Clinical Research Center, Radiology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Vita Salute San Raffaele University, Milan, Italy; Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
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Kumar S, Santos RJ, McGuigan AJ, Singh U, Johnson P, Kunzmann AT, Turkington RC. The Role of Circulating Protein and Metabolite Biomarkers in the Development of Pancreatic Ductal Adenocarcinoma (PDAC): A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2022; 31:1090-1102. [PMID: 34810209 PMCID: PMC9377754 DOI: 10.1158/1055-9965.epi-21-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/19/2021] [Accepted: 11/08/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and this is attributed to it being diagnosed at an advanced stage. Understanding the pathways involved in initial development may improve early detection strategies. This systematic review assessed the association between circulating protein and metabolite biomarkers and PDAC development. METHODS A literature search until August 2020 in MEDLINE, EMBASE, and Web of Science was performed. Studies were included if they assessed circulating blood, urine, or salivary biomarkers and their association with PDAC risk. Quality was assessed using the Newcastle-Ottawa scale for cohort studies. Random-effects meta-analyses were used to calculate pooled relative risk. RESULTS A total of 65 studies were included. Higher levels of glucose were found to be positively associated with risk of developing PDAC [n = 4 studies; pooled relative risk (RR): 1.61; 95% CI: 1.16-2.22]. Additionally, an inverse association was seen with pyridoxal 5'-phosphate (PLP) levels (n = 4 studies; RR: 0.62; 95% CI: 0.44-0.87). Meta-analyses showed no association between levels of C-peptide, members of the insulin growth factor signaling pathway, C-reactive protein, adiponectin, 25-hydroxyvitamin D, and folate/homocysteine and PDAC risk. Four individual studies also reported a suggestive positive association of branched-chain amino acids with PDAC risk, but due to differences in measures reported, a meta-analysis could not be performed. CONCLUSIONS Our pooled analysis demonstrates that higher serum glucose levels and lower levels of PLP are associated with risk of PDAC. IMPACT Glucose and PLP levels are associated with PDAC risk. More prospective studies are required to identify biomarkers for early detection.
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Affiliation(s)
- Swati Kumar
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Ralph J. Santos
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Andrew J. McGuigan
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Urvashi Singh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Peter Johnson
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Andrew T. Kunzmann
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Richard C. Turkington
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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Huang Y, Zhu N, Zheng X, Liu Y, Lu H, Yin X, Hao H, Tan Y, Wang D, Hu H, Liang Y, Li X, Hu Z, Yin Y. Intratumor Microbiome Analysis Identifies Positive Association Between Megasphaera and Survival of Chinese Patients With Pancreatic Ductal Adenocarcinomas. Front Immunol 2022; 13:785422. [PMID: 35145519 PMCID: PMC8821101 DOI: 10.3389/fimmu.2022.785422] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Human tumors harbor a plethora of microbiota. It has been shown that the composition and diversity of intratumor microbiome are significantly associated with the survival of patients with pancreatic ductal adenocarcinoma (PDAC). However, the association in Chinese patients as well as the effect of different microorganisms on inhibiting tumor growth are unclear. In this study, we collected tumor samples resected from long-term and short-term PDAC survivors and performed 16S rRNA amplicon sequencing. We found that the microbiome in samples with different survival time were significantly different, and the differential bacterial composition was associated with the metabolic pathways in the tumor microenvironment. Furthermore, administration of Megasphaera, one of the differential bacteria, induced a better tumor growth inhibition effect when combined with the immune checkpoint inhibitor anti-programmed cell death-1 (anti-PD-1) treatment in mice bearing 4T1 tumor. These results indicate that specific intratumor microbiome can enhance the anti-tumor effect in the host, laying a foundation for further clarifying the underlying detailed mechanism.
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Affiliation(s)
- Yu Huang
- Department of General Surgery, No.903 Hospital of People’s Liberation Army Joint Logistic Support Forcel, Hangzhou, China
| | - Ning Zhu
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Xing Zheng
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Yanhong Liu
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Haopeng Lu
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Xiaochen Yin
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Huaijie Hao
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Yan Tan
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Dongjie Wang
- Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Han Hu
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Yong Liang
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
| | - Xinxing Li
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqian Hu
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of General Surgery, Changzheng Hospital, The Second Military Medical University, Shanghai, China
| | - Yiming Yin
- Department of Research and Development, Shenzhen Xbiome Biotech Co. Ltd., Shenzhen, China
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Damaskos C, Garmpis N, Garmpi A, Georgakopoulou VE, Patsouras A, Sypsa G, Syllaios A, Antoniou EA. Ethical Dilemma: Is it Worthwhile Operating an End-Stage Pancreatic Cancer Patient with Acute Mesenteric Artery Ischemia? Acta Med Litu 2021; 28:325-329. [PMID: 35474924 PMCID: PMC8958651 DOI: 10.15388/amed.2021.28.2.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/26/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
Pancreatic cancer is as an aggressive malignancy with low survival rates. We present the first case of an operation of acute mesenteric ischemia performed in a patient with end-stage pancreatic adenocarcinoma. Through this case, we also discuss raising concerns regarding the management of severe complications such as acute mesenteric ischemia in patients with progressed pancreatic carcinoma. How ethical is to leave patients untreated? The decisions for management of patients with advanced disease are strongly based on the expected quality of life, ethical principles, different religions and spiritualities, and the burden of healthcare cost.
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Hua S, Gao J, Li T, Wang M, You L, Chen G, Han X, Liao Q. The promoting effects of hsa_circ_0050102 in pancreatic cancer and the molecular mechanism by targeting miR-1182/NPSR1. Carcinogenesis 2021; 42:471-480. [PMID: 33289016 DOI: 10.1093/carcin/bgaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/08/2020] [Accepted: 12/07/2020] [Indexed: 12/22/2022] Open
Abstract
Pancreatic cancer is one of the most lethal tumors across the world with an overall 5-year survival rate of 9%, and great efforts have been devoted in early diagnosis and treatment in the past decades. Competing endogenous RNAs are novel and specific regulatory mechanisms of gene expression, and researches have indicated its important roles in tumor regulation. In this study, we explored the circ-0050102 expression in pancreatic cancer and its impacts on tumor malignant phenotypes and further investigated the correlations among circ-0050102, miR-1182 and NPSR1. Results of real-time quantitative PCR showed that circ-0050102 expressed higher in pancreatic cancers compared with that in adjacent normal tissues. In cell functional experiment, downregulation of circ-0050102 could suppress cell proliferation, migration and invasion ability, boost cell apoptosis and arrest cell cycle in both PANC-1 and CFPAC-1 cells. Furthermore, allogeneic transplantation in nude mice was performed and results showed that the inhibition of circ-0050102 could slow down tumor formation in vivo. Mechanism research suggested that circ-0050102 could downregulate miR-1182, while miR-1182 could not influence the expression of circ-0050102, and miR-1182 could directly target at NPSR1 and suppress it. Moreover, circ-0050102 could reverse the effects of si-NPSR1 on pancreatic cancer cells. In conclusion, we identified that circ-0050102 played an important role in promoting pancreatic cancer by regulating the miR-1182/NPSR1 pathway.
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Affiliation(s)
- Surong Hua
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyi Gao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyi Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei You
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianlin Han
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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11
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Zhao J, Chen S, Zhu L, Zhang L, Liu J, Xu D, Tian G, Jiang T. Antitumor Effect and Immune Response of Nanosecond Pulsed Electric Fields in Pancreatic Cancer. Front Oncol 2021; 10:621092. [PMID: 33634030 PMCID: PMC7900424 DOI: 10.3389/fonc.2020.621092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023] Open
Abstract
Nanosecond pulsed electric fields (nsPEFs) have emerged as a novel and effective strategy for the non-surgical and minimally invasive removal of tumors. However, the effects of nsPEFs treatment on the tumor immune microenvironment remain unknown. In this study, the changes in the morphology and function of pancreatic cancer cells after nsPEFs were assessed and the modifications in the immune profile in pancreatic cancer models were investigated. To this end, electrodes were inserted with different parameters applied to ablate the targeted tumor tissues. Tumor development was found to be inhibited, with decreased volumes post-nsPEFs treatment compared with control tumors (P < 0.05). Hematoxylin and eosin staining showed morphological changes in pancreatic cancer cells, Ki-67 staining confirmed the effects of nsPEFs on tumor growth, and caspase-3 staining indicated that nsPEFs caused apoptosis in the early stages after treatment. Three days after nsPEFs, positron emission tomography demonstrated little residual metabolic activity compared with the control group. Gene expression profiling identified significant changes in immune-related pathways. After treatment with nsPEFs, CD8+ T lymphocytes increased. We showed that nsPEFs led to a significant decrease in immune suppressive cells, including myeloid derived suppressor cells, T regulatory cells, and tumor-associated macrophages. In addition, the levels of TNF-α and IL-1β increased (P < 0.05), while the level of IL-6 was decreased (P < 0.05). NsPEFs alleviated the immunosuppressive components in pancreatic cancer stroma, including hyaluronic acid and fibroblast activation protein-α. Our data demonstrate that tumor growth can be effectively inhibited by nsPEFs in vivo. NsPEFs significantly altered the infiltration of immune cells and triggered immune response.
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Affiliation(s)
- Jing Zhao
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
| | - Shuochun Chen
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Zhu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liang Zhang
- Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China.,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingqi Liu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Danxia Xu
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Guo Tian
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Hangzhou, China
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12
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Abstract
Pancreatic cancer is a tumor with a high degree of malignancy, morbidity, and mortality. Immunotherapy is another important treatment for pancreatic cancer in addition to surgery and chemotherapy, but its application in pancreatic cancer is very limited, which is related to the unique biological behavior of pancreatic cancer and the tumor microenvironment. The immunosuppressive microenvironment of pancreatic cancer is highly heterogeneous and presents challenges for immunotherapy. The transformation of tumor immunosuppressive microenvironment contributes to the response to tumor immunotherapy, such that the tumor undergoes functional reprogramming to change from immunologically "cold" to immunologically "hot." In this review, we summarized the research and progress in immunotherapy for pancreatic cancer, including immune checkpoint inhibitors, vaccines, adoptive T cell therapy, oncolytic viruses, and immunomodulators, and suggest that individualized, combination, and precise therapy should be the main direction of future immunotherapy in pancreatic cancer.
