Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes

Low prealbumin level is a poor prognostic biomarker for surgically treated pancreatic cancer

The present study aimed to evaluate the clinicopathological and prognostic significance of preoperative prealbumin levels in patients with surgically treated pancreatic cancer. The present retrospective study included 95 patients with pancreatic cancer who underwent radical surgery between January 2011 and December 2021. Of the patients, 49 were male and 46 were female, with a median age of 73 years. According to the median preoperative prealbumin level of 21.1 mg/dl, the patients were divided into low (<21.1 mg/dl) and high (≥21.1 mg/dl) prealbumin groups. Univariate and multivariate analyses were performed to evaluate the prognostic significance of prealbumin levels. Notably, no clinicopathological factors were associated with low prealbumin levels. Overall (P=0.008) and recurrence-free (P=0.004) survival were significantly lower in the low prealbumin group than those in the high prealbumin group. In addition, multivariate analysis showed that low prealbumin levels were an independent risk factor for poor overall (P=0.024) and recurrence-free (P=0.013) survival. Furthermore, the liver (P=0.038) and peritoneal recurrence (P=0.012) rates were higher in the low prealbumin group than those in the high prealbumin group. In conclusion, low preoperative prealbumin levels may be a poor prognostic biomarker in patients with surgically treated pancreatic cancer.

Role of m5C methylation in digestive system tumors (Review)

Currently, the incidence of digestive system tumors has been increasing annually, thus becoming a prevalent cause of cancer‑related mortalities. Although significant strides have been made in targeting the molecular mechanisms that underpin the development of these tumors, their treatment and prognosis still pose substantial challenges. This is primarily due to the ambiguity of early diagnostic indicators and the fact that most digestive system tumors are detected at an advanced stage. However, epigenetic modifications are capable of altering the expression of oncogenes and regulating biological processes in cancer. In recent years, the study of methylation in relation to tumor pathogenesis has become a focus of prominent research. Among the various types of methylation, 5‑methylcytosine (m5C) methylation plays a crucial role in the development of digestive system tumors and is anticipated to serve as a novel therapeutic target. However, to date, a comprehensive and systematic review concerning the role of m5C methylation in digestive system tumors is lacking. Consequently, the present study reviewed the role of m5C methylation in digestive system tumors such as esophageal cancer, gastric cancer and hepatocellular carcinoma, with the aim of providing a valuable reference for future research endeavors.

Emerging biomarkers for pancreatic cancer: from early detection to personalized therapy

Pancreatic cancer (PC) remains one of the most lethal malignancies, primarily due to its poor prognosis and late diagnosis. Biomarkers are essential in enhancing diagnostic accuracy, prognostic assessments, and therapeutic strategies, thereby addressing these challenges. Conventional biomarkers, such as CA 19-9, are widely used for monitoring disease progression but have limitations in early detection and specificity, necessitating complementary markers like CEA and MUC1. Emerging genetic biomarkers, including KRAS mutations and TP53 alterations, offer critical insights into tumorigenesis and serve as valuable diagnostic, prognostic, and therapeutic targets. Epigenetic biomarkers, such as DNA methylation and histone modifications, provide additional molecular layers, with aberrant methylation patterns and dysregulated histone modifications influencing tumor aggressiveness and therapy resistance. RNA-based biomarkers, particularly microRNAs (miRNAs) and long noncoding RNAs (lncRNAs), play pivotal roles in regulating tumor biology and offer significant diagnostic and therapeutic potential. Protein-based biomarkers, including glycoproteins and cytokines, alongside liquid biopsy components like circulating tumor DNA (ctDNA), exosomes, and circulating tumor cells (CTCs), facilitate real-time disease monitoring and early detection. Personalized therapy is increasingly guided by these biomarkers, which predict responses to chemotherapy and immunotherapy. Despite challenges in biomarker validation and clinical implementation, advancements in multi-omics, artificial intelligence, and collaborative research hold promise for improving patient outcomes and survival rates in PC.

Interplay Between Schwann Cells and Peripheral Cancers: Mechanisms and Therapeutic Targets in Cancer Progression

Cancer, a leading global health concern, is characterized by uncontrolled proliferation of cells, high invasion into surrounding tissues, and eventual metastasis to distant organs. The complexity of cancer is further amplified by diverse cellular components within the tumor microenvironment (TME), encompassing both cancerous and non-cancerous cells that fuel tumorigenesis and progression. Schwann cells (SCs), the main glial cells of the peripheral nervous system, have emerged as crucial components within the TME in cancer development. Here, we summarize the multifaceted roles of SCs in tumor growth, epithelial-mesenchymal transition, perineural invasion, and chemotherapy resistance. This review focuses on the effects of SCs on eight distinct peripheral cancer types, particularly pancreatic, lung, and colorectal cancers, along with cancer-related pain, one of the most common symptoms that affect quality of life and prognosis in cancer patients. Furthermore, we emphasize the therapeutic potential of SCs by delving into advanced technologies and clinical strategies related to SCs, which make us advocate for further research to elucidate the events and molecular mechanisms underlying the SC-cancer relationship. Translating these insights into clinical applications may offer new hope for improved cancer management and patient outcomes.

Comparative study of the anti-tumour effects of the imipridone, ONC201 and its fluorinated analogues on pancreatic cancer cell line

Pancreatic ductal adenocarcinoma has a high mortality rate, with a 5-year survival rate of ~ 12%. Therefore, developing new targeted therapies is urgently needed. ONC-201, a promising candidate, is currently undergoing clinical trials. The main objective of the present work is to investigate the anti-tumour activity of ONC-201 and its two fluorinated analogues (TBP-134, TBP-135). The viability of two pancreatic adenocarcinoma cell lines (PANC-1, MIA PaCa-2) and three other tumour cell lines (A2058, EBC-1, COLO-205) was assessed after 72-hour treatment with drugs at 0.5, 10, and 25 µM. Significant antiproliferative effects were observed, with 0.5 µM TBP-134 achieving the highest potency, reducing cell viability to approximately 50%. None of the molecules exhibited significant cytotoxicity toward normal human dermal fibroblast cells or cardiomyocytes, indicating a selective anti-tumour profile. The analogues showed more effective results than ONC201 on PANC-1 cells (IC50: 0.35 and 1.8 µM vs. IC50: 6.1 µM, respectively). All analogues induced G2/M phase arrest followed by apoptosis in PANC-1 cells. The site of the fluorination influenced the mechanism of apoptotic action of these compounds. Overall, TBP-134 showed superior efficacy, making it a promising candidate for structural optimization within the imipridone family to develop more effective, selective treatments for pancreatic tumours.

The role and significance of the oncobiota in selected cancers: a review

This review provides an overview of research evidence focused on the microbial components essential to clinical cancer care, called the oncobiota (the interaction of human microbiota and cancer cells). It specifically examines the oncobiota in central nervous system cancer,breast cancer, pancreatic cancer, liver cancer, lung cancer, and cervical cancer. The literature review reveals insufficient knowledge about the oncobiota of organs once considered sterile. Many studies on oncobiota focus on small, geographically specific patient groups, and the absence of a reference (control) group complicates the development of microbial profiles for selected cancers. Consequently, this review aims to analyze the literature data and reports on the role of oncobiota in selected "sterile" organs and the resulting therapeutic or preventive implications. All relevant publications on oncobiota in patients with the selected cancers were considered to provide the most thorough analysis possible. Understanding the significance and role of oncobiota in the pathomechanisms of carcinogenesis may pave the way for targeted cancer prevention methods. Furthermore, therapeutic strategies based on oncobiota could represent a novel area of ​​personalized cancer treatment. Additionally, oncobiota may serve as an additional diagnostic tool in oncology.

Pancancer analysis of DNA damage repair gene mutations and their impact on immune regulatory gene expression

DNA damage is a key factor in many human disorders, including cancer, chronic inflammation, and early aging. Genes involved in DNA damage repair (DDR) not only maintain genomic stability but also contribute to immune responses by regulating the expression of antimicrobial peptides and ligands that activate immune receptors. Various components of the DNA damage response (DDR), including DNA damage sensors, transducer kinases, and effector proteins, are capable of activating diverse immunological signaling pathways. While DDR gene mutations are common in cancers, their effects on immune characteristics are not well understood. We investigated how mutations in DDR genes influence the expression of immune regulatory genes, including immune stimulators, inhibitors, and genes related to the major histocompatibility complex (MHC) pathway. Using gene expression data from The Cancer Genome Atlas (TCGA) and mutation data from cBioPortal, we analyzed 264 DDR-related genes and 66 immune regulatory genes. These genes were clustered and categorized using Metascape, an integrative bioinformatics tool that applies enrichment-based analysis to group functionally related genes into clusters. The clustered genes were further validated through a literature review and the GeneCards database. We scored the change in immune regulatory gene expression in response to DDR gene mutations to identify differentially expressed immune stimulators, inhibitors, and MHC-related genes. Our analysis revealed positive and negative correlations between DDR gene mutations and the expression of immune modulators. These findings could help guide future cancer treatments based on biomarkers and immunotherapy strategies.

