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Zhang J, Jiang X, Liu N, Qi Z, Mi X, Fang Y, Zhang W, Yang Z, Ou W, Lin X, Hou J. Clinical characteristics and prognosis of pancreatitis associated with immune checkpoint inhibitors. Clin Transl Oncol 2024:10.1007/s12094-024-03573-7. [PMID: 38995514 DOI: 10.1007/s12094-024-03573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND OBJECTIVE Immune checkpoint inhibitors (ICIs) have shown remarkable efficacy against various cancers in clinical practice. However, ICIs can cause immune checkpoint inhibitor-associated pancreatic injury, often leading to drug withdrawal, and then patients must go to specialized treatment. The patients, their primary tumors are sensitive to ICIs therapy, may experience treatment delays due to such adverse reactions. Therefore, there is a need for systematic clinical researches on immune-related pancreatic toxicity to provide a clinical basis for its prevention and treatment. METHODS This study involved the collection of data from patients treated with ICIs and addressed pancreatic injury with preemptive treatment before continuing ICIs therapy. Then, we also statistically analyzed the incidence of pancreatic injury in patients with different courses and combined treatment, and the success rate of rechallenge treatment. RESULTS The study included 62 patients, with 33.9% (21/62) experiencing varying degrees of pancreatic injury. Patients with pancreatic injury, 10 cases evolved into pancreatitis, representing 47.6% (10/21) in the pancreatic injury subgroup and 16.1% (10/62) of the total patient cohort. Preemptive treatment was administered to 47.6% (10/21) of patients with pancreatitis, the effective rate was 100%. Among these patients, 70% (7/10) underwent successful rechallenge with ICIs. The occurrence of pancreatic injury was positively correlated with the treatment duration (P < 0.05) but showed no significant correlation with combination therapies (P > 0.05). CONCLUSION The likelihood of pancreatic injury increased with longer treatment durations with ICIs; no significant association was found between the incidence of ICIs-related pancreatic damage and combination therapies. Preemptive treatment for immune-related pancreatitis is feasible, allowing some patients to successfully undergo rechallenge with ICIs therapy.
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Affiliation(s)
- Junzi Zhang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xianzhuo Jiang
- Department of Tumor Comprehensive Therapy, Jilin Provincial People's Hospital, Changchun, Jilin, China
| | - Ning Liu
- General Surgery of the First Clinical Hospital of Jilin Academy of Chinese Medicine Sciences, Changchun, Jilin, China
| | - Zhaoxue Qi
- Department of Secretory Metabolism, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xuguang Mi
- Department of Central Laboratory, Jilin Provincial People's Hospital, Changchun, Jilin, China
| | - Yanqiu Fang
- Department of Tumor Comprehensive Therapy, Jilin Provincial People's Hospital, Changchun, Jilin, China
| | - Wenqi Zhang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhen Yang
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Wenjie Ou
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Xiuying Lin
- Department of Tumor Comprehensive Therapy, Jilin Provincial People's Hospital, Changchun, Jilin, China
| | - Junjie Hou
- Department of Tumor Comprehensive Therapy, Jilin Provincial People's Hospital, Changchun, Jilin, China.
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Mirzoev IA, Medzhidov RT, Abdullaeva AZ, Magomedova SM. [Clinical forms and surgical strategy for chronic pancreatitis]. Khirurgiia (Mosk) 2023:19-27. [PMID: 36800865 DOI: 10.17116/hirurgia202303119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To analyze treatment outcomes in patients with various forms of chronic pancreatitis. MATERIAL AND METHODS We analyzed 434 patients with chronic pancreatitis. These ones underwent 2879 different examinations to determine morphological type of pancreatitis and dynamics of pathological process, as well as substantiate treatment strategy and functional monitoring of various organs and systems. Morphological type A (Buchler et al. 2002) was present in 51.6% of cases, type B - 40.0%, type C - 4.3%. Cystic lesions were detected in 41.7% of cases, pancreatic calculi - 45.7%, choledocholithiasis - 19.1%, tubular stricture of distal choledochus - 21.4%, pancreatic duct enlargement - 95.7%, narrowing or interruption of the duct - 93.5%, communication of the duct with the cyst - in 17.4% of patients. Induration of pancreatic parenchyma was noted in 97% of patients, heterogeneous structure - 94.4%, enlargement of the pancreas - 10.8%, shrinkage of the gland - in 49.5% of cases. Surgical treatment was performed in 186 patients: ERCP + EPST in 8 patients, ERCP + EPST + pancreatic duct stenting in 2 patients, ERCP + EPST + wirsungotomy with stenting in 2 patients, laparotomy with hepaticocholedochojejunostomy in 6 patients, laparotomy with gastropancreatoduodenal resection in 19 patients, laparotomy with Puestow I procedure in 18 patients, Puestow II procedure in 34 patients, laparotomy + pancreatic tail resection + Duval procedure in 3 patients, laparotomy with Frey surgery in 19 cases, laparotomy and Beger procedure in 2 patients, external drainage of pseudocyst in 21 patients, endoscopic internal drainage of pseudocyst in 9 patients, laparotomy with cystodigestive anastomosis in 34 patients, excision of fistula and distal pancreatectomy in 9 cases). RESULTS Postoperative complications developed in 22 (11.8%) patients. Mortality rate was 2.2%.