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Affiliation(s)
- Jia Wu
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China
| | - Jianting Cai
- Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang Province, China.
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13
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Laukamp KR, Tirumani SH, Lennartz S, Hokamp NG, Gupta A, Pennig L, Persigehl T, Gilkeson R, Ramaiya N. Evaluation of equivocal small cystic pancreatic lesions with spectral-detector computed tomography. Acta Radiol 2021; 62:172-181. [PMID: 32306744 DOI: 10.1177/0284185120917119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Evaluation of small cystic lesions of the pancreas remains a challenging task, as due to their size appearance can be rather hypodense than clearly fluid-filled. PURPOSE To evaluate whether additional information provided by novel dual-layer spectral-detector computed tomography (SDCT) imaging can improve assessment of these lesions. MATERIAL AND METHODS For this retrospective study, we reviewed reports of 1192 contrast-enhanced portal-venous phase SDCT scans of the abdomen conducted between May 2017 and January 2019. On basis of the radiological report 25 small (≤1.5 cm) cystic pancreatic lesions in 22 patients were identified, in which additional short-term follow-up imaging was recommended to confirm/clarify cystic nature. Conventional images (CI) and spectral images (SI) including virtual-monoenergetic images at 40 keV (VMI), iodine-density and iodine-overlay images were reconstructed. Two readers indicated lesion conspicuity and confidence for presence of cystic nature on three-point scales. First, solely CI were evaluated, while in a second reading after a four-week interval, the combination of CI and corresponding SI were reviewed. Quantitatively, ROI-based mean attenuation was measured in CI and VMI. RESULTS In the subjective reading, SI significantly improved lesion conspicuity (CI 2 [1-2], SI 3 [2-3], P < 0.001) and confidence regarding presence of cystic nature (CI 2 [1-2], SI 3 [3-3], P < 0.001). Inter-observer agreement depicted by intraclass correlation coefficient improved considerably from 0.51 with only CI to 0.85 when the combination with SI was used. Further, VMI displayed significantly higher signal-to-noise (CI 1.2 ± 0.8, VMI 3.2 ± 1.8, P < 0.001) and contrast-to-noise ratios (CI 2.6 ± 0.8, VMI 4.7 ± 1.9). CONCLUSION Compared to CI alone, combination with SI significantly improves visualization and confidence in evaluation of small equivocal cystic pancreatic lesions.
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Affiliation(s)
- Kai Roman Laukamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
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14
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Systematic Analysis of the Expression and Prognostic Significance of P4HA1 in Pancreatic Cancer and Construction of a lncRNA-miRNA-P4HA1 Regulatory Axis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8877334. [PMID: 33415167 PMCID: PMC7769637 DOI: 10.1155/2020/8877334] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/15/2022]
Abstract
Objectives Prolyl 4-hydroxylase subunit alpha 1 (P4HA1) plays a crucial role in modulating extracellular matrix component and promoting tumor progression by changing tumor adhesion, migration, and other biological behaviors in some cancers. However, its expression pattern, biological function, and underlying mechanism in pancreatic cancer remain largely unclear. Materials and Methods In this study, a set of bioinformatics tools were used to analyze the expression of P4HA1 and its prognostic value in pancreatic cancer. In addition, the mechanism through which P4HA1 promotes the progression of pancreatic cancer was explored by constructing a competing endogenous RNA (ceRNA) regulatory axis. Results It was found that the mRNA and protein expression of P4HA1 was significantly higher in pancreatic cancer tissues than in normal tissues. Its high P4HA1 expression correlated with poor clinicopathological features (T stage: P = 0.0078; N stage: P = 0.0124; TNM stage: P = 0.0013; pathological grade: P = 0.0108) and poor prognosis [OS: HR = 1, 95% CI (1-1.01), P = 0.00028; DSS: HR = 1, 95% CI (1-1.01), P = 0.00049; PFI: HR = 1.01, 95% CI (1.01-1.02), P = 0.0057; and DFI: HR = 1, 95% CI (1-1.01), P = 0.0034]. The LINC01503/miR-335-5p/P4HA1 axis might mediate the effects of P4HA1 in promoting the progression on pancreatic cancer. Conclusions Collectively, our findings suggest that high expression of P4HA1 may be used as a promising prognostic biomarker and could be considered for the development of a novel therapeutic strategy for pancreatic cancer in the future.
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15
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Multifocal pancreatobiliary malignancies: A diagnostic and therapeutic challenge. Radiol Case Rep 2020; 16:289-294. [PMID: 33299511 PMCID: PMC7708658 DOI: 10.1016/j.radcr.2020.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
The synchronous presentation of multifocal pancreatobiliary tumors is a rare occurrence and can prove to be a significant diagnostic and therapeutic challenge. We describe the case of a 70-year-old female who presented with a 2-week history of jaundice, reduced appetite, and mild epigastric discomfort of insidious onset. Radiological evaluation with computed tomography and magnetic resonance imaging demonstrated features consistent with a hilar cholangiocarcinoma , also known as a Klatskin tumor, involving both the cystic duct and gallbladder neck. In addition to this, a pancreatic neoplasm with associated splenic vein occlusion and metastatic deposits in the liver and lung were identified. The patient was managed with percutaneous transhepatic external biliary drainage and stenting by interventional radiology. Cytology results from the brushings obtained from the aforementioned procedure were nondiagnostic. Core biopsies were performed of the pancreatic lesion; the histopathological results of which were in keeping with pancreatic ductal adenocarcinoma . The patient was scheduled for chemotherapy however unfortunately deteriorated clinically prior to commencement. This case highlights the diagnostic and management challenges of synchronous pancreatobiliary malignancies.
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16
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Roh YH, Kang BK, Song SY, Lee CM, Jung YK, Kim M. Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy. PLoS One 2020; 15:e0243515. [PMID: 33270774 PMCID: PMC7714124 DOI: 10.1371/journal.pone.0243515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/22/2020] [Indexed: 02/06/2023] Open
Abstract
Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.
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Affiliation(s)
- Yun Hwa Roh
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Soon-Young Song
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yun Kyung Jung
- Department of Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Seoul, Republic of Korea
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17
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Gentili F, Guerrini S, Mazzei FG, Monteleone I, Di Meglio N, Sansotta L, Perrella A, Puglisi S, De Filippo M, Gennaro P, Volterrani L, Castagna MG, Dotta F, Mazzei MA. Dual energy CT in gland tumors: a comprehensive narrative review and differential diagnosis. Gland Surg 2020; 9:2269-2282. [PMID: 33447579 DOI: 10.21037/gs-20-543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dual energy CT (DECT)with image acquisition at two different photon X-ray levels allows the characterization of a specific tissue or material/elements, the extrapolation of virtual unenhanced and monoenergetic images, and the quantification of iodine uptake; such special capabilities make the DECT the perfect technique to support oncological imaging for tumor detection and characterization and treatment monitoring, while concurrently reducing the dose of radiation and iodine and improving the metal artifact reduction. Even though its potential in the field of oncology has not been fully explored yet, DECT is already widely used today thanks to the availability of different CT technologies, such as dual-source, single-source rapid-switching, single-source sequential, single-source twin-beam and dual-layer technologies. Moreover DECT technology represents the future of the imaging innovation and it is subject to ongoing development that increase according its clinical potentiality, in particular in the field of oncology. This review points out recent state-of-the-art in DECT applications in gland tumors, with special focus on its potential uses in the field of oncological imaging of endocrine and exocrine glands.
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Affiliation(s)
- Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Giuseppe Mazzei
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ilaria Monteleone
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Nunzia Di Meglio
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Letizia Sansotta
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Armando Perrella
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Sara Puglisi
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Massimo De Filippo
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Gennaro
- Department of Maxillofacial Surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Volterrani
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Grazia Castagna
- Unit of Endocrinology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Dotta
- Unit of Diabetology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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18
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Gao J, Wang M, Li T, Liu Q, You L, Liao Q. Up-regulation of CDHR5 expression promotes malignant phenotype of pancreatic ductal adenocarcinoma. J Cell Mol Med 2020; 24:12726-12735. [PMID: 33025744 PMCID: PMC7687006 DOI: 10.1111/jcmm.15856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023] Open
Abstract
CDHR5 has been reported to play key roles in carcinogenesis of various cancers, but its roles in pancreatic cancer have not been reported. The present study was designed to investigate its clinical value in pancreatic ductal adenocarcinoma (PDAC). Tissue microarray-based immunohistochemistry was performed to analyse the correlation between CDHR5 expression and clinical and pathological features of PDAC, as well as the CDHR5 expression during tumour progression. Cell function assays were performed to investigate CDHR5's effects on PDAC cells. Moreover, qRT-PCR was applied to investigate the expression of CDHR5 isoforms in PDAC cells. Expression of CDHR5 was higher on the membrane of PDAC cells. This high expression level was associated with shorter overall survival of PDAC patients and was identified as an independent prognostic factor for overall survival by multivariate Cox regression analysis. In addition, expression level of CDHR5 presented an increased trend in the occurrence and progression of PDAC. Cell experiment suggested that CDHR5 could notably promote invasion and migration of PDAC cells. Moreover, analysis of CDHR5 isoforms indicated CDHR5-L was the major isoform expressed in PDAC cell lines. CDHR5 appears to be a promising and novel prognostic factor for PDAC, and its promotion in PDAC metastasis might be ascribed to the isoform CDHR5-L.