Impact of coronary artery stenting on perioperative mortality and complications in patients undergoing pancreaticoduodenectomy

BACKGROUND

Postoperative morbidity and mortality rates from pancreaticoduodenectomy (PD) have significantly decreased, allowing for greater consideration of patients with severe comorbidities. This study aimed to evaluate the effect of previous coronary artery intervention on morbidity and mortality among patients who underwent PD.

METHODS

Patients who underwent PD were identified from the American College of Surgeon National Surgical Quality Improvement Program database. Patients with previous coronary artery intervention received either balloon dilatation or stent placement. The main outcome measures included in-hospital mortality and postoperative myocardial infarction (MI).

RESULTS

Of 10,848 patients who underwent PD, 698 (6.4%) received previous coronary artery intervention. Compared with patients without coronary artery intervention, those with previous coronary artery intervention were older (65 vs 70 years, respectively; P <.001), were less likely to be female (50.2% vs 26.4%, respectively; P <.001), and had higher median body mass index (26 vs 27 kg/m2, respectively; P =.003). Compared with patients not in the angioplasty/stent cohort, those in the angioplasty/stent cohort were more likely to have diabetes mellitus (22.0% vs 39.3%, respectively), functional impairment (2.4% vs 4.9%, respectively), chronic obstructive pulmonary disease (4.1% vs 8.2%, respectively), hypertension (51.2% vs 86.2%, respectively), and bleeding disorders (2.2% vs 8.0%, respectively) (all P <.001). Compared with patients not in the angioplasty/stent cohort, those in the stent/angioplasty group were more likely to have postoperative complications (41.0% vs 51.4%, respectively; P <.001). Previous stent/angioplasty procedure (odds ratio [OR], 2.61 [95% CI, 1.42-4.57]; P =.001) was associated with developing postoperative MI but was not an independent predictor of in-hospital mortality (OR, 1.19 [95% CI, 0.81-1.70]; P =.369).

CONCLUSION

Previous stent placement/angioplasty was not associated with increased in-hospital mortality in patients who underwent PD, despite being correlated with an increased risk of MI and severe complications. Previous coronary artery angioplasty and/or stenting is not an absolute contraindication for PD, but patients should be medically optimized preoperatively to mitigate the risk of major adverse cardiac events.

Cytology-Radiology Correlation Series: Pancreatic cytopathology

The prevalence of pancreatic lesions has increased over the years because of an increase in accessibility to and the quality of cross-sectional imaging. This commentary describes the common non-neoplastic and neoplastic pancreatic lesions. The images in this commentary depict classic cross-sectional images, sonographic findings, and the cytopathologic diagnosis of each lesion. Most common non-neoplastic lesions include pseudocysts, autoimmune pancreatitis, and chronic pancreatitis. Most common neoplastic lesions include serous cystadenomas, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, solid pseudopapillary neoplasms, neuroendocrine tumors, pancreatic ductal adenocarcinoma, acinar cell carcinoma, and metastases to the pancreas. The aim of this Cytoimaging Correlation Series is to demonstrate the multidisciplinary involvement in the diagnosis of pancreatic pathology and to highlight main findings in the most common entities found in everyday practice.

Blood circulating miRNAs as pancreatic cancer biomarkers: An evidence from pooled analysis and bioinformatics study

Pancreatic cancer (PC) is one of the deadliest cancers, characterized by a poor prognosis. Currently, there are no screening programs for the early detection of PC, and existing diagnostic methods are primarily limited to high-risk individuals. Biomarkers such as CA19-9 have not significantly improved early diagnosis, making the identification of new potential biomarkers crucial for routine clinical practice. Among the candidate biomarkers, miRNAs have been most extensively studied due to their role in regulating gene expression (either as oncomiRs or tumor suppressor miRNAs) and their potential for minimally invasive analysis through liquid biopsy techniques. This review aims to summarize the current literature on blood-circulating miRNAs and their diagnostic value in PC detection, considering the context of CA19-9 and benign pancreatic diseases. The data from the collected studies were curated through both statistical and bioinformatics analyses to identify the most promising miRNAs with optimal diagnostic accuracy for PC detection and to assess their role in the molecular processes leading to tumor development.

Neoadjuvant Chemoradiotherapy Using Moderately Hypofractionated Intensity-Modulated Radiotherapy Versus Upfront Surgery for Resectable Pancreatic Cancer: A Retrospective Cohort Study

BACKGROUND

The efficacy of neoadjuvant chemoradiotherapy for resectable pancreatic ductal adenocarcinoma (R-PDAC) remains unclear. This study was designed to evaluate neoadjuvant chemoradiotherapy by using intensity-modulated radiotherapy (NAC-IMRT) for R-PDAC compared with upfront surgery (UpS).

METHODS

Among 198 patients with R-PDAC who were indicated for resection between 2013 and 2021, 130 were included in this study after excluding patients who underwent neoadjuvant chemotherapy and did not meet the NAC-IMRT criteria (Eligible set). NAC-IMRT was planned for 58 patients, and UpS was planned for 72 patients. Additionally, in 105 patients who could undergo the planned treatment (As-treated set), the surgical, pathological, and oncological outcomes were evaluated.

RESULTS

In the Eligible set, median overall survival (OS) was 50.5 months with NAC-IMRT and 34.7 months with UpS and progression-free survival was 20.4 months with NAC-IMRT and 13.9 months with UpS. In the As-treated set, OS was longer in the NAC-IMRT group (66.7 months vs. 34.7 months, p = 0.007). On multivariate analysis, NAC-IMRT was identified as an independent factor for better OS (hazard ratio 0.617, 95% confidence interval 0.382-0.995, p = 0.047, in the Eligible set). The incidence of postoperative complications did not show a difference between the two groups, and NAC-IMRT suppressed local tumor invasion, including lymphatic, venous, perineural invasion, and lymph node metastases.

CONCLUSIONS

NAC-IMRT may offer superior survival outcomes and manageable toxicity in R-PDAC patients compared with upfront surgery. This study supports the efficacy and safety of NAC-IMRT and recommends its consideration in R-PDAC treatment protocols.

PLXDC1+ Tumor-Associated Pancreatic Stellate Cells Promote Desmoplastic and Immunosuppressive Niche in Pancreatic Ductal Adenocarcinoma

Pancreatic stellate cells (PSCs) contribute to pancreatic ductal adenocarcinoma (PDAC) progression and therapeutic resistance, yet their detailed functions remain unclear. This study combined RNA sequencing and assay for transposase-accessible chromatin using sequencing (ATAC-seq) on sorted PSCs from adjacent normal and PDAC tissues to investigate their transcriptional and epigenetic activation. PSCs heterogeneity and functions are characterized through bulk, single-cell, and spatial transcriptomes, as well as in situ sequencing. The clinical relevance of PSCs in immunotherapy is assessed using an in-house immune-checkpoint blockade (ICB) treatment cohort. Findings showed that stress and hypoxia signaling activated PSCs in PDAC. Three common PSCs (CPSCs) and four tumor-associated PSCs (TPSCs) are identified, each with distinct functions. CPSCs differentiated into CCL19+ TPSCs in immune-enriched regions, MYH11+ TPSCs in the stromal region, and PLXDC1+ TPSCs, which exhibited cancer-associated myofibroblasts (myCAFs) phenotype linked to poor prognosis. Notably, PLXDC1+ TPSCs, located near aggressive LRRC15+ myCAFs and SPP1+ macrophages, formed a desmoplastic and immunosuppressive niche around the tumor boundary, promoting CD8 T cell exhaustion. Single-cell transcriptomics of PDAC patients treated with ICB revealed that PLXDC1+ TPSCs correlated with poor immunotherapy efficacy. Overall, this study provides key insights into PSCs in PDAC and potential therapeutic targets.

Claudin 18 (43-14A clone) expression in pancreatic ductal adenocarcinoma: Assessment of a potential clinical biomarker for zolbetuximab therapy

Pancreatic ductal adenocarcinoma (PDAC) remains highly lethal, with a five-year survival rate below 15 %. Claudin 18.2 (CLDN18.2) has emerged as a novel potential therapeutic target in PDAC. Zolbetuximab, a monoclonal antibody targeting CLDN18.2, has demonstrated therapeutic benefit in gastric cancers and is now in phase 2 clinical trials for PDAC. Trial eligibility for zolbetuximab requires tumor membranous immunohistochemical staining with the pan-claudin 18 companion diagnostic antibody clone 43-14A. However, the expression of CLDN18 detected using this clone has only been evaluated in 62 patients from a single retrospective study. Herein, we report immunohistochemical staining using 43-14A on surgically resected PDAC samples (n = 120). Samples were stained following the protocol used in clinical trials, using the 43-14A VENTANA antibody in a prediluted kit, and according to the manufacturer's recommended protocol. Positive cases were defined as ≥ 75 % of tumor cells exhibiting membranous staining with an intensity of ≥ 2+. Out of 120 PDAC cases, 39 (32.5 %) stained positive for CLDN18 with 43-14A. A significant association was observed between lower tumor grade and higher 43-14A staining (p < 0.05). CLDN18-positive cases demonstrated significantly improved survival at the cohort's median overall survival (23 months, p < 0.05), suggesting that claudin expression could serve as a both a diagnostic and prognostic marker. Our findings indicate that 32.5 % of PDAC tumors in this cohort are positive for CLDN18, suggesting that a significant proportion of patients with PDAC could benefit from zolbetuximab and other CLDN18.2 targeted immunotherapies if pancreatic cancer therapeutic trials prove successful.