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Affiliation(s)
- I A Mirzoev
- Dagestan State Medical University, Makhachkala, Russia
| | - R T Medzhidov
- Dagestan State Medical University, Makhachkala, Russia
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Wen H, Li Q, Lu N, Su YY, Ma PH, Zhang MX. Intestinal flora and pancreatitis: Present and future. Shijie Huaren Xiaohua Zazhi 2021; 29:1269-1275. [DOI: 10.11569/wcjd.v29.i22.1269] [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
The role of intestinal flora in human health and diseases has attracted more and more attention. At present, there have been some reports on the relationship between intestinal flora and pancreatitis. These reports reveal that intestinal flora plays some important roles in the occurrence and development of pancreatitis. The specific mechanisms of action are unclear, but there is preliminary consensus that intestinal microbiome dysregulation promotes inflammatory changes in the pancreas. This paper summarizes the correlation between intestinal flora and pancreatitis, in order to provide some references and ideas for further research.
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Affiliation(s)
- Hua Wen
- Xi'an Medical University, Xi'an 710000, Shaanxi Province, China,Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Qian Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Ning Lu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Yuan-Yuan Su
- Xi'an Medical University, Xi'an 710000, Shaanxi Province, China,Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Pei-Han Ma
- The Second Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, Shaanxi Province, China
| | - Ming-Xin Zhang
- The Second Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, Shaanxi Province, China
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Liu Y, Wang D, Guo HL, Hao L, Wang T, Zhang D, Yang HY, Ma JY, Li J, Zhang LL, Lin K, Chen C, Han X, Lin JH, Bi YW, Xin L, Zeng XP, Chen H, Xie T, Liao Z, Cong ZJ, Wang LS, Xu ZL, Li ZS, Hu LH. Risk factors and nomogram for diabetes mellitus in idiopathic chronic pancreatitis. J Gastroenterol Hepatol 2020; 35:343-352. [PMID: 31318997 DOI: 10.1111/jgh.14785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Diabetes mellitus (DM) is a common complication of idiopathic chronic pancreatitis (ICP), which impairs the quality of life for patients. This study aimed to identify risk factors and develop nomogram for DM in ICP to help early diagnosis. METHODS Idiopathic chronic pancreatitis patients admitted to our center from January 2000 to December 2013 were included. Cumulative rates of DM were calculated by Kaplan-Meier method. Patients were randomly assigned, in a 2:1 ratio, to the training and validation cohort. Based on training cohort, risk factors for DM were identified through Cox proportional hazards regression model, and nomogram was developed. Internal and external validations were performed based on the training and validation cohort, respectively. RESULTS Totally, 1633 patients with ICP were finally enrolled. The median follow-up duration was 9.8 years. DM was found in 26.3% (430/1633) of patients after the onset of CP. Adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct were identified risk factors for DM development. The nomogram achieved good concordance indexes in the training and validation cohorts, respectively, with well-fitted calibration curves. CONCLUSIONS Risk factors were identified, and nomogram was developed to determine the risk of DM in ICP patients. Patients with one or more of the risk factors including adult at onset of ICP, biliary stricture at/before diagnosis of CP, steatorrhea at/before diagnosis of CP, and complex pathologic changes in main pancreatic duct have higher incidence of DM.
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Affiliation(s)
- Yu Liu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Dan Wang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hong-Lei Guo
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lu Hao
- Department of Gastroenterology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Endoscopy Center, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Teng Wang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Di Zhang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Huai-Yu Yang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jia-Yi Ma
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Juan Li
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ling-Ling Zhang
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Kun Lin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Cui Chen
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xu Han
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Jin-Huan Lin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ya-Wei Bi
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Lei Xin
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiang-Peng Zeng
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hui Chen
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Ting Xie
- Department of Gastroenterology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhuan Liao
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Zhi-Jie Cong
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, The Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Guangdong, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Liang-Hao Hu
- Department of Gastroenterology, Gongli Hospital, The Second Military Medical University, Shanghai, China.,Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Mohammadpour R, Dobrovolskaia MA, Cheney DL, Greish KF, Ghandehari H. Subchronic and chronic toxicity evaluation of inorganic nanoparticles for delivery applications. Adv Drug Deliv Rev 2019; 144:112-132. [PMID: 31295521 PMCID: PMC6745262 DOI: 10.1016/j.addr.2019.07.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/02/2019] [Accepted: 07/04/2019] [Indexed: 12/31/2022]
Abstract
Inorganic nanoparticles provide the opportunity to localize bioactive agents to the target sites and protect them from degradation. In many cases, acute toxicities of inorganic nanoparticles used for delivery applications have been investigated. However, little information is available regarding the long-term toxicity of such materials. This review focuses on the importance of subchronic and chronic toxicity assessment of inorganic nanoparticles investigated for delivery applications. We have attempted to provide a comprehensive review of the available literature for chronic toxicity assessment of inorganic nanoparticles. Where possible correlations are made between particle composition, physiochemical properties, duration, frequency and route of administration, as well as the sex of animals, with tissue and blood toxicity, immunotoxicity and genotoxicity. A critical gap analysis is provided and important factors that need to be considered for long-term toxicology of inorganic nanoparticles are discussed.
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Affiliation(s)
- Raziye Mohammadpour
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, Utah, USA
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Cancer Research Technology Program, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Darwin L Cheney
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, Utah, USA
| | - Khaled F Greish
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama 329, Bahrain; Nanomedicine Research Unit, Princess Al-Jawhara Centre for Molecular Medicine and Inherited Disorders, Arabian Gulf University, Manama 329, Bahrain
| | - Hamidreza Ghandehari
- Utah Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, Utah, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, Utah, USA; Department of Bioengineering, University of Utah, Salt Lake City, Utah, USA.
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