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Affiliation(s)
- Junyi Gao
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Mengyi Wang
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Tong Li
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Qiaofei Liu
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Lei You
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
| | - Quan Liao
- Department of General SurgeryPeking Union Medical College Hospital (PUMCH)Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)BeijingChina
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19
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Fang L, Yan FH, Liu C, Chen J, Wang D, Zhang CH, Lou CJ, Lian J, Yao Y, Wang BJ, Li RY, Han SL, Bai YB, Yang JN, Li ZW, Zhang YQ. Systemic Inflammatory Biomarkers, Especially Fibrinogen to Albumin Ratio, Predict Prognosis in Patients with Pancreatic Cancer. Cancer Res Treat 2020; 53:131-139. [PMID: 32854494 PMCID: PMC7811998 DOI: 10.4143/crt.2020.330] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose Systemic inflammatory response is a critical factor that promotes the initiation and metastasis of malignancies including pancreatic cancer (PC). This study was designed to determine and compare the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and fibrinogen-to-albumin ratio (FAR) in resectable PC and locally advanced or metastatic PC. Materials and Methods Three hundred fifty-three patients with resectable PC and 807 patients with locally advanced or metastatic PC were recruited in this study. These patients were classified into a training set (n=758) and a validation set (n=402). Kaplan-Meier survival plots and Cox proportional hazards regression models were used to analyze prognosis. Results Overall survival (OS) was significantly better for patients with resectable PC with low preoperative PLR (p=0.048) and MLR (p=0.027). Low FAR, MLR, NLR (p < 0.001), and PLR (p=0.003) were significantly associated with decreased risk of death for locally advanced or metastatic PC patients. FAR (hazard ratio [HR], 1.522; 95% confidential interval [CI], 1.261 to 1.837; p < 0.001) and MLR (HR, 1.248; 95% CI, 1.017 to 1.532; p=0.034) were independent prognostic factors for locally advanced or metastatic PC. Conclusion The prognostic roles of FAR, MLR, NLR, and PLR in resectable PC and locally advanced or metastatic PC were different. FAR showed the most prognostic power in locally advanced or metastatic PC. Low FAR was positively correlated with OS in locally advanced or metastatic PC, which could be used to predict the prognosis.
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Affiliation(s)
- Lin Fang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Fei-Hu Yan
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chao Liu
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Jing Chen
- Department of Hematopathology, Anshan Hospital, The First Affiliated Hospital of China Medical University, Anshan, China
| | - Dan Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chun-Hui Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chang-Jie Lou
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jie Lian
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Yang Yao
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Bo-Jun Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Rui-Yang Li
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shu-Ling Han
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yi-Bing Bai
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jia-Ni Yang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhi-Wei Li
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yan-Qiao Zhang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China.,Translational Medicine Research and Cooperation Center of Northern China, Heilongjiang Academy of Medical Sciences, Harbin, China
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Shun SC. Proposing a Comprehensive Prehabilitation Model for Individuals with Operable Pancreatic Cancer. Asia Pac J Oncol Nurs 2020; 7:255-258. [PMID: 32642496 PMCID: PMC7325771 DOI: 10.4103/apjon.apjon_18_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Shiow-Ching Shun
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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21
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Xu JY, Li C, Zhang H, Liu Y, Wei JM. Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy. Risk Manag Healthc Policy 2020; 13:761-770. [PMID: 32753989 PMCID: PMC7358091 DOI: 10.2147/rmhp.s257677] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Sarcopenia has been proven to be a risk factor after pancreatoduodenectomy (PD). We aimed to evaluate if decreased psoas muscle area and density shown in CT scan, as measures for sarcopenia, were associated with postoperative major complications and adverse outcomes in patients who underwent PD. PATIENTS AND METHODS We analyzed 152 consecutive patients who underwent open PD. Total psoas area and muscle attenuation were measured on CT images at the level of the third lumbar vertebra. Total psoas area index (TPAI) was calculated, the cut-off values of TPAI were estimated and validated. The relationship between radiographic characters and outcomes was analyzed. RESULTS The optimal cut-off values of TPAI were 4.78 cm2/m2 for males and 3.46 cm2/m2 for females. The values were validated by outcomes with significant differences in the rate of major complications, re-operation, length of stay, and total cost. The prevalence of TPAI-defined sarcopenia and sarcopenic overweight/obesity was 38.8% and 17.1% in total. In multivariate logistic regression, rate of major complications was associated with TPAI [OR=0.605, 95% CI (0.414, 0.883), P=0.009], TPAI-defined sarcopenia [OR=8.256, 95% CI (2.890, 23.583), P=0.000] and sarcopenic overweight/obesity [OR=7.462, 95% CI (2.084, 26.724), P=0.002]; meanwhile, NRS2002-defined nutritional risk and GLIM-defined malnutrition did not show relationship with major complications. CONCLUSION Both sarcopenia and sarcopenic overweight/obesity determined by new TPAI cut-off values were associated with a higher rate of major complications and adverse outcomes in Chinese patients undergoing open PD whereas usual nutritional assessment was not.
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Affiliation(s)
- Jing-Yong Xu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - Chen Li
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - He Zhang
- Community Health Service Administration Center of Dongcheng District, Beijing100006, People’s Republic of China
| | - Yuan Liu
- Department of Sonography, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
| | - Jun-Min Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing100730, People’s Republic of China
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22
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Xue L, Shen Y, Zhai Z, Zheng S. miR‑539 suppresses the proliferation, migration, invasion and epithelial mesenchymal transition of pancreatic cancer cells through targeting SP1. Int J Mol Med 2020; 45:1771-1782. [PMID: 32236568 PMCID: PMC7169848 DOI: 10.3892/ijmm.2020.4561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
MicroRNA (miR)‑539 has inhibitory effects on certain types of cancer, but its role in pancreatic cancer (PCa) remains unclear. The present study investigated the effects of miR‑539 on PCa, and aimed to determine possible therapeutic targets for the treatment of PCa. The expression of miR‑539 in PCa tissues, paired normal adjacent tissues and PCa cell lines (CAPAN‑2, BxPC3, CFPAC1, SW1990 and PANC1), and human non‑cancerous pancreatic cells (hTRET‑HPNE) was determined and compared. The effects of upregulation and downregulation of miR‑539 on proliferation, apoptosis, cell cycle, invasion, migration and epithelial‑mesenchymal transition (EMT) of PCa cells were investigated. Additionally, the target gene of miR‑539 was predicted and its effects on PCa cells were further investigated. The results revealed low expression of miR‑539 in PCa tissues and cell lines. Additionally, increasing miR‑539 expression inhibited the proliferation, migration, invasion and EMT of PCa cells and induced apoptosis by blocking G1 phase of the cell cycle, while reducing miR‑539 expression had the opposite results. Furthermore, specificity protein 1 (SP1) was found to be the target gene of miR‑539. SP1 promoted the proliferation, migration, invasion and EMT transformation of PCa cells, but these effects were reversed by high expression of miR‑539. Additionally, miR‑539 suppressed the proliferation, metastasis, invasion and EMT transformation of PCa cells through targeting SP1. Therefore, miR‑539 overexpression may contribute toward development of novel therapeutic strategies for PCa in the future.
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Affiliation(s)
| | | | - Zhenglong Zhai
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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23
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Zheng YW, Gao PF, Ma MZ, Chen Y, Li CY. Role of ubiquitin-conjugating enzyme E2T in the carcinogenesis and progression of pancreatic cancer. Oncol Lett 2020; 20:1462-1468. [PMID: 32724389 DOI: 10.3892/ol.2020.11644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 10/22/2019] [Indexed: 01/10/2023] Open
Abstract
Ubiquitin-conjugating enzyme E2T (UBE2T) is a recently discovered oncogenic protein. Numerous studies reported that UBE2T is highly expressed in various types of human cancer; however, its role in the carcinogenesis and progression of pancreatic cancer remains unknown. The aim of the present study was to investigate the role of UBE2T in pancreatic cancer progression through in vitro experiments in pancreatic cancer tissues and cell lines. The results obtained in the present study demonstrated that UBE2T served an important role in the initiation and progression of pancreatic cancer. Furthermore, increased expression of UBE2T in human pancreatic cancer tissues and pancreatic cancer cells was observed compared with normal tissues and cells. The effect of upregulating and downregulating UBE2T in pancreatic cancer cell lines was investigated using the MTT, wound-healing and migration and invasion assays. The results demonstrated that overexpression of UBE2T significantly promoted pancreatic cancer cell proliferation, migration and invasion compared with controls. However, UBE2T downregulation resulted in the inhibition of pancreatic cancer cell proliferation, migration and invasion. In addition, the results demonstrated that UBE2T may promote the epithelial mesenchymal transition in pancreatic cancer cells.