The Combination of Oncolytic Virus and Antibody Blockade of TGF-β Enhances the Efficacy of αvβ6-Targeting CAR T Cells Against Pancreatic Cancer in an Immunocompetent Model

BACKGROUND/OBJECTIVES

CAR T cell therapy, as a rapidly advancing immuno-oncology modality, has achieved significant success in the treatment of leukaemia and lymphoma. However, its application in solid tumours remains limited. The challenges include the heterogeneity of tumours, local immunosuppression, poor trafficking and infiltration, life-threatening toxicity and the lack of precise representative immunocompetent research models. Considering its typically dense and immunosuppressive tumour microenvironment (TME) and early metastasis, pancreatic ductal adenocarcinoma (PDAC) was employed as a model to address the challenges that hinder CAR T cell therapies against solid tumours and to expand immunotherapeutic options for advanced disease.

METHODS

A novel murine A20FMDV2 (A20) CAR T cell targeting integrin αvβ6 (mA20CART) was developed, demonstrating efficient and specific on-target cytotoxicity. The mA20CART cell as a monotherapy for orthotopic pancreatic cancer in an immunocompetent model demonstrated modest efficacy. Therefore, a novel triple therapy regimen, combining mA20CART cells with oncolytic vaccinia virus encoding IL-21 and a TGF-β-blocking antibody was evaluated in vivo.

RESULTS

The triple therapy improved overall survival, improved the safety profile of the CAR T cell therapy, attenuated metastasis and enhanced T cell infiltration. Notably, the potency of mA20CART was dependent on IL-2 supplementation.

CONCLUSIONS

This study presents an αvβ6-targeting murine CAR T cell, offering a novel approach to developing CAR T cell technologies for solid tumours and a potential adjuvant therapy for pancreatic cancer.

Concurrent pancreatic ductal adenocarcinoma and poorly differentiated neuroendocrine carcinoma: A case report and review of the literature

INTRODUCTION

Concurrent pancreatic ductal adenocarcinoma (PDAC) and poorly differentiated neuroendocrine carcinoma (NEC) is a rare condition. This simultaneous occurrence poses significant diagnostic and therapeutic challenges due to the unique characteristics and treatment protocols of each cancer. An accurate diagnosis is crucial to optimizing treatment outcomes and prognosis.

PRESENTATION OF CASE

We present a case of a 55-year-old male with type 2 diabetes and psoriatic arthritis, referred for an elevated serum CA 19-9 level found during a check-up. Imaging studies, including CT and EUS, revealed a 6 cm mass in the pancreatic head. EUS-guided biopsy confirmed PDAC. After a Whipple procedure, pathology showed concurrent poorly differentiated NEC with a 30 % neuroendocrine component. After surgery, the patient received gemcitabine-based chemotherapy and was disease-free at six months post-surgery.

DISCUSSION

This case illustrates the diagnostic intricacy of simultaneous PDAC and poorly differentiated NEC. Effective management in such scenarios benefits from a collaborative approach among surgeons, oncologists, and pathologists. Due to the limited number of documented cases, there is insufficient evidence to inform the best treatment strategies, particularly concerning the most effective chemotherapy options. This case adds to the growing body of literature on rare concurrent pancreatic tumors and highlights the need for further research to enhance understanding and develop comprehensive clinical guidelines.

CONCLUSION

The combination of PDAC and poorly differentiated NEC poses unique diagnostic and treatment challenges. This case underscores the importance of a multidisciplinary approach and calls for further research to develop evidence-based management protocols for these rare malignancies.

Association of comorbid schizophrenia with cancer stage at admission, treatments, length of stay, and 30-day in-hospital mortality in patients with pancreatic cancer: A retrospective matched-pair cohort study in Japan

BACKGROUND

Previous studies have suggested an association between comorbid schizophrenia and various outcomes in patients with cancer, including cancer stage at admission, treatment, and in-hospital mortality. However, studies focusing specifically on patients with pancreatic cancer are limited.

AIMS

This study aimed to elucidate the association between comorbid schizophrenia and cancer stage at admission, treatment, length of stay, and 30-day in-hospital mortality in patients with pancreatic cancer, while considering patient background factors, medical facilities, and year of treatment.

METHOD

We conducted a retrospective matched-pair cohort study using data from the Japanese Diagnosis Procedure Combination database. Patients with pancreatic cancer and comorbid schizophrenia were matched to those without psychiatric disorders at a maximum ratio of 1:4 according to sex, age group, year of admission, and admission facility. Each matched pair was treated as a cluster, and multivariable regression analyses using generalised estimating equations were performed to evaluate the association between psychiatric comorbidities and cancer-related outcomes.

RESULTS

After adjusting for patient background factors, medical facilities, and the year of treatment, patients with comorbid schizophrenia were significantly more likely to be admitted with stage IV cancer, less likely to undergo chemotherapy, and more likely to have longer hospital stays and higher 30-day in-hospital mortality than those without psychiatric disorders. Although not statistically significant, patients with schizophrenia were less likely to undergo cancer-directed surgery.

CONCLUSIONS

Patients with pancreatic cancer and comorbid schizophrenia were significantly more likely to present with advanced cancer at admission, were less likely to receive chemotherapy, had longer hospital stays, and experienced higher 30-day in-hospital mortality than those without psychiatric disorders. Although not statistically significant, patients with schizophrenia were less likely to undergo cancer-directed surgery.

Preoperative prediction of postoperative pancreatic fistula after Pancreaticoduodenectomy: Determination and validation of a cut-off value for the Roberts Score

BACKGROUND

POPF after pancreaticoduodenectomy can be life-threatening. For risk stratification, prediction could be key. The aim of this study is to determine and validate a cut-off value for the Roberts Score, which is one of the few purely preoperative multicenter validated predictive models for POPF.

METHODS

582 patients were included. The Youden index determined a cut-off in the exploratory cohort (n ​= ​466). The validation cohort's (n ​= ​116) ability to predict CR-POPF was tested using univariate and multivariate regression analysis.

RESULTS

AUC of Roberts Score for the exploration cohort was 0.768. The identified cut-off of 0.268 was confirmed in the validation cohort (p ​< ​0.001). Higher scores were significantly associated with longer time to drain removal and ICU stay. Multiple logistic regression showed the cut-off as an independent predictor of CR-POPF (p ​= ​0.038).

CONCLUSION

The scoring variables and the cut-off itself were both independent predictors, which may improve the identification of high-risk patients and help to investigate the development of POPF.

Novel mRNA biomarker-based liquid biopsy for the detection of resectable pancreatic cancer

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies and most often diagnosed at an advanced stage. Identification of markers for the early diagnosis of PDAC is crucial. In this study, we aimed to identify novel mRNA biomarkers for diagnosing PDAC, focusing on early-stage tumorigenesis and associated immunological changes.

METHODS

Blood samples and clinical information from 1,963 individuals were obtained from a single tertiary hospital between 2015 and 2021. Candidate mRNA biomarkers were identified through literature review, and their expression levels in buffy coat samples were measured using reverse-transcription quantitative polymerase chain reaction. Machine learning-based feature selection confirmed the final biomarker panel, which was tested using an independent dataset for diagnostic performance.

RESULTS

In total, 1,504 individuals (417 patients with PDAC and 1,087 non-disease controls) were eligible for the study. Among the 55 candidate biomarkers identified, 15 mRNAs (CCL5, CCR5, CLEC7A, CXCL8, CXCR2, CXCR4, FOXP3, IFNA1, IFNL1, PTGES, PTGES2, PTGS2, SLC27A2, TNF, and VEGFA) were selected based on their diagnostic performance in distinguishing PDAC from control groups. The final model, HELP-15 (Human Early Liquid biopsy for PDAC), identified all PDAC stages (area under the curve [AUC] = 0.956) in the test set. For resectable pancreatic cancer (RPC), the AUC was 0.968, compared to 0.910 for carbohydrate antigen 19 - 9 (CA19-9). The combined model of the panel and CA19-9 achieved an AUC of 0.985 in patients with RPC. For all PDAC stages in patients with normal CA19-9 levels, the AUC of the panel was 0.967, whereas CA19-9 alone or in combination with the panel had AUCs of 0.658 and 0.885, respectively.

CONCLUSION

Compared to CA19-9, the mRNA biomarker panel, HELP-15, improved diagnostic performance in patients with RPC, particularly in those with normal CA19-9 levels.

Proposing oligo-recurrence criteria in pancreatic ductal adenocarcinoma: A stratified analysis of locoregional treatment benefits

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis with high recurrence rates following curative resection. Locoregional treatment (LT), including metastasectomy, radiation therapy, and radiofrequency ablation, has shown potential survival benefits in selected patients with recurrent PDAC. However, criteria for selecting patients who may benefit from LT remain unclear. The aim of this study is to define oligo-recurrence in PDAC by evaluating the impact of LT on survival after recurrence (SAR).

METHODS

Among 586 patients who underwent curative pancreatectomy between 2006 and 2022, 380 developed recurrence and were included in this study. The primary outcome was SAR, with prognostic factors identified using multivariate Cox regression analysis. Subgroup analysis was performed to identify the patient profiles most likely to benefit from LT.

RESULTS

LT was performed in 79 patients (20.8 %) and not in 301 patients (79.2 %). Independent predictors of poor SAR included time to recurrence (TTR) ≤ 12 months, CA19-9 > 200 U/mL at recurrence, and multi-organ recurrence or ≥ 4 tumors (P < 0.001 for each). Subgroup analysis of these factors identified two groups with significant survival benefits from LT: patients with "TTR >12 months" and "single-organ recurrence (SOR) with ≤3 tumors," with or without "CA19-9 > 200 U/mL."

CONCLUSIONS

Patients with recurrent PDAC characterized by "TTR >12 months" and "SOR with ≤3 tumors" may achieve long-term survival with LT, leading to the proposal of defining them as having "oligo-recurrence" in PDAC.

Tumor-educated platelet, a potential liquid biopsy biosource in pancreatic cancer: A review

Pancreatic cancer (PC) is a frequent and aggressive digestive system cancer with a very poor prognosis. The best chance for recovery lies in early surgical removal of the tumor. Unfortunately, because PC often develops without noticeable symptoms, diagnosis is frequently delayed. Limited treatment options, the metastasis potential of pancreatic cancer cells, and its generally poor prognosis mean that patients are often diagnosed late, significantly reducing the effectiveness of treatment. Consequently, there's a critical need for new biomarkers and technologies to improve early detection through screening. Recently, the liquid biopsy has developed as a powerful means for detecting and monitoring cancer at the molecular level. Its advantages include the ease and non-invasive nature of sample collection and its ability to reflect the dynamic changes within a tumor. Platelets, the second most numerous type of blood cell, offer a particularly promising source for liquid biopsy. It is known that cancer affects various aspects of platelets, including their number, size, activation state, and the proteins and RNA they contain. However, the full implications of these changes for cancer detection have not yet been fully integrated into routine clinical practice. Platelets have a unique ability to captivate nucleic acids and proteins from their surroundings, and they alter their transcriptome in response to external signals. This leads to the development of tumor-educated platelets (TEPs). Liquid biopsies that utilize TEP biomarkers hold considerable potential for screening, early detection, prognosis, guiding personalized treatment strategies, ongoing monitoring of the disease, and predicting recurrence. Encouraging results from preclinical studies have highlighted the potential of platelets as a novel liquid biopsy source for a wide range of cancers. This review will explore the potential of using platelets as a liquid biopsy method, specifically for pancreatic cancer.

Global disparities in the burden of pancreatic cancer (1990-2021): insights from the 2021 Global Burden of Disease study

BACKGROUND

Pancreatic cancer (PC) is a highly lethal malignancy, ranking seventh among cancer-related deaths worldwide. This study utilizes data from the 2021 Global Burden of Disease (GBD) study to examine the global burden of PC and associated health inequalities from 1990 to 2021, with a focus on key risk factors such as obesity, high fasting plasma glucose, and the Socio-Demographic Index (SDI).

METHODS

Disability-Adjusted Life Years (DALYs) for PC were estimated using GBD 2021 data. The analysis incorporated SDI, age, gender, and major risk factors, including obesity and high fasting plasma glucose. Descriptive statistics and visualizations, such as age-sex pyramids and geographic maps, were employed to assess global, regional, and national burdens. Health disparities were quantified using the Concentration Index (CI) and the Slope Index of Inequality (SII), with CI assessing relative health distribution by income and SII measuring absolute socioeconomic inequality.

RESULTS

Globally, PC-related DALYs rose from 1.76 million in 1990 to 4.25 million in 2021 (141.48% increase), with the age-standardized DALY rate up 11.57% to 48.71 (95% UI 23.43 to 74.33). The burden was highest in high SDI regions, while low SDI areas still faced elevated rates; transitional and developing economies showed the highest age-standardized DALY rates. The SII increased from 189.63 (95% CI 177.65 to 245.17) in 1990 to 321.17 (95% CI 294.48 to 379.722) in 2021, indicating widening socioeconomic disparities.

CONCLUSION

PC remains a significant global health challenge with growing socioeconomic and geographic disparities. Urgent action is needed to address modifiable risk factors (e.g., obesity, diabetes) through enhanced healthcare infrastructure, early detection, and treatment access in low SDI countries, alongside improved data systems and international collaboration.

RNA biosensors for detection of pancreatic cancer

Pancreatic cancer is recognized as one of the most lethal types of cancer globally, characterized by a high mortality rate and a bleak prognosis, which greatly contributes to cancer-related deaths. Forecasts suggest that by 2030, pancreatic cancer will exceed other cancer types in prevalence. The disease presents considerable difficulties owing to the lack of prominent symptoms in its early stages, restricted options for early detection, rapid progression, and unfavorable outcomes. Presently, traditional methods for diagnosing pancreatic cancer primarily rely on imaging techniques. However, these methods often entail significant costs, require considerable time, and necessitate specialized skills for both operating the equipment and interpreting the resulting images. To overcome these obstacles, the use of biosensors has been proposed as a potentially valuable tool for the early detection of pancreatic cancer. MicroRNAs (miRs), a type of small non-coding RNA molecules, have emerged as highly sensitive molecular diagnostic tools that have the potential to function as precise indicators for a range of diseases, including cancer. Biosensors have been suggested as a potential solution for tackling these challenges, offering a promising approach for the early detection of pancreatic cancer. Small non-coding RNA molecules known as MicroRNAs (miRs) have become recognized as extremely sensitive molecular diagnostic tools and can act as precise biomarkers for different diseases, such as cancer. Moreover, this manuscript presents a thorough summary of the latest innovations in nano-biosensors that have been specifically developed for the identification of non-coding RNAs related to pancreatic cancer.

Comprehensive analysis of UPK3B as a marker for prognosis and immunity in pancreatic adenocarcinoma

The low immunogenicity of pancreatic cancer inhibits effective antitumor immune responses, primarily due to the immune evasion mediated by low expression of the major histocompatibility complex (MHC). Through comprehensive analysis, our study identifies UPK3B as a gene closely associated with low MHC expression and low immunogenicity in pancreatic cancer. UPK3B has been reported as a marker of primary mesothelial cells, mature epicardium and promotes extracellular matrix signaling. However, the role of UPK3B in pancreatic cancer remain unclear. We found that UPK3B is highly predictive of overall survival (OS) in patients with pancreatic ductal adenocarcinoma (PDAC) and is significantly related to clinical features, immune cell infiltration, and response to immune checkpoint inhibitor (ICI) therapy. Gene enrichment analysis revealed significant downregulation of immune regulatory and BCR signaling pathways in the UPK3B high-expression group. Additionally, UPK3B is positively correlated with immunosuppressive cells, suggesting that high UPK3B expression may inhibit antitumor immune responses by promoting low MHC expression. UPK3B is also positively correlated with immune checkpoints, indicating that tumors with high UPK3B expression may not benefit from ICI therapy. Therefore, UPK3B may serve as a novel biomarker and therapeutic target for pancreatic cancer.

Prognostic Impact of Phenotypic and Genetic Features of Pancreatic Malignancies

Pancreatic cancer is a tumor with a poor prognosis, and improving its survival outcomes remains a formidable challenge, requiring a multidisciplinary approach that integrates innovative surgical and pharmacological strategies, guided by molecular and genetic insights. The pathomorphological and genetic characteristics of pancreatic cancer, reflected in morphological, immunohistochemical, and serological marker expression, reveal key patterns of tumor genotypic changes during carcinogenesis, aiding in prognostic evaluation and clinical strategy development. The mutational profile of pancreatic tumors is quite heterogeneous and diverse in terms of mutated genes, including in relation to morphological subtypes, but certain patterns have been identified as a result of studies. Pancreatic adenocarcinoma, for instance, is frequently driven by mutations regulating cell division (KRAS). The disease prognosis often depends on the morphological subtype and tumor microenvironment. Neuroendocrine tumors of the pancreas are characterized by a number of pathogenetic features that distinguish them from adenocarcinomas. Thus, neuroendocrine tumors are characterized by mutations of the MENIN protein, which prevents cells from entering the mitosis phase by stimulating the expression of cell cycle regulators. Thus, epithelial and neuroendocrine malignancies of the pancreas differ in immunohistochemical and genetic features, but there are similar mechanisms of pathogenesis, such as BRCA1 and BRCA2 gene mutations, impaired expression of p53 antioncogene, and HIF-2α and mTOR receptor mutations. The predictive impact of serological markers, such as CA 19-9 and CEA, offers insights into tumor metastasis and long-term outcomes, emphasizing the need for personalized therapeutic strategies. Tailoring treatments based on individual molecular profiles holds promise for improving prognosis, as the genetic landscape of pancreatic tumors varies significantly between patients. This underscores the importance of a systematic, patient-specific approach that addresses tumor heterogeneity, resistance mechanisms, and the molecular underpinnings of carcinogenesis.