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Affiliation(s)
- Yuan-Wen Zheng
- Department of Organ Transplantation and Second Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
| | - Peng-Fei Gao
- School of Medicine of Shandong University, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Ming-Ze Ma
- Department of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yong Chen
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Chun-You Li
- Department of Organ Transplantation and Second Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, P.R. China
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24
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Zhang T, Jiang Z, Chen L, Pan C, Sun S, Liu C, Li Z, Ren W, Wu A, Huang P. PCN-Fe(III)-PTX nanoparticles for MRI guided high efficiency chemo-photodynamic therapy in pancreatic cancer through alleviating tumor hypoxia. NANO RESEARCH 2020; 13:273-281. [DOI: 10.1007/s12274-019-2610-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 08/30/2023]
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25
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Cai Q, Mao Y, Yang Q, Wen H, Lv Y, Zhang R. Are left ventricular muscle area and radiation attenuation associated with overall survival in advanced pancreatic cancer patients treated with chemotherapy? Clin Radiol 2019; 75:238.e1-238.e9. [PMID: 31858988 DOI: 10.1016/j.crad.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/12/2019] [Indexed: 01/08/2023]
Abstract
AIM To evaluate whether cardiac muscle area and radiation attenuation, determined using pre-chemotherapy computed tomography (CT), are associated with therapeutic response and overall survival (OS) in chemotherapy-treated advanced pancreatic cancer (APC) patients. MATERIALS AND METHODS Ninety-eight chemotherapy-treated APC patients who underwent pre-chemotherapy CT between 2009 and 2018 were considered. Left ventricular muscle area (LVMA) and left ventricular muscle radiation attenuation (LVMRA) were measured using pre-chemotherapy arterial-phase CT. OS and progression-free survival (PFS) were analysed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were performed to analyse potential factors affecting OS and PFS. RESULTS Patients with low LVMRA, low LVMA at baseline CT, and multiple metastases had a significantly shorter median OS than patients with high LVMRA, high LVMA, and without multiple metastases (8.8 versus 14 months, p=0.017; 12.2 versus 18.1 months, p=0.038; 7.3 versus 13.5 months, p<0.001, respectively). Patients with low LVMRA and distant metastasis had a shorter median PFS than patients with high LVMRA and those without distant metastasis (4.9 versus 8.3 months, p=0.032; 5.4 versus 9.9 months, p=0.002, respectively). Moreover, the mean LVMRA was the highest in the partial response group (p=0.028). CONCLUSION LVMRA could well predict PFS and OS in chemotherapy-treated APC patients.
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Affiliation(s)
- Q Cai
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China
| | - Y Mao
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Hepato-biliary-pancreatic Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China
| | - Q Yang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China
| | - H Wen
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China
| | - Y Lv
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China.
| | - R Zhang
- State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, 510060, Guangzhou, China.
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26
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Shah KP, Baugh KA, Brubaker LS, Van Buren G, Villafane-Ferriol N, McElhany AL, Mohamed S, Silberfein EJ, Hsu C, Massarweh NN, Tran Cao HS, Mendez-Reyes JE, Fisher WE. Long-Term Assessment of Pancreatic Function After Pancreatectomy for Cystic Neoplasms. J Surg Res 2019; 247:547-555. [PMID: 31740011 DOI: 10.1016/j.jss.2019.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/20/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND With advances in cross-sectional imaging, pancreatic cysts are more frequently diagnosed and have become a common indication for pancreatectomy. The impact of pancreatectomy in these patients is important. The purpose of this study was to assess short-term outcomes, long-term nutritional status, quality of life (QOL), and pancreas function after pancreatectomy for cystic neoplasms. MATERIALS AND METHODS At a single institution, patients at least 3 y post-pancreatectomy for benign cystic neoplasms were identified. Using a validated questionnaire, short-term outcomes, long-term outcomes including endocrine and exocrine insufficiency, long-term nutritional status, and preoperative and postoperative QOL were compared based on operation and indication for resection. RESULTS Among 102 eligible patients, 70 had valid contact information and 51 (72.9%) agreed to participate. Median follow-up was 6 (4-8) y. Patients undergoing pancreatoduodenectomy for benign cysts had higher morbidity than a similar cohort resected for pancreatic adenocarcinoma (patients with at least 1 ≥ grade 2 complication [49.0% versus 31.6%, P = 0.038]). After long-term follow-up, pancreatectomy did not significantly affect perceived QOL. Half of patients had mild-moderate or severe malnourishment, but pancreatic enzyme replacement was reported by only 4 (7.8%) patients. New-onset diabetes was present in 15 (29.4%) patients with median time-to-diagnosis of 6 (1-12) mo after resection. CONCLUSIONS Pancreatectomy for benign cysts did not negatively impact patients' perceived QOL. However, after long-term follow-up, malnutrition and pancreatic insufficiency occurred in a significant percentage and may be greater than previously estimated. Consideration of short- and long-term outcomes should factor into preoperative counseling, especially in cysts with minimal risk of progression to malignancy.
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Affiliation(s)
- Kevin P Shah
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Katherine A Baugh
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Lisa S Brubaker
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - George Van Buren
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Amy L McElhany
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sadde Mohamed
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eric J Silberfein
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Cary Hsu
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nader N Massarweh
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hop S Tran Cao
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jose E Mendez-Reyes
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - William E Fisher
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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27
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El Kayal N, Lennartz S, Ekdawi S, Holz J, Slebocki K, Haneder S, Wybranski C, Mohallel A, Eid M, Grüll H, Persigehl T, Borggrefe J, Maintz D, Heneweer C. Value of spectral detector computed tomography for assessment of pancreatic lesions. Eur J Radiol 2019; 118:215-222. [DOI: 10.1016/j.ejrad.2019.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/08/2019] [Accepted: 07/15/2019] [Indexed: 01/05/2023]
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28
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Konings ICAW, Canto MI, Almario JA, Harinck F, Saxena P, Lucas AL, Kastrinos F, Whitcomb DC, Brand RE, Lachter J, Malleo G, Paiella S, Syngal S, Saltzman JR, Stoffel EM, van Hooft JE, Hruban RH, Poley JW, Fockens P, Goggins MG, Bruno MJ. Surveillance for pancreatic cancer in high-risk individuals. BJS Open 2019; 3:656-665. [PMID: 31592073 PMCID: PMC6773633 DOI: 10.1002/bjs5.50180] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/02/2019] [Indexed: 12/26/2022] Open
Abstract
Background Surveillance of individuals at high risk of pancreatic ductal adenocarcinoma (PDAC) and its precursors might lead to better outcomes. The aim of this study was to determine the prevalence and outcomes of PDAC and high-risk neoplastic precursor lesions among such patients participating in surveillance programmes. Methods A multicentre study was conducted through the International CAncer of the Pancreas Screening (CAPS) Consortium Registry to identify high-risk individuals who had undergone pancreatic resection or progressed to advanced PDAC while under surveillance. High-risk neoplastic precursor lesions were defined as: pancreatic intraepithelial neoplasia (PanIN) 3, intraductal papillary mucinous neoplasia (IPMN) with high-grade dysplasia, and pancreatic neuroendocrine tumours at least 2 cm in diameter. Results Of 76 high-risk individuals identified in 11 surveillance programmes, 71 had undergone surgery and five had been diagnosed with inoperable PDAC. Of the 71 patients who underwent resection, 32 (45 per cent) had PDAC or a high-risk precursor (19 PDAC, 4 main-duct IPMN, 4 branch-duct IPMN, 5 PanIN-3); the other 39 patients had lesions thought to be associated with a lower risk of neoplastic progression. Age at least 65 years, female sex, carriage of a gene mutation and location of a lesion in the head/uncinate region were associated with high-risk precursor lesions or PDAC. The survival of high-risk individuals with low-risk neoplastic lesions did not differ from that in those with high-risk precursor lesions. Survival was worse among patients with PDAC. There was no surgery-related mortality. Conclusion A high proportion of high-risk individuals who had surgical resection for screening- or surveillance-detected pancreatic lesions had a high-risk neoplastic precursor lesion or PDAC at the time of surgery. Survival was better in high-risk individuals who had either low- or high-risk neoplastic precursor lesions compared with that in patients who developed PDAC.
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Affiliation(s)
- I C A W Konings
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - M I Canto
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - J A Almario
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - F Harinck
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - P Saxena
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Gastroenterology and Hepatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - A L Lucas
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - F Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, USA
| | - D C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - R E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J Lachter
- Department of Gastroenterology, Rambam Healthcare Campus, Haifa, Israel
| | - G Malleo
- Department of General Surgery, University Hospital of Verona, Verona, Italy
| | - S Paiella
- Department of General Surgery, University Hospital of Verona, Verona, Italy
| | - S Syngal
- Department of Gastroenterology, Brigham and Women's Hospital and Population Sciences Division, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - J R Saltzman
- Department of Gastroenterology, Brigham and Women's Hospital and Population Sciences Division, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - E M Stoffel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - J E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - R H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - J W Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - M G Goggins
- Department of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Birnbaum DJ, Finetti P, Birnbaum D, Mamessier E, Bertucci F. XPO1 Expression Is a Poor-Prognosis Marker in Pancreatic Adenocarcinoma. J Clin Med 2019; 8:E596. [PMID: 31052304 PMCID: PMC6572621 DOI: 10.3390/jcm8050596] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
Abstract
Pancreatic adenocarcinoma (PAC) is one of the most aggressive human cancers and new systemic therapies are urgently needed. Exportin-1 (XPO1), which is a member of the importin-β superfamily of karyopherins, is the major exporter of many tumor suppressor proteins that are involved in the progression of PAC. Promising pre-clinical data using XPO1 inhibitors have been reported in PAC, but very few data are available regarding XPO1 expression in clinical samples. Retrospectively, we analyzed XPO1 mRNA expression in 741 pancreatic samples, including 95 normal, 73 metastatic and 573 primary cancers samples, and searched for correlations with clinicopathological and molecular data, including overall survival. XPO1 expression was heterogeneous across the samples, higher in metastatic samples than in the primary tumors, and higher in primaries than in the normal samples. "XPO1-high" tumors were associated with positive pathological lymph node status and aggressive molecular subtypes. They were also associated with shorter overall survival in both uni- and multivariate analyses. Supervised analysis between the "XPO1-high" and "XPO1-low" tumors identified a robust 268-gene signature, whereby ontology analysis suggested increased XPO1 activity in the "XPO1-high" tumors. XPO1 expression refines the prognostication in PAC and higher expression exists in secondary versus primary tumors, which supports the development of XPO1 inhibitors in this so-lethal disease.
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Affiliation(s)
- David Jérémie Birnbaum
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, F-13273 Marseille, France.