Comprehensive insights into pancreatic cancer treatment approaches and cutting-edge nanocarrier solutions: from pathology to nanomedicine

Pancreatic cancer is one of the most lethal malignancies worldwide. It is characterized by poor prognosis, high mortality, and recurrence rates. Various modifiable and non-modifiable risk factors are associated with pancreatic cancer incidence. Available treatments for pancreatic cancer include surgery, chemotherapy, radiotherapy, photodynamic therapy, supportive care, targeted therapy, and immunotherapy. However, the survival rates for PC are very low. Regrettably, despite efforts to enhance prognosis, the survival rate of pancreatic cancer remains relatively low. Therefore, it is essential to investigate new approaches to improve pancreatic cancer treatment. By synthesizing current knowledge and identifying existing gaps, this article provides a comprehensive overview of risk factors, pathology, conventional treatments, targeted therapies, and recent advancements in nanocarriers for its treatment, along with various clinical trials and patents that justify the safety and efficacy of innovative carriers for drug delivery systems. Ultimately, this review underscores the potential of these innovative formulations to improve outcomes and contribute significantly to the advancement of Pancreatic Cancer treatment. Together, these insights highlight nano-formulations as a promising frontier for effectively treating Pancreatic Cancer.

Beneficial Probiotics with New Cancer Therapies for Improved Treatment of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a malignant form of primary liver cancer. Intricate networks linked to the host immune system may be associated with the pathogenesis of HCC. A huge amount of interdisciplinary medical information for the treatment of HCC has been accumulated over recent years. For example, advances in new immunotherapy have improved the results of treatment for HCC. This approach can be advantageously combined with standard conventional treatments such as surgical resection to improve the therapeutic effect. However, several toxic effects of treatments may pose a significant threat to human health. Now, a shift in mindset is important for achieving superior cancer therapy, where probiotic therapy may be considered, at least within the bounds of safety. The interplay between the gut microbiota and immune system could affect the efficacy of several anticancer treatments, including of immune checkpoint therapy via the alteration of Th17 cell function against various malignant tumors. Here, some recent anticancer techniques are discussed, whereby the growth of HCC may be effectively and safely repressed by probiotic therapy.

Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and it does not exhibit mass lesions. It is suspected based on changes in the main pancreatic duct in magnetic resonance cholangiopancreatography. Sometimes only an unclear duct shows in magnetic resonance cholangiopancreatography with no focal strictures and upstream dilatation of the main pancreatic duct. Serial pancreatic juice cytology is valuable in diagnosis of those patients.

Advancements in the application of ablative therapy and its combination with immunotherapy in anti-cancer therapy

Cancer is a significant health issue impacting humans. Currently, systemic therapies such as chemotherapy have significantly increased the life expectancy of cancer patients. However, some patients are unable to endure systemic treatment due to its significant adverse effects, leading to an increased focus on local therapies including radiation and ablation therapy. Ablation therapy is a precise, low-toxicity, and minimally invasive localized therapy that is increasingly acknowledged by clinicians and cancer patients. Many cancer patients have benefited from it, with some achieving full recovery. Currently, numerous studies have shown that ablation therapy is effective due to its ability to kill cancer cells efficiently and activate the body's anti-cancer immunity. It can also convert "cold cancers" into "hot cancers" and enhance the effectiveness of immunotherapy when used in combination. In this article, we categorize ablation therapy into thermal ablation, cryoablation, photodynamic therapy (PDT), irreversible electroporation (IRE), etc. Thermal ablation is further divided into Radiofrequency ablation (RFA), microwave ablation (WMA), high-frequency focused ultrasound (HIFU), photothermal therapy (PTT), magnetic heat therapy (MHT), etc. We systematically review the most recent advancements in these ablation therapies that are either currently used in clinic or are anticipated to be used in clinic. Then, we also review the latest development of various ablative therapies combined with immunotherapy, and its future development. CLINICAL RELEVANCE STATEMENT: Ablation therapy, an invasive localized treatment, offers an alternative to systemic therapies for cancer patients who cannot tolerate their adverse effects. Its ability to kill cancer cells efficiently and activate anti-cancer immunity. This article reviews recent advancements in ablation therapies, including thermal, cryoablation, PDT, and IRE, and their potential clinical applications, both standalone and in combination with immunotherapy.

Therapeutic potential of flavonoids in gastrointestinal cancer: Focus on signaling pathways and improvement strategies (Review)

Flavonoids are a group of polyphenolic compounds distributed in vegetables, fruits and other plants, which have considerable antioxidant, anti‑tumor and anti‑inflammatory activities. Several types of gastrointestinal (GI) cancer are the most common malignant tumors in the world. A large number of studies have shown that flavonoids have inhibitory effects on cancer, and they are recognized as a class of potential anti‑tumor drugs. Therefore, the present review investigated the molecular mechanisms of flavonoids in the treatment of different types of GI cancer and summarized the drug delivery systems commonly used to improve their bioavailability. First, the classification of flavonoids and the therapeutic effects of various flavonoids on human diseases were briefly introduced. Then, to clarify the mechanism of action of flavonoids on different types of GI cancer in the human body, the metabolic process of flavonoids in the human body and the associated signaling pathways causing five common types of GI cancer were discussed, as well as the corresponding therapeutic targets of flavonoids. Finally, in clinical settings, flavonoids have poor water solubility, low permeability and inferior stability, which lead to low absorption efficiency in vivo. Therefore, the three most widely used drug delivery systems were summarized. Suggestions for improving the bioavailability of flavonoids and the focus of the next stage of research were also put forward.

Rg3 inhibits hypoxia-induced tumor exosomes from boosting pancreatic cancer vasculogenic mimicry through the HIF-1α/LARS1/mTOR axis

BACKGROUND

Pancreatic cancer (PC), characterized by a poor prognosis, can utilize hypoxia to activate vasculogenic mimicry (VM) and facilitate metastasis. Exosomes serve as crucial mediators in this hypoxic environment. Our previous studies demonstrated that Rg3 could counteract VM by modulating the impact of PC-derived exosomes.

AIM

This study focuses on the carcinogenic mechanism of PC in a hypoxic environment.

METHODS

Exosomes from PANC-1 and BxPC-3 cells under normoxic or hypoxic conditions were isolated and characterized by western blot (WB) and nanoparticle trafficking analysis. These PC cells' VM potential was assessed through tube formation and WB. Molecular mechanisms were explored using proteomics analysis, bioinformatics analysis, and the gain- and loss-of-function studies, and the efficacy of Rg3 targeting these exosomes was examined in vitro and in vivo.

RESULTS

Exosomes from PANC-1 and BxPC-3 cells enhanced VM formation in PC cells under hypoxic conditions. Proteomics analysis revealed that these exosomes involved the HIF-1α/LARS1/mTOR axis. Hypoxia-activated HIF-1α led to high expression of LARS1 in PC cell exosomes, which were uptaken by recipient PC cells activating the mTOR signaling and promoting VM formation. Interaction between HIF-1α and LARS1 was further confirmed. In vitro and in vivo experiments demonstrated that Rg3 can diminish VM formation of PC cells triggered by the LARS1/mTOR axis in PC-derived exosomes under hypoxic conditions, improving the therapeutic effect of Rg3.

CONCLUSIONS

Our findings revealed a novel mechanism through which Rg3 inhibits VM in PC by modulating hypoxia-induced tumor exosomes, offering novel experimental insights for PC treatment.

MIAT: A pivotal oncogenic long noncoding RNA tunning the hallmarks of solid malignancies

Long non-coding RNAs (LncRNAs) have emerged as intriguing players in cellular regulation, challenging the traditional view of non-coding RNAs as mere "dark genome". Non-coding DNA makes up most of the human genome and plays a pivotal role in cancer development. These RNA molecules, which do not code for proteins, have captivated researchers with their diverse and crucial roles in gene regulation, chromatin dynamics, and other cellular processes. In several physiological and pathological circumstances, lncRNAs serve critical functions. This review will tackle the complex function of the lncRNA myocardial infarction-associated transcript (MIAT) in various solid malignancies. A special emphasis would be directed on the correlation between cancer patients' clinicopathological features and the expression profile of MIAT. MIAT is a oncogenic regulator in many malignant tumors, where it can control the growth, invasion, metastasis, and resistance to death of cells. As a result, MIAT is thought to be a possible biomarker and therapeutic target for cancer patients. The biological functions, mechanisms and potential clinical implications of MIAT during carcinogenesis and finally the current possible therapeutic approaches targeting MIAT are also outlined in this review.

Surgical Outcomes and Survival in Pancreatic and Periampullary Cancers: A Single Centre Experience

Pancreatic cancer is an aggressive malignancy with many cases diagnosed at locally advanced stages making pancreaticoduodenectomy a technically challenging surgery with significant mortality and morbidity. This study analyses the surgical outcomes and survival after surgery for pancreatic cancers from a single centre in south India. This is a retrospective analysis of pancreatic and periampullary cancer patients who were treated in our institute between January 2014 and November 2022 (n = 71). The median age at diagnosis was 55 years. In about 2/3rd of cases, tumour was located in periampullary region and 62 out of 71 patients underwent curative resection. The most common histopathological diagnosis was adenocarcinoma (87%). Nodal metastasis were detected in 13% of specimens. The predominant morbidity was delayed gastric emptying (DGE 12.7%) and clinically relevant postoperative pancreatic fistula (CR-POPF 11%) with a combined overall morbidity of 35.2% and 30-day mortality of 7.3%. Pre-op nutritional status had a strong association with postoperative morbidity. The median time of survival was 20 months, with a median follow-up of 22 months. Age less than 60 years (P value = 0.0264) and receiving all 6 or more cycles of chemo were significantly associated with improved survival (P value = 0.0297). Lower-stage cancers (T1, T2, and N0) were associated with better survival. The patient characteristics, histological factors, and perioperative outcomes were similar to the reports from other Indian studies. The 3-year survival rate was 30%. There was an increasing trend of survival in patients with age less than 60 years and in patients who received 6 or more cycles of chemotherapy.

Technical Feasibility of Microwave Ablation in Pancreatic Tumors: A Scoping Review of Procedural Efficacy and Safety

BACKGROUND/OBJECTIVES

Pancreatic cancer remains one of the most aggressive and lethal malignancies, with limited effective treatment options for advanced stages. Microwave Ablation (MWA) has emerged as a minimally invasive therapeutic modality, offering potential benefits in tumor control. This review aims to critically assess the safety and efficacy of MWA in the treatment of pancreatic cancer, focusing on its application in various pancreatic lesions.

METHODS

We systematically reviewed studies published between 2010 and 2023 that evaluated the use of MWA in pancreatic tumors, including locally advanced pancreatic cancer (LAPC), pancreatic neuroendocrine tumors (PNETs), and pancreatic metastases from renal cell carcinoma (RCC). Due to limited data on survival rates and long-term outcomes, our analysis concentrated primarily on the technical aspects and immediate procedural outcomes of MWA.

RESULTS

MWA was technically feasible in all cases. The overall complication rate was approximately 16.7% (nine patients), with higher incidences in tumors located in the pancreatic head. Reported complications included pancreatitis and pseudocyst formation. Procedural parameters varied, with applied energy ranging from 20 to 80 watts and ablation times between 2 to 15 min, depending on the microwave generator type and approach (percutaneous, intraoperative or endoscopic). All cases demonstrated effective necrosis of the target tissue, and several studies reported notable tumor size reductions, averaging up to 70%.

CONCLUSIONS

MWA shows promise as a therapeutic option for pancreatic cancer, achieving high technical success rates and significant tumor reductions. However, the procedure is associated with a moderate complication rate, particularly in tumors located in the pancreatic head.

Can AI Be Useful in the Early Detection of Pancreatic Cancer in Patients with New-Onset Diabetes?

Pancreatic cancer is one of the most lethal neoplasms. Despite considerable research conducted in recent decades, not much has been achieved to improve its survival rate. That may stem from the lack of effective screening strategies in increased pancreatic cancer risk groups. One population that may be appropriate for screening is new-onset diabetes (NOD) patients. Such a conclusion stems from the fact that pancreatic cancer can cause diabetes several months before diagnosis. The most widely used screening tool for this population, the ENDPAC (Enriching New-Onset Diabetes for Pancreatic Cancer) model, has not achieved satisfactory results in validation trials. This provoked the first attempts at using artificial intelligence (AI) to create larger, multi-parameter models that could better identify the at-risk population, which would be suitable for screening. The results shown by the authors of these trials seem promising. Nonetheless, the number of publications is limited, and the downfalls of using AI are not well highlighted. This narrative review presents a summary of previous publications, recent advancements and feasible solutions for effective screening of patients with NOD for pancreatic cancer.

From Microbiome to Malignancy: Unveiling the Gut Microbiome Dynamics in Pancreatic Carcinogenesis

Pancreatic cancer is a major cause of cancer-associated mortality globally, characterized by a poor prognosis and limited therapeutic response. The current approach for treating pancreatic cancer involves locoregional control with surgical resection and systemic therapy in the form of cytotoxic chemotherapy. However, despite standard-of-care treatment, the outcomes remain dismal. Emerging evidence suggests that the gut microbiota plays a significant role in pancreatic carcinogenesis through dysbiosis, chronic inflammation and immune modulation. Dysbiosis-driven alterations in the gut microbiota composition can disrupt intestinal homeostasis, promote systemic inflammation and create a tumor-permissive microenvironment in the pancreas. Moreover, the gut microbiota modulates the efficacy of systemic therapies, including chemotherapy and immunotherapy, by impacting drug metabolism and shaping the tumor immune landscape. This review is mainly focused on exploring the intricate interplay between the gut microbiota and pancreatic cancer, and also highlighting its dual role in carcinogenesis and the therapeutic response.

METTL3-dependent m6A methylation of circCEACAM5 fuels pancreatic cancer progression through DKC1 activation

BACKGROUND

Pancreatic cancer is highly lethal and has a poor prognosis. Research has highlighted the role of circular RNAs and m6A methylation in cancer progression. METTL3, a key m6A methyltransferase, is linked to various cancers, but its interaction with circular RNAs in pancreatic cancer is unclear. This study examined the role of circCEACAM5 in pancreatic cancer, particularly its regulation by METTL3-mediated m6A methylation and interaction with effectors such as DKC1.

METHODS

circCEACAM5 expression in pancreatic cancer tissues and cell lines was evaluated via RT‒qPCR. Its characteristics were validated through Sanger sequencing, stability assays, and FISH. Functional assays (CCK-8, EdU, Transwell, and flow cytometry) were conducted in AsPC-1 cells, and in vivo tumor models were established. m6A modification was analyzed via bioinformatics tools and m6A-specific immunoprecipitation, while RNA pull-down assays were used to examine the interaction of circCEACAM5 with METTL3 and DKC1.

RESULTS

circCEACAM5 was significantly upregulated in pancreatic cancer and correlated with poor clinical outcomes. CircCEACAM5 promoted cell proliferation, invasion, and migration while inhibiting apoptosis both in vitro and in vivo. METTL3-mediated m6A methylation of circCEACAM5 was confirmed, and METTL3 knockdown reversed the effects of circCEACAM5 silencing on the malignant behavior of pancreatic cancer cells. circCEACAM5 interacted with DKC1, and DKC1 overexpression reversed the effects of circCEACAM5 knockdown on the malignant behavior of pancreatic cancer cells.

CONCLUSION

METTL3-mediated m6A methylation of circCEACAM5 drives pancreatic cancer progression by increasing DKC1 expression, suggesting potential new therapeutic targets for this aggressive malignancy.

Dynamic evaluation of postoperative survival in pancreatic ductal adenocarcinoma

The pancreatic ductal adenocarcinoma has a high degree of malignancy, and traditional prognostic assessment methods have limited evaluative capacity. This study is based on the Kallikrein-related peptidase 7 (KLK7) expression and uses conditional survival algorithms to perform dynamic survival assessments of patients. The Cox proportional hazards model was employed for identifying and adjusting for potential confounders. The Kaplan-Meier technique was utilized to estimate the overall survival rate. The computation of the likelihood of patients surviving an additional year after X years of survival was achieved using the equation CS1 = OS(X + 1)/OS(X). A subgroup analysis based on CS1 was conducted for each individual risk factor. A total of 243 eligible patients were included in the study. Conditioned survival (CS) refers to the years a patient has already survived and the predicted years they are likely to survive in the future, while conducting a time-varying analysis of the factors influencing prognosis. The survival probability assessed by CS1 increased year by year, with the 1-, 2-, and 3-year survival rates rising from 50.4% to 91.2%. In contrast, the actuarial overall survival (OS) decreased from 81.9% at 1 year to 38.6% at 3 years post-surgery. The results of the conditional analysis indicate that patients who survive longer within a certain timeframe have better survival expectations in the future. Adverse factors, including KLK7, have a decreasing impact on survival over time. Conditional survival analysis based on KLK7 can provide more accurate survival predictions for patients who has identified KLK7.

Increased Herpesvirus Entry Mediator Expression on Circulating Monocytes and Subsets Predicts Poor Outcomes in Pancreatic Ductal Adenocarcinoma Patients

Pancreatic ductal adenocarcinoma (PDAC) is aggressive, with a 5-year survival rate of only 12.8%, and its increasing incidence in Western countries highlights the urgent need for better early-stage detection and treatment methods. Early diagnosis significantly improves the chances of survival, but non-specific symptoms and undetectable precursor lesions pose a major challenge. To date, there are no reliable screening tools to detect PDAC at an early stage. Herpesvirus entry mediator (HVEM) has already been proposed as a prognostic marker in numerous cancer types. Therefore, we investigated the role of HVEM in PDAC. Flow cytometry was used to analyze HVEM expression in immune cells and its inhibitory receptors (CD160 and BTLA) on T-cells, as well as its subsets in the peripheral blood of 57 diagnosed PDAC patients and 17 clinical controls. In addition, survival analyses were performed within the PDAC cohort, changes in HVEM expression were analyzed in relation to clinicopathological parameters, and a correlation analysis between HVEM expression and cytokine levels of IL-6 and IL-10 was conducted. Furthermore, HVEM expression on monocytes and their subsets was evaluated as a potential prognostic marker and compared with the prognostic utility of CA19-9. We found that HVEM expression is significantly elevated on immune cells, particularly on monocytes (p < 0.0001) and their subsets, in PDAC patients, and is associated with reduced survival (p = 0.0067) and clinicopathological features such as perineural, lymphovascular, and vascular invasion. Moreover, HVEM-expressing monocytes demonstrated superior predictive value compared to CA19-9, highlighting their potential as part of a combined screening tool for PDAC. In conclusion, HVEM on monocytes could serve as a novel prognostic marker for PDAC.