- Département de Chirurgie Générale et Viscérale, AP-HM, F-13000 Marseille, France.
| | - Pascal Finetti
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - Daniel Birnbaum
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - Emilie Mamessier
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - François Bertucci
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, F-13273 Marseille, France.
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30
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Ibrahim IM, Abdelmalek DH, Elfiky AA. GRP78: A cell's response to stress. Life Sci 2019; 226:156-163. [PMID: 30978349 PMCID: PMC7094232 DOI: 10.1016/j.lfs.2019.04.022] [Citation(s) in RCA: 358] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/01/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
Background Glucose-Regulated Protein 78 (GRP78) is a chaperone heat shock protein that has been intensely studied in the last two decades. GRP78 is the master of the unfolded protein response (UBR) in the Endoplasmic Reticulum (ER) in normal cells. GRP78 force the unfolded proteins to refold or degrade using cellular degradation mechanisms. Scope Under stress, the overexpression of GRP78 on the cell membrane mediates the vast amount of disordered proteins. Unfortunately, this makes it a tool for pathogens (bacterial, fungal and viral) to enter the cell and to start different pathways leading to pathogenesis. Additionally, GRP78 is overexpressed on the membranes of various cancer cells and increase the aggressiveness of the disease. Major conclusions The current review summarizes structure, function, and different mechanisms GRP78 mediate in response to normal or stress conditions. General significance GRP78 targeting and possible inhibition mechanisms are also covered in the present review aiming to prevent the virulence of pathogens and cancer.
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Affiliation(s)
- Ibrahim M Ibrahim
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Doaa H Abdelmalek
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt
| | - Abdo A Elfiky
- Biophysics Department, Faculty of Science, Cairo University, Giza, Egypt.
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31
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Maharaj AD, Ioannou L, Croagh D, Zalcberg J, Neale RE, Goldstein D, Merrett N, Kench JG, White K, Pilgrim CHC, Chantrill L, Cosman P, Kneebone A, Lipton L, Nikfarjam M, Philip J, Sandroussi C, Tagkalidis P, Chye R, Haghighi KS, Samra J, Evans SM. Monitoring quality of care for patients with pancreatic cancer: a modified Delphi consensus. HPB (Oxford) 2019; 21:444-455. [PMID: 30316625 DOI: 10.1016/j.hpb.2018.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/02/2018] [Accepted: 08/31/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Best practise care optimises survival and quality of life in patients with pancreatic cancer (PC), but there is evidence of variability in management and suboptimal care for some patients. Monitoring practise is necessary to underpin improvement initiatives. We aimed to develop a core set of quality indicators that measure quality of care across the disease trajectory. METHODS A modified, three-round Delphi survey was performed among experts with wide experience in PC care across three states in Australia. A total of 107 potential quality indicators were identified from the literature and divided into five areas: diagnosis and staging, surgery, other treatment, patient management and outcomes. A further six indicators were added by the panel, increasing potential quality indicators to 113. Rated on a scale of 1-9, indicators with high median importance and feasibility (score 7-9) and low disagreement (<1) were considered in the candidate set. RESULTS From 113 potential quality indicators, 34 indicators met the inclusion criteria and 27 (7 diagnosis and staging, 5 surgical, 4 other treatment, 5 patient management, 6 outcome) were included in the final set. CONCLUSIONS The developed indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research in PC care.
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Affiliation(s)
- Ashika D Maharaj
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Liane Ioannou
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Daniel Croagh
- Monash University, Melbourne, Victoria, Australia; Monash Health, Clayton, Victoria, Australia; Epworth Healthcare, Richmond, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, NSW, Australia
| | - Neil Merrett
- School of Medicine, Western Sydney University, NSW, Australia
| | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Central Clinical School, University of Sydney, NSW, Australia
| | - Kate White
- Sydney Nursing School, University of Sydney, Australia
| | - Charles H C Pilgrim
- Alfred Health, Melbourne, Victoria, Australia; Cabrini, Malvern, Victoria, Australia; Peninsula Health, Frankston, Victoria, Australia; Peninsula Private Hospital, Frankston, Victoria, Australia
| | - Lorraine Chantrill
- Kinghorn Cancer Centre, St Vincent's Hospital, NSW, Australia; Garvan Institute of Medical Research and University of New South Wales, NSW, Australia
| | - Peter Cosman
- School of Medicine, Faculty of Science, Medicine & Health, University of Wollongong, NSW, Australia
| | | | - Lara Lipton
- Cabrini, Malvern, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia; Western Health, Sunshine, Victoria, Australia
| | - Mehrdad Nikfarjam
- Melbourne University, Parkville, Victoria, Australia; Austin Health, Heidelberg, Australia
| | | | | | - Peter Tagkalidis
- Alfred Health, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Richard Chye
- St Vincent's Private Hospital, Darlinghurst, NSW, Australia; Faculty of Health, University of Technology, NSW, Australia
| | - Koroush S Haghighi
- Prince of Wales Clinical School, UNSW Medicine, NSW, Australia; Kinghorn Cancer Centre, St Vincent's Hospital, NSW, Australia
| | - Jaswinder Samra
- Department of Upper GI Surgery, Royal North Shore Hospital, NSW, Australia; Macquarie University Hospital, Macquarie University, Australia
| | - Sue M Evans
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.
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Olson MT, Ly QP, Mohs AM. Fluorescence Guidance in Surgical Oncology: Challenges, Opportunities, and Translation. Mol Imaging Biol 2019; 21:200-218. [PMID: 29942988 PMCID: PMC6724738 DOI: 10.1007/s11307-018-1239-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Surgical resection continues to function as the primary treatment option for most solid tumors. However, the detection of cancerous tissue remains predominantly subjective and reliant on the expertise of the surgeon. Surgery that is guided by fluorescence imaging has shown clinical relevance as a new approach to detecting the primary tumor, tumor margins, and metastatic lymph nodes. It is a technique to reduce recurrence and increase the possibility of a curative resection. While significant progress has been made in developing this emerging technology as a tool to assist the surgeon, further improvements are still necessary. Refining imaging agents and tumor targeting strategies to be a precise and reliable surgical strategy is essential in order to translate this technology into patient care settings. This review seeks to provide a comprehensive update on the most recent progress of fluorescence-guided surgery and its translation into the clinic. By highlighting the current status and recent developments of fluorescence image-guided surgery in the field of surgical oncology, we aim to offer insight into the challenges and opportunities that require further investigation.
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Affiliation(s)
- Madeline T Olson
- Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Quan P Ly
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Aaron M Mohs
- Fred and Pamela Buffet Cancer Center, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, 5-12315 Scott Research Tower, Omaha, NE, 68198, USA.
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
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Lu JJ, Yuan Z. Application of DNA methylation in early diagnosis and treatment of pancreatic cancer. Shijie Huaren Xiaohua Zazhi 2019; 27:13-19. [DOI: 10.11569/wcjd.v27.i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) is one of the most malignant gastrointestinal tumors, characterized by a poor prognosis. Most of the patients have an advanced disease at the time of diagnosis and lose the opportunity of radical surgery, resulting in a 5-year survival rate of less than 5%. Circulating tumor DNA, whose concentration in plasma of patients with pancreatic adenocarcinoma is higher than that in health controls, carries specific gene mutation and aberrant DNA methylation. Epigenetic change is one of the important characteristics of cell carcinogenesis. DNA methylation is an early event in tumorigenesis, which is more helpful for early diagnosis than gene mutation and can be observed in each stage of PC. Therefore, the detection of aberrant DNA methylation in the promoter region in patients with PC may be a non-invasive method for early cancer detection, predicting prognosis, and monitoring recurrence. In the present review, we discuss the recent advances in the study of DNA methylation in the early diagnosis of PC, and the potential application value in the treatment of PC.
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Affiliation(s)
- Jia-Jun Lu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhou Yuan
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Solaini L, de Rooij T, Marsman EM, Te Riele WW, Tanis PJ, van Gulik TM, Gouma DJ, Bhayani NH, Hackert T, Busch OR, Besselink MG. Pancreatoduodenectomy with colon resection for pancreatic cancer: a systematic review. HPB (Oxford) 2018; 20:881-887. [PMID: 29705346 DOI: 10.1016/j.hpb.2018.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/25/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radical resection of advanced pancreatic cancer may occasionally require a simultaneous colon resection. The risks and benefits of this combined procedure are largely unknown. This systematic review aimed to assess short and long term outcome after pancreatoduodenectomy with colon resection (PD-colon) for pancreatic ductal adenocarcinoma (PDAC). METHODS A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1994 and 2017 concerning PD-colon for PDAC. RESULTS After screening 2038 articles, 5 articles with a total of 181 patients undergoing PD-colon were eligible for inclusion. Included studies showed a relatively low risk of bias. The pooled complication rate was 73% (95% CI 61-84) including a pooled colonic anastomotic leak rate of 5.5%. Pooled mortality was 10% (95% CI 6-15). Pooled mean survival (data from 86 patients) was 18 months (95% CI 13-23) with pooled 3- and 5-year survival of 31% (95% CI 20-72) and 19% (95% CI 6-38). CONCLUSION Based on the available data, PD-colon for PDAC seems to be associated with an increased morbidity and mortality but with survival comparable with standard PD in selected patients. Future large series are needed to allow for better patient selection for PD-colon.
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Affiliation(s)
- Leonardo Solaini
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Dept of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Thijs de Rooij
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - E Madelief Marsman
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Wouter W Te Riele
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands; Dept of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands
| | - Pieter J Tanis
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk J Gouma
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Neal H Bhayani
- Program for Liver, Pancreas, and Foregut Tumors, Department of Surgery, College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, USA
| | - Thilo Hackert
- Dept of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Olivier R Busch
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc G Besselink
- Dept of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
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C-Reactive Protein on Postoperative Day 1 Is a Reliable Predictor of Pancreas-Specific Complications After Pancreaticoduodenectomy. J Gastrointest Surg 2018; 22:818-830. [PMID: 29327310 DOI: 10.1007/s11605-017-3658-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 12/11/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula and pancreas-specific complications have a significant influence on patient management and outcomes after pancreatoduodenectomy. The aim of the study was to assess the value of serum C-reactive protein on the postoperative day 1 as early predictor of pancreatic fistula and pancreas-specific complications. METHODS Between 2013 and 2016, 110 patients underwent pancreaticoduodenectomy. Clinical, biological, intraoperative, and pathological characteristics were prospectively recorded. Pancreatic fistula was graded according to the International Study Group on Pancreatic Fistula classification. A composite endpoint was defined as pancreas-specific complications including pancreatic fistula, intra-abdominal abscess, postoperative hemorrhage, and bile leak. The diagnostic accuracy of serum C-reactive protein on postoperative day 1 in predicting adverse postoperative outcomes was assessed by ROC curve analysis. RESULTS Six patients (5%) died and 87 (79%) experienced postoperative complications (pancreatic-specific complications: n = 58 (53%); pancreatic fistula: n = 48 (44%)). A soft pancreatic gland texture, a main pancreatic duct diameter < 3 mm and serum C-reactive protein ≥ 100 mg/L on postoperative day 1 were independent predictors of pancreas-specific complications (p < 0.01) and pancreatic fistula (p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 100 mg/L on postoperative day 1 was a significant predictor of pancreatic fistula (AUC: 0.70; 95%CI: 0.60-0.79, p < 0.01) and pancreas-specific complications (AUC: 0.72; 95%CI: 0.62-0.82, p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 50 mg/L at discharge was a significant predictor of 90-day hospital readmission (AUC: 0.70; 95%CI: 0.60-0.79, p < 0.01). CONCLUSIONS C-reactive protein levels reliably predict risks of pancreatic fistula, pancreas-specific complications, and hospital readmission, and should be inserted in risk-stratified management algorithms after pancreaticoduodenectomy.
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Guilbaud T, Birnbaum DJ, Loubière S, Bonnet J, Chopinet S, Grégoire E, Berdah S, Hardwigsen J, Moutardier V. Comparison of different feeding regimes after pancreatoduodenectomy - a retrospective cohort analysis. Nutr J 2017; 16:42. [PMID: 28676052 PMCID: PMC5496601 DOI: 10.1186/s12937-017-0265-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/25/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Delayed gastric emptying (DGE) is the most frequent pancreatic specific complication (PSC) after pancreaticoduodenectomy (PD). Several gastric decompression systems exist to manage DGE. Patients with a pancreatic tumor require prolonged nutrition; however, controversies exist concerning nutrition protocol after PD. The aim of the study was to assess the safety and efficacy of nasogastric (NG), gastrostomy (GT), and gastrojejunostomy (GJ) tubes with different feeding systems on postoperative courses. METHODS Between January 2013 and March 2016, 86 patients underwent PD with pancreaticogastrostomy. Patients were divided into three groups: GJ group with enteral nutrition (EN, n = 12, 14%), NG (n = 31, 36%) and GT groups (n = 43, 50%), both with total parenteral nutrition (TPN). RESULTS Patients in the GJ (n = 9, 75%) and GT (n = 18, 42%) groups had an American Society of Anesthesiologists (ASA) score of 3 more often than those in the NG group (n = 5, 16%, p ≤ 0.01). Multivariate analysis identified the GT tube with TPN as an independent risk factor of severe morbidity (p = 0.02) and DGE (p < 0.01). An ASA score of 3, jaundice, common pancreatic duct size ≤3 mm and soft pancreatic gland texture (p < 0.05) were found as independent risk factors of PSCs. Use of a GJ tube with EN, GT tube with TPN, jaundice, and PSCs were identified as independent risk factors for greater postoperative length of hospital stay (p < 0.01). Mean global hospitalization cost did not differ between groups. CONCLUSION GT tube insertion with TPN was associated with increased severe postoperative morbidity and DGE and should not be recommended. EN through a GJ tube after PD is feasible but does not have clear advantages on postoperative courses compared to an NG tube.
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Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20 Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20 Marseille, France
| | - Sandrine Loubière
- Self perceived Health Assessment Research Unit and Department of Public health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, cedex 20 Marseille, France
| | - Julien Bonnet
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20 Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20 Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20 Marseille, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20 Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20 Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20 Marseille, France
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Zhang D, Wu J, Liu S, Zhang X, Zhang B. Network meta-analysis of Chinese herbal injections combined with the chemotherapy for the treatment of pancreatic cancer. Medicine (Baltimore) 2017; 96:e7005. [PMID: 28538415 PMCID: PMC5457895 DOI: 10.1097/md.0000000000007005] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND This study sought to use a network meta-analysis to assess the effectiveness and safety of Chinese herbal injections (CHIs) combined with the chemotherapy for the treatment of pancreatic cancer. METHODS Randomized controlled trials (RCTs) regarding CHIs to treat pancreatic cancer were searched in PubMed, the Cochrane library, Embase, the China National Knowledge Infrastructure Database (CNKI), the Wan-Fang Database, the Chinese Scientific Journals Full-text Database (VIP), and the Chinese Biomedical Literature Database (SinoMed) up to November 2016. The quality assessment was conducted by the Cochrane risk of bias tool and network meta-analysis was performed to compare the effectiveness and safety of different CHIs combined with the chemotherapy. Data were analyzed using STATA 12.0 and Win-BUGS 1.4 software. RESULTS A total of 278 records were searched, and 22 eligible RCTs involving 1329 patients and 9 CHIs were included. The results of the network meta-analysis demonstrated that compared with the chemotherapy alone, Compound Kushen, Kangai or Kanglaite injection combined with chemotherapy yielded significantly higher probability of improving performance status. Aidi injection combined with chemotherapy was more effective in relieving leucopenia than using chemotherapy single. And these between-group differences were statistically significant. However, CHIs combined with chemotherapy could not achieve a better effect in the total clinical effect, nausea and vomiting. As for the cluster analysis for the adverse reactions (ADRs), the chemotherapy alone and Huachansu injection combined with the chemotherapy were inferior to relieve ADRs than the other CHIs plus chemotherapy for patients with pancreatic cancer. CONCLUSIONS The current evidence showed that using CHIs on the basis of the chemotherapy could be beneficial for patients with pancreatic cancer in improving performance status and reducing the ADRs.
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Mortalin expression in pancreatic cancer and its clinical and prognostic significance. Hum Pathol 2017; 64:171-178. [PMID: 28412209 DOI: 10.1016/j.humpath.2017.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/06/2017] [Accepted: 03/23/2017] [Indexed: 11/23/2022]
Abstract
Mortalin, an essential mitochondrial chaperone protein, is involved in the tumorigenesis of a number of malignancies. This study aimed to investigate the expression of Mortalin in pancreatic ductal adenocarcinoma (PDAC) cells and to determine its clinicopathological and prognostic significance. The localization of Mortalin protein was detected in BXPC-3 PDAC cells using immunofluorescence. Immunohistochemistry was also used to detect Mortalin expression in well-defined tissues obtained from 106 PDAC patients and 46 corresponding nontumor pancreatic tissues. Clinicopathological parameters and overall survival data were collected and compared between different Mortalin statuses. The results of immunohistochemistry and immunofluorescence showed that Mortalin was primarily present in the cytoplasm of PDAC cells. The ratio of strong positive staining for Mortalin was higher in PDAC tissues (55.66%; 59/106) than in normal adjacent tissues (23.91%; 11/46). Positive relationships between Mortalin expression and clinical stage, perineural invasion, lymph node metastasis, and lower overall survival were observed. Multivariate Cox regression analysis identified Mortalin as a significant independent prognostic factor, in addition to location, clinical stage, and perineural invasion, for survival of PDAC patients. Therefore, we present strong evidence that Mortalin may function as a practical marker to predict prognosis and as a potential therapeutic target in PDAC treatment.
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Abstract
PURPOSE Metabolic activity, as defined by F-FDG uptake on PET, is a prognostic marker for multiple malignancies; however, no study has examined the prognostic value of imaging with FDG PET in stage I and II pancreatic cancer. We examined the value of PET FDG uptake in early-stage pancreatic cancer patients. METHODS We identified patients with early-stage pancreatic cancer (I-II) who had FDG PET scan performed as part of their preoperative evaluation. The patients were divided into either high or low FDG uptake according to the median primary tumor standard uptake value (SUVmax). Our primary end points were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meier estimate was used for survival analysis. Pathologic data were compared using the Fisher exact and χ tests. RESULTS One hundred five patients were identified: 51 patients with low FDG uptake and 54 patients with high FDG uptake. Eighty-five patients (81%) had PET avid tumors, whereas 20 (19%) patients did not. High FDG uptake correlated with pathologic stage (P = 0.012). Patients with low FDG uptake had significantly better median OS than patients with high FDG uptake (28 vs. 16 months; P = 0.036). Patients with low-FDG uptake had significantly longer median RFS than patients with high FDG uptake (14 vs. 12 months; P = 0.049). CONCLUSIONS Low FDG uptake in PET scans in patients with stage I and II pancreatic cancer correlates with improved OS and RFS. This supports the concept that glucose metabolic pathways are important in pancreatic cancer biology and that PET scan activity can be used as a prognostic biomarker after pancreatectomy.