Metallic trace elements in pancreatic tissue are associated with higher risk of pancreatic adenocarcinoma - METAPANDA study

OBJECTIVES

Few recent studies have indicated the possible involvement of some metallic trace element (MTE), commonly known as heavy metals, in pancreatic ductal adenocarcinoma (PDAC). To evaluate the potential role of MTE in PDAC onset, we compared concentrations of 23 MTE in healthy pancreas tissue close to the tumor, from patients who underwent pancreatic surgery for PDAC in cases group and for neuroendocrine or other lesion for controls.

METHODS

Samples were taken from paraffin-embedded pancreatectomy blocks of 33 PDAC cases and 29 controls. Concentrations of 23 MTE were determined by inductively coupled plasma mass spectrometry (ICP-MS).

RESULTS

In multivariate analysis, associations were found between risk of PDAC and higher tissue concentration of antimony (OR 6.31, 95 % CI 2.06-29.03; p = 0.006), thallium (OR 3.23, 95 % CI 1.35-12.07; p = 0.033) arsenic (OR 2.96, 95 % CI 1.22-10.10; p = 0.04) and lead (OR 2.27, 95 % CI 1.13-5.77; p = 0.044).

CONCLUSIONS

This pilot study presents unpublished information about a large set of MTE in pancreatic tissues, confirming the possible involvement of arsenic and lead in PDAC onset and highlighting the potential role of antimony and thallium which have never been implicated before.

In Silico Identification of ANKRD22 as a Theragnostic Target for Pancreatic Cancer and Fostamatinib's Therapeutic Potential

Pancreatic cancer (PC) is one of the most tremendously malignant cancers with a poor prognosis, especially when it advances to metastasis. Besides, PC patients have encountered resistance to recent therapeutic approaches. In recent work, we effectively determined ANKRD22 by re-analyzing RNA-seq datasets from cell lines and human tissues deriving from PC. We demonstrated that ANKRD22 expression was remarkably high in the PC group compared to the normal group at both gene expression and protein levels. ANKRD22 resulted in a worse overall survival (OS) rate of PC patients (HR = 1.7, p = 0.0082). Intriguingly, ANKRD22 was statistically highly expressed in the mutated KRAS group relative to the wildtype group (p < 0.05). Similarly, compared to the wildtype TP53, in the mutated TP53, ANKRD22 also significantly expressed (p < 0.05); their concurrent expression, ANKRD22 and KRAS; ANKRD22 and TP53 exacerbated the survival outcome relative to the co-expression of low ANKRD22 and unaltered genes (p < 0.001; HR > 2.6). We explored the potential pathways and biological processes ANKRD22 might not only contribute to promoting PC, including cell-cycle regulation, E2F1 targets, and apoptosis but also foster the dissemination of PC by involve in invasion and migration processes. In the investigation of drugs that might target ANKRD22, we figured out fostamatinib. Molecular docking and molecular dynamic simulation (MDs) techniques provided extensive insights into the binding mode of ANKRD22 and fostamatinib. ANKRD22 exhibited strong binding affinity (ΔG = -7.0 kcal/mol in molecular docking and ∆Gbind = -38.66 ± 6.09 kcal/mol in MDs). Taken together, ANKRD22 could be a promising theragnostic target that might be inhibited by fostamatinib, thereby suppressing PC growth.

Effect of travel distance on utilization of ancillary services among patients with pancreatic ductal adenocarcinoma: A single institution study

BACKGROUND

Fragmentation of care among patients with pancreatic cancer between specialized tertiary centers and community centers may be associated with increased patient burden and poorer outcomes. However, the impact of distance from a tertiary center on utilization of key ancillary services such as dietician consultation, and palliative or pain medicine consultation is unclear. We sought to examine how this travel distance influences the utilization of key ancillary services.

METHODS

This retrospective cohort study included 200 consecutive patients who were seen for a diagnosis of pancreatic ductal adenocarcinoma (PDAC) in 2021. Patients were grouped by travel distance: < 12.5, 12.5-49, and > 50 miles. Demographics, disease staging, and use of key ancillary services such as, dietician consultation, palliative, and pain medicine consultation were compared. Multiple logistic regression assessed associations between travel distance and ancillary service utilization.

RESULTS

Of the 200 patients, 14.5% traveled < 12.5 miles, 39.5% traveled 12.5-49 miles, and 46% traveled over 50 miles to our institution. Patients living over 50 miles away were significantly more likely to receive chemotherapy and radiation locally (81.8% vs 44.4%, p < 0.001). Importantly, they were less likely to utilize key ancillary services, including registered dietician consultation (Odds Ratio (OR) 0.34, p = 0.03), pancreatic enzyme prescriptions (OR 0.35, p = 0.03), pain medicine consultation (OR 0.20, p < 0.01), and palliative care consultation (OR 0.24, p < 0.01) compared to those living closer.

CONCLUSIONS

Patients living over 50 miles from our institution were significantly less likely to receive key supportive services. Despite similar clinical characteristics, these disparities show how initiatives are necessary to guarantee equitable access to comprehensive cancer care, regardless of geographic location.

Potential of Proliferative Markers in Pancreatic Cancer Management: A Systematic Review

Background and Aims

Pancreatic cancer is an aggressive malignancy with poor prognosis and limited treatment options. Chemotherapy remains a primary therapeutic approach, but patient responses vary significantly, emphasizing the need for reliable biomarkers. This review explores the potential role of proliferative markers, including Ki-67, PCNA, Cyclin D1, and PHH3, as predictive and prognostic indicators in pancreatic cancer management, aiming to enhance personalized treatment strategies.

Methods

We conducted a narrative review by searching Scopus, PubMed, and Google Scholar for studies focusing on Ki-67, PCNA, Cyclin D1, and PHH3 in relation to pancreatic cancer and chemotherapy. The literature was reviewed to evaluate the role of these markers in predicting chemotherapy response, tumor progression, and overall patient survival.

Results

The review highlights the clinical significance of these markers. Ki-67 and PCNA are associated with cell proliferation, while Cyclin D1 regulates cell cycle progression and PHH3 is linked to mitotic activity. High expression levels of these markers often correlate with increased tumor aggressiveness and poorer patient outcomes. Moreover, they show promise in predicting chemotherapy response, which can inform tailored therapeutic strategies. However, challenges remain, including standardization of detection methods and determination of optimal cutoff values.

Conclusion

Proliferative markers such as Ki-67, PCNA, Cyclin D1, and PHH3 hold potential as predictive and prognostic tools in pancreatic cancer management. Their integration into clinical practice could improve the accuracy of treatment decisions and enhance patient outcomes. Further research and validation are necessary to overcome existing challenges and optimize their application in personalized oncology.

Isolation, structural characterization, and molecular docking studies on the bioactive compound from n-Hexane extract of Emilia sonchifolia (L.) DC against the pancreatic cancer target Aurora 2 Kinase

OBJECTIVES

Natural flora historically has played a substantial part in drug development since they serve as active ingredients in medications and templates for the synthesis of novel pharmaceuticals. Emilia sonchifolia is a conventionally utilised therapeutic flora in Indian pharmacopoeia. Therefore, the current study is intended to separate, structurally describe and analyse the anti-pancreatic cancer potential of isolated natural bio-constituents from E. sonchifolia (L.) DC.

METHODS

n-Hexane extract using chromatographic techniques and structurally characterize them using spectroscopic techniques. Further, in silico molecular docking method was employed to investigate the bioactivity of the isolated compound against Aurora 2 Kinase (pancreatic cancer target protein).

RESULTS

A mixture of stigmasterol with straight-chain monounsaturated alcohol (C49H86O) was isolated and identified from the aerial parts of E. sonchifolia using chromatographic techniques. The docking results showed that the isolated natural compound of stigmasterol with straight-chain monounsaturated alcohol has good docking results compared with Food and Drug Administration-permitted medicine.

CONCLUSIONS

Based on the outcomes, it can be concluded that the stigmasterol with straight-chain monounsaturated alcohol may act as a novel inhibitor for Aurora 2 Kinase. In the future, it may lead to the development of drugs targeting Aurora 2 Kinase for the effective treatment of pancreatic cancer.