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Burmeister EA, Waterhouse M, Jordan SJ, O'Connell DL, Merrett ND, Goldstein D, Wyld D, Beesley V, Gooden H, Janda M, Neale RE. Determinants of survival and attempted resection in patients with non-metastatic pancreatic cancer: An Australian population-based study. Pancreatology 2016; 16:873-81. [PMID: 27374480 DOI: 10.1016/j.pan.2016.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are indications that pancreatic cancer survival may differ according to sociodemographic factors, such as residential location. This may be due to differential access to curative resection. Understanding factors associated with the decision to offer a resection might enable strategies to increase the proportion of patients undergoing potentially curative surgery. METHODS Data were extracted from medical records and cancer registries for patients diagnosed with pancreatic cancer between July 2009 and June 2011, living in one of two Australian states. Among patients clinically staged with non-metastatic disease we examined factors associated with survival using Cox proportional hazards models. To investigate survival differences we examined determinants of: 1) attempted surgical resection overall; 2) whether patients with locally advanced disease were classified as having resectable disease; and 3) attempted resection among those considered resectable. RESULTS Data were collected for 786 eligible patients. Disease was considered locally advanced for 561 (71%) patients, 510 (65%) were classified as having potentially resectable disease and 365 (72%) of these had an attempted resection. Along with age, comorbidities and tumour stage, increasing remoteness of residence was associated with poorer survival. Remoteness of residence and review by a hepatobiliary surgeon were factors influencing the decision to offer surgery. CONCLUSIONS This study indicated disparity in survival dependent on patients' residential location and access to a specialist hepatobiliary surgeon. Accurate clinical staging is a critical element in assessing surgical resectability and it is therefore crucial that all patients have access to specialised clinical services.
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Affiliation(s)
- E A Burmeister
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; The University of Queensland, Brisbane, Queensland, Australia.
| | - M Waterhouse
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - S J Jordan
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - D L O'Connell
- Cancer Council NSW, Sydney, Australia; University of Newcastle, NSW, Australia; University of Sydney, NSW, Australia
| | - N D Merrett
- Western Sydney University, NSW, Australia; Bankstown Hospital, NSW, Australia
| | - D Goldstein
- University of New South Wales, NSW, Australia; Prince of Wales Hospital, NSW, Australia
| | - D Wyld
- The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - V Beesley
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - H Gooden
- University of Sydney, NSW, Australia
| | - M Janda
- Queensland University of Technology, Brisbane, Australia
| | - R E Neale
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Insulander J, Sanjeevi S, Haghighi M, Ivanics T, Analatos A, Lundell L, Del Chiaro M, Andrén-Sandberg Å, Ansorge C. Prognosis following surgical bypass compared with laparotomy alone in unresectable pancreatic adenocarcinoma. Br J Surg 2016; 103:1200-8. [PMID: 27250937 DOI: 10.1002/bjs.10190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/25/2016] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection with curative intent has been shown to prolong survival of patients with locoregional pancreatic ductal adenocarcinoma (PDAC). However, up to 33 per cent of patients are deemed unresectable at exploratory laparotomy owing to unanticipated locally advanced or metastatic disease. In these patients, prophylactic double bypass (PDB) procedures have been considered the standard of care. The aim of this study was to compare PDB with exploratory laparotomy alone in terms of impact on postoperative course, chemotherapy and overall survival. METHODS This retrospective observational cohort study (2004-2013) was conducted using a prospective institutional database. Patients with histologically confirmed, unresectable PDAC were included. Relationships between PDB procedures, exploratory laparotomy alone, postoperative chemotherapy and best supportive care were investigated by means of Cox regression. Overall survival was compared using Kaplan-Meier estimations and log rank test. RESULTS Of 503 patients with PDAC scheduled for resection with curative intent, 104 were deemed unresectable at laparotomy (resection rate 79·3 per cent). Seventy-four patients underwent PDB procedures and 30 had exploratory laparotomy alone. PDB and exploratory laparotomy were similar in terms of perioperative mortality, initiation of chemotherapy and overall survival. Compared with best supportive care, postoperative chemotherapy prolonged survival (8·0 versus 14·4 months in locally advanced PDAC, P = 0·007; 2·3 versus 8·0 months in metastatic PDAC, P < 0·001). Patients undergoing chemotherapy following exploratory laparotomy alone had longer median overall survival than patients undergoing chemotherapy following PDB procedures (16·3 versus 10·3 months; P = 0·040). CONCLUSION Patients with pancreatic cancer deemed unresectable at laparotomy may derive survival benefit from subsequent chemotherapy as opposed to supportive care alone. At laparotomy, proceeding with a bypass procedure for prophylactic symptom control may be prognostically unfavourable.
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Affiliation(s)
- J Insulander
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - S Sanjeevi
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Haghighi
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - T Ivanics
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Analatos
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden
| | - M Del Chiaro
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden
| | - Å Andrén-Sandberg
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - C Ansorge
- Department of Surgical Gastroenterology, Section of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden
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Onesti JK, Wright GP, Kenning SE, Tierney MT, Davis AT, Doherty MG, Chung MH. Sarcopenia and survival in patients undergoing pancreatic resection. Pancreatology 2016; 16:284-9. [PMID: 26876798 DOI: 10.1016/j.pan.2016.01.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent studies have suggested that lean core muscle area may predict outcomes from major abdominal surgeries. Pancreatic resections have been independently analyzed less frequently. METHODS Pancreatic resections from 2005 to 2012 were reviewed. Sarcopenia was defined as the lowest tertile for lean psoas muscle area (LPMA). Preoperative risk factors, including comorbidities, albumin, weight loss, age and gender, were analyzed with a primary endpoint of overall survival. Secondary endpoints included complications, discharge destination and readmission. RESULTS The study sample of 270 patients had complications in 42% of patients, with 26% developing serious complication. The majority (80%) were discharged home, and 1.9% died in the peri-operative period. The mean length of follow up was 31.2 months (range 0-94), and 37% required at least one readmission. LPMA was predictive of discharge destination for females (p = 0.038). Sarcopenia was predictive of readmission in males, compared to subjects in the second LPMA tertile (HR 0.3; 95% CI: 0.1-0.9). In all male subjects, including a subset with adenocarcinoma, patients with sarcopenia were more likely to die than males in the highest LPMA tertile (HR: 2.6; 95% CI: 1.4-4.8 and HR: 2.4; 95% CI: 1.2-4.9, respectively). In all patients with pancreatic ductal adenocarcinoma, transfusion (HR: 1.9; 95% CI: 1.1-3.4) and positive margins (HR: 2.0; 95% CI: 1.2-3.3) were the only factors predictive of overall survival. CONCLUSIONS Sarcopenia appears to be a predictor of overall survival in male patients undergoing pancreatic resections, but not specifically for patients with pancreatic ductal adenocarcinoma. As prospective data in future studies are identified, sarcopenia may become a useful tool in predicting outcomes.
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Affiliation(s)
- Jill K Onesti
- Department of Surgical Oncology, Mercy Health Physician Partners, Lack Cancer Center, USA.
| | | | | | | | - Alan T Davis
- GRMEP Research Department, USA; MSU Department of Surgery, USA
| | | | - Mathew H Chung
- MSU Department of Surgery, USA; Department of Surgical Oncology, Spectrum Health Medical Group, USA
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Burmeister EA, Jordan SJ, O'Connell DL, Beesley VL, Goldstein D, Gooden HM, Janda M, Merrett ND, Wyld D, Neale RE. Using a Delphi process to determine optimal care for patients with pancreatic cancer. Asia Pac J Clin Oncol 2016; 12:105-14. [PMID: 26800012 DOI: 10.1111/ajco.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/07/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Dianne L O'Connell
- Cancer Council NSW
- University of Newcastle
- University of New South Wales
- University of Sydney
| | | | | | | | | | - Neil D Merrett
- University of Western Sydney
- Bankstown Hospital; NSW Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital; Brisbane
- School of Medicine; University of Queensland; Queensland
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Jiang XH, Hu NZ, Wei MT. Value of 18F-fluorodeoxyglucose positron emission tomography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis of pancreatic cancer: A systemic review and meta-analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:136-146. [DOI: 10.11569/wcjd.v24.i1.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) and 18F-FDG PET/computed tomography (CT) in the diagnosis of pancreatic cancer.
METHODS: Medline, EMBASE, Science Direct, Springer link, CBM, Cnki, Wan fang and VIP databases were searched by computer before April 1, 2015 to retrieve articles on the study of 18F-FDG PET and 18F-FDG PET/CT in diagnosing pancreatic cancer. Studies were selected according to the inclusion and exclusion criteria, and quality assessment was made using the QUADAS scale. Meta-Disc 1.4 software was used to analyze the heterogeneity of the included articles, and the SROC curve was plotted to calculate the pooled sensitivity and specificity. The publication bias was assessed with Stata 12.0 software.
RESULTS: A total of 51 English-language articles were included. The summary sensitivity and specificity of 18F-FDG PET in diagnosing pancreatic cancer were 87% (95%CI: 85%-89%) and 78% (95%CI: 74%-81%), respectively. The positive and negative likelihood ratios were 3.38 (95%CI: 2.64-4.33) and 0.18 (95%CI: 0.14-0.23), respectively. The diagnostic odds ratio (DOR) was 21.91 (95%CI: 14.15-33.93), and the area under the SROC curve was 0.8930. The summary sensitivity and specificity of 18F-FDG PET/CT in diagnosing pancreatic cancer were 91% (95%CI: 88%-93%) and 77% (95%CI: 72%-82%), respectively. The positive and negative likelihood ratios were 3.57 (95%CI: 2.96-4.31) and 0.14 (95%CI: 0.11-0.18), respectively. The DOR was 28.52 (95%CI: 19.63-41.42), and the area under the SROC curve was 0.9315.
CONCLUSION: 18F-FDG PET/CT and 18F-FDG PET have higher diagnostic value than CT in diagnosing pancreatic cancer. 18F-FDG PET/CT is superior to 18F-FDG PET in terms of sensitivity and both of them can be used as diagnostic tools for pancreatic cancer with negative traditional examinations.