The protective role of anti-parkinsonian drugs in pancreatic cancer risk: A comprehensive case-control study in Taiwan

Pancreatic cancer is among the deadliest cancers, with a grim prognosis despite advances in treatment. We conducted a population-based case-control study from Taiwan, linking Health and Welfare Data Science Center data to the Taiwan Cancer Registry, which offers a promising strategy for its treatment through drug repurposing. The study aims to identify the association of anti-parkinsonian drugs with pancreatic cancer risk across different age groups. The analysis encompassed 18,921 pancreatic cancer cases and 75,684 matched controls, employing conditional logistic regression to assess the impact of anti-parkinsonian drugs on the risk of pancreatic cancer. Key findings revealed a statistically significant association of the administration with specific anti-parkinsonian medications, including anticholinergic agents, tertiary amines, dopa derivatives, and dopamine receptor agonists, with a reduction in pancreatic cancer risk. These associations were represented as adjusted odds ratios (aORs), ranging from 0.620 (95% CI 0.470-0.810) to 0.764 (95% CI 0.655-0.891). Further, age-stratified analysis revealed variations in efficacy across different age groups. Anticholinergic agents and tertiary amines exhibited greater effectiveness in the 40-64-year age group (aOR, 0.653; 95% CI, 0.489-0.872), whereas dopa derivatives and dopamine receptor agonists were particularly efficacious in the cohort aged ≥65 years (aOR, 0.728; 95% CI, 0.624-0.850 and aOR, 0.665; 95% CI, 0.494-0.894, respectively). Notably, specific drugs such as trihexyphenidyl, levodopa/dopa decarboxylase inhibitor (DDCI), and pramipexole demonstrated a significant decrease in cancer risk, especially in the elderly population. These preliminary findings can contribute to the possible therapeutic role of anti-parkinsonian drugs in the treatment of pancreatic cancer.

Metformin use and pancreatic ductal adenocarcinoma outcomes: a narrative review

BACKGROUND

Metformin is a diabetes medication with anti-mitotic properties. A narrative review was performed to investigate people using metformin and the risk of developing pancreatic ductal adenocarcinoma (PDAC) as well as survival outcomes in established PDAC.

METHODS

Relevant studies on metformin use and PDAC were retrieved from PubMed including observational studies on metformin and the risk of developing PDAC and survival outcomes in PDAC, and randomized controlled trials of metformin as a treatment in PDAC.

RESULTS

Of the 367 studies searched, 26 studies fulfilled the criteria for this review. Metformin was not consistently associated with a reduced risk of developing PDAC. However, metformin use, especially higher cumulative doses, in some studies was associated with longer survival in patients with established PDAC, especially in the subgroup with resectable PDAC. Metformin use was not associated with longer survival in more advanced (non-resectable metastatic) PDAC.

CONCLUSION

Metformin was not consistently associated with a reduced risk of developing PDAC. Metformin may be associated with overall survival benefits in patients with PDAC including the resectable PDAC subgroup but not in the metastatic PDAC subgroup. The evidence to date does not support the routine use of metformin as an adjuvant therapy for advanced PDAC.

A Copper-Manganese Based Nanocomposite Induces Cuproptosis and Potentiates Anti-Tumor Immune Responses

Cancer is one of the most important challenges worldwide with an increasing incidence. However, most of patients with malignant cancer receiving traditional therapies have tumor recurrence and short-term 5-year survival. Herein, a novel Cu2O-MnO@PEG (CMP) nanomaterial is developed to treat tumors. CMP directly mediates cuproptosis in tumor cells. Meanwhile, CMP potentiates anti-tumor immune responses in the tumor microenvironment (TME) to induce tumor regression. CMP improves the tumor antigen processing and presentation of dendritic cells and tumor-associated macrophages, and further promotes CD8+ T cell responses, especially for cytotoxic CD8+ T cells and transitory exhausted CD8+ T cells. Additionally, CMP downregulates the proportion of Treg cells and CTLA-4 expression on Treg cells. Notably, CMP induces systemic immune responses against distant tumors and long-term immune memory. Furthermore, CMP synergized with PD-L1 mAb promotes tumor inhibition and sustains the anti-tumor efficacy post PD-L1 mAb treatment. Collectively, this strategy has the clinically therapeutic potential for tumors by facilitating cuproptosis in tumor cells and anti-tumor immune responses.

The World Health Organization Reporting System for Pancreaticobiliary Cytopathology: Review and Comparison to the Papanicolaou Society of Cytopathology System

CONTEXT.—

The World Health Organization (WHO) Reporting System for Pancreaticobiliary Cytopathology (WHO System) is the product of a joint venture between the World Health Organization, the International Academy of Cytology, and the International Agency for Research on Cancer. The WHO System revises the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology (PSC System) and replaces the 6-tiered system with a 7-tiered system.

OBJECTIVE.—

To explain the WHO System and the differences with the PSC System.

DATA SOURCES.—

The WHO System and the PSC System of Reporting Pancreaticobiliary Cytopathology.

CONCLUSIONS.—

The diagnostic categories of the WHO System are "Insufficient/Inadequate/Nondiagnostic"; "Benign (Negative for Malignancy)"; "Atypical"; "Pancreaticobiliary Neoplasm, Low Risk/Low Grade (PaN-Low)"; "Pancreatic Neoplasm, High Risk/High Grade (PaN-High)"; "Suspicious for Malignancy"; and "Malignant." In the WHO System, the "benign" category includes both nonneoplastic and neoplastic lesions, so the "Neoplastic: Benign" category of the PSC system has been eliminated. Low-grade malignancies, pancreatic neuroendocrine tumors (PanNETs), and solid-pseudopapillary neoplasm (SPN) classified as "Neoplastic: Other" in the PSC System are classified as "Malignant" in the WHO System, leaving in the "Neoplasm" category intraductal lesions, which are divided into 2 new diagnostic categories: "Pancreaticobiliary Neoplasm (PaN)-Low Risk/Grade" and "PaN-High Risk/Grade." As with the PSC System, the WHO System advocates close correlation with imaging and encourages incorporation of ancillary testing into the final diagnosis, such as biochemical (carcinoembryonic antigen [CEA] and amylase) and molecular testing. The WHO System includes risk of malignancy per category, and reporting and diagnostic management options that recognize the variations in resources of low- and middle-income countries.

Oral and fecal microbiota as accurate non-invasive tools for detection of pancreatic cancer in the Chinese population

Pancreatic cancer (PCA), a leading cause of cancer-related deaths, has limited non-invasive diagnostic methods. We aimed to identify oral and fecal microbiome biomarkers and construct diagnostic classifiers. Oral and fecal samples from 97 PCA patients and 90 healthy controls underwent 16S rRNA sequencing. Samples were randomly divided into training and validation cohorts in a 7:3 ratio. Random forest models were constructed using training cohort and validated internally and externally in Chinese, Japanese, and Spanish populations. Results revealed significant dysbiosis of the oral and fecal microbiota of PCA patients. Most of the differential taxa shared between oral and fecal samples showed similar changes. Relative abundances of Streptococcus in oral samples, and of Bifidobacterium, Klebsiella and Akkermansia in fecal samples, were enriched in PCA. The fecal Firmicutes to Bacteroidota ratio was higher in PCA patient samples. Oral and fecal microbiome classifiers based on the top 20 contributing genera were constructed, and internal validation showed that the area under the curve (AUC) values were 0.963 and 0.890, respectively. The fecal microbiome classifier performed well in the external Chinese population, with an AUC of 0.878, but poorly in the Japanese and Spanish populations. Furthermore, fecal microbiomes could predict metastasis status in PCA patients, with an AUC of 0.804. In conclusion, oral and fecal microbiota were dysbiotic in PCA patients. Fecal microbiome classifier provides a feasible, non-invasive, and cost-effective tool with high precision for PCA screening in China; oral microbiome classifier requires further validation in external populations sampled with the same simple and convenient methods.

Curcumin Inhibits the Development of Pancreatic Cancer by Targeting the circ_0079440/miR-522-3p/EIF4A1 Pathway

Pancreatic cancer (PC) is a common gastrointestinal cancer with high invasiveness and high mortality. Curcumin is a natural polyphenol with anti-tumor activity against different cancers, including PC. Curcumin has been verified to mediate the expression of circular RNAs (circRNAs) to inhibit tumor development. This study aimed to explore the function and regulatory mechanism of curcumin on circ_0079440 in PC. PC cells were treated with different concentrations of curcumin (0, 5, 10 or 15 μM) for 24 h. Gene expression in PC cells and tissues was detected using RT-qPCR. Cell malignant phenotypes were determined by functional assays. The levels of EMT-related proteins were tested using western blot. RNA interaction was determined using RNA pulldown assay, luciferase reporter assay and RIP assay. The results showed that curcumin suppressed cell proliferative, migratory, and invasive capabilities, and weakened epithelial-mesenchymal transition (EMT) in a concentration-dependent way. Circ_0079440 was expressed at a high level in PC and its level was reduced via curcumin administration in PC cells. Rescue assays showed that circ_0079440 overexpression reversed the suppressive effects of curcumin on PC cell malignant phenotypes. Furthermore, in the xenograft mouse models, curcumin treatment inhibited tumor growth and metastasis, and circ_0079440 upregulation reversed the function of curcumin. Additionally, circ_0079440 was revealed to bind to miR-522-3p to upregulate eukaryotic initiation factor 4A1 (EIF4A1) expression in