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45
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Quiney B, Harris A, McLaughlin P, Nicolaou S. Dual-energy CT increases reader confidence in the detection and diagnosis of hypoattenuating pancreatic lesions. ACTA ACUST UNITED AC 2015; 40:859-64. [PMID: 25270000 DOI: 10.1007/s00261-014-0254-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To prospectively compare detection and reader confidence of pancreatic lesions using a standard multi-detector computed tomography (MDCT) imaging protocol to a dual-energy computed tomography (DECT) imaging protocol with additional virtual non-contrast series. METHODS 60 subjects imaged for suspected or known pancreatic lesions were included. Subjects underwent pancreatic MDCT including non-contrast, pancreatic phase, and portal venous phase (PVP). The PVP was performed in dual energy mode. Virtual non-contrast and blended 120 kVp weighted images were created from the DECT data. Overall noise and absolute attenuation differences of pancreatic lesions and normal pancreatic tissue were measured. Images were read by two staff radiologists blinded to the underlying diagnosis. MDCT and DECT scans were reviewed separately to evaluate image quality and level of confidence in diagnosis of a pancreatic lesion. RESULTS Image quality was ranked excellent for 90 % and 95 % of the 120 kVp studies and 93 % and 95 % of the 100 kVp studies by readers 1 and 2, respectively. VNC was ranked sufficient quality or better by both readers. Average attenuation difference was 74 HU (120 kVp) and 71 HU (100 kVp). Average noise was 11.31 HU (120 kVp) and 15.89 HU (100 kVp). No lesions were missed by either approach. There was increased confidence in diagnostic interpretation in 14 % (± 9 % [95 % CI]) and 9 % (± 7 % [95 % CI]) of DECT scans compared to MDCT. CONCLUSIONS DECT compared to MDCT pancreatic imaging leads to increased reader confidence with identical diagnostic sensitivity for pathologically proven cases. This approach could be implemented as a single phase acquisition study with calculated VNC leading to a significant dose savings to the patient.
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Affiliation(s)
- Brendan Quiney
- Department of Radiology, Faculty of Medicine, University of British Columbia, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 4E3, Canada,
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Schmuck RB, de Carvalho-Fischer CV, Neumann C, Pratschke J, Bahra M. Distal bile duct carcinomas and pancreatic ductal adenocarcinomas: postulating a common tumor entity. Cancer Med 2015; 5:88-99. [PMID: 26645826 PMCID: PMC4708893 DOI: 10.1002/cam4.566] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/27/2015] [Accepted: 09/23/2015] [Indexed: 12/15/2022] Open
Abstract
The set definition of distal cholangiocarcinomas and adenocarcinomas of the pancreatic head is challenged by their close anatomical relation, similar growth pattern, and corresponding therapeutic outcome. They show a mutual development during embryologic organ formation and share phenotypic characteristics. This review will highlight the similarities with regard to the common origin of their primary organs, histopathological similarities, and modern clinical management. Thus, we propose to subsume those entities under a common superfamily.
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Affiliation(s)
- Rosa B Schmuck
- General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christopher Neumann
- General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Bahra
- General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Li S, Wu L, Wang Q, Li Y, Wang X. KDM4B promotes epithelial-mesenchymal transition through up-regulation of ZEB1 in pancreatic cancer. Acta Biochim Biophys Sin (Shanghai) 2015; 47:997-1004. [PMID: 26511091 DOI: 10.1093/abbs/gmv107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/18/2015] [Indexed: 12/21/2022] Open
Abstract
Lysine (K)-specific demethylase 4B (KDM4B) is a histone H3K9 demethylase and is reported to activate gene transcription through regulation of chromatin structures. Previous research has revealed that KDM4B plays special regulatory roles in colorectal, prostate and gastric cancers. However, its physiological role in pancreatic cancer remains largely unknown. In the present study, it is demonstrated KDM4B plays a crucial in epithelial-mesenchymal transition (EMT) in pancreatic cancer. siRNA mediated silencing of KDM4B inhibits cell migration, invasion and EMT. Moreover, KDM4B was demonstrated to epigenetically regulate the expression of ZEB1 in the TGF-β-induced EMT process. In tumor tissues of pancreatic cancer patient, the protein level of KDM4B was positively correlated with ZEB1. In conclusion, our results suggested that KDM4B is a key mediator in EMT process, and may serve as an important prognostic marker and therapeutic target for the metastatic progression of human pancreatic cancer.
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Affiliation(s)
- Shuo Li
- Department of Intervetional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Qingbing Wang
- Department of Intervetional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yingyi Li
- Cancer Research Institute, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Xiaolin Wang
- Department of Intervetional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Scally CP, Yin H, Birkmeyer JD, Wong SL. Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery. J Surg Oncol 2015; 112:866-71. [DOI: 10.1002/jso.24085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/20/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Christopher P. Scally
- Department of Surgery, University of Michigan; Center for Healthcare Outcomes and Policy; Ann Arbor Michigan
| | - Huiying Yin
- Department of Surgery, University of Michigan; Center for Healthcare Outcomes and Policy; Ann Arbor Michigan
| | - John D. Birkmeyer
- Department of Surgery, University of Michigan; Center for Healthcare Outcomes and Policy; Ann Arbor Michigan
| | - Sandra L. Wong
- Department of Surgery, University of Michigan; Center for Healthcare Outcomes and Policy; Ann Arbor Michigan
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Sanjeevi S, Ivanics T, Lundell L, Kartalis N, Andrén-Sandberg Å, Blomberg J, Del Chiaro M, Ansorge C. Impact of delay between imaging and treatment in patients with potentially curable pancreatic cancer. Br J Surg 2015; 103:267-75. [DOI: 10.1002/bjs.10046] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/22/2015] [Accepted: 10/07/2015] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Locoregional pancreatic ductal adenocarcinoma (PDAC) may progress rapidly and/or disseminate despite having an early stage at diagnostic imaging. A prolonged interval from imaging to resection might represent a risk factor for encountering tumour progression at laparotomy. The aim of this study was to determine the therapeutic window for timely surgical intervention.
Methods
This observational cohort study included patients with histologically confirmed PDAC scheduled for resection with curative intent from 2008 to 2014. The impact of imaging-to-resection/reassessment (IR) interval, vascular involvement and tumour size on local tumour progression or presence of metastases at reimaging or laparotomy was evaluated using univariable and multivariable regression. Risk estimates were approximated using hazard ratios (HRs).
Results
Median IR interval was 42 days. Of 349 patients scheduled for resection, 82 had unresectable disease (resectability rate 76·5 per cent). The unresectability rate was zero when the IR interval was 22 days or shorter, and was lower for an IR interval of 32 days or less compared with longer waiting times (13 versus 26·2 per cent; HR 0·42, P = 0·021). It was also lower for tumours smaller than 30 mm than for larger tumours (13·9 versus 32·5 per cent; HR 0·34, P < 0·001). Tumours with no or minor vascular involvement showed decreased rates of unresectable disease (20·6 per cent versus 38 per cent when there was major or combined vascular involvement; HR 0·43, P = 0·007). However, this failed to reach statistical significance on multivariable analysis (P = 0·411), in contrast to IR interval (P = 0·028) and tumour size (P < 0·001).
Conclusion
Operation within 32 days of diagnostic imaging reduced the risk of tumour progression to unresectable disease by half compared with a longer waiting time. The results of this study highlight the importance of efficient clinical PDAC management.
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Affiliation(s)
- S Sanjeevi
- Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - T Ivanics
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - L Lundell
- Division of Surgery, Karolinska Institute, Stockholm, Sweden
| | - N Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | | | - J Blomberg
- Division of Surgery, Karolinska Institute, Stockholm, Sweden
| | - M Del Chiaro
- Division of Surgery, Karolinska Institute, Stockholm, Sweden
| | - C Ansorge
- Division of Surgery, Karolinska Institute, Stockholm, Sweden
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50
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Niu Z, Wang M, Zhou L, Yao L, Liao Q, Zhao Y. Elevated GRP78 expression is associated with poor prognosis in patients with pancreatic cancer. Sci Rep 2015; 5:16067. [PMID: 26530532 PMCID: PMC4632002 DOI: 10.1038/srep16067] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/06/2015] [Indexed: 01/05/2023] Open
Abstract
Glucose-regulated protein 78 (GRP78) is a member of the heat-shock protein 70 family. We evaluated the expression of GRP78 using tissue microarray-based immunohistochemistry in tumor tissues and adjacent nontumor tissues from 180 pancreatic ductal adenocarcinoma (PDAC) patients. The associations between the expression levels of GRP78, clinicopathological factors, and overall survival were evaluated. The results showed that the expression of GRP78 was significantly higher in PDAC cells than in normal pancreatic duct cells within adjacent nontumor tissues (p < 0.05). The increased expression of GRP78 in the tumor tissues was significantly correlated with a higher T-stage (p < 0.05) and a shorter overall survival (OS, p < 0.05). In an in vitro study, the regulation of GRP78 in the PDAC cell lines affected the proliferation, migration, and invasion of PDAC cells through the regulation of CyclinD1, cyclin-dependent kinase (CDK) 4, CDK6, phospho-signal transducer, activator of transcription 3 (p-STAT3), janus kinase 2 (JAK2), ras homolog gene family member A (RhoA), Rho-associated kinase 1 (ROCK1), and sterile alpha motif domain containing protein 4 (Smad4). The present data suggest that GRP78 plays a crucial role in the proliferation, migration, and invasion of pancreatic cancer cells and may be a suitable prognostic marker in PDAC.
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Affiliation(s)
- Zheyu Niu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
| | - Mengyi Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
| | - Lutian Yao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
| | - Quan Liao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science &Peking Union Medical College, Beijing 100730, China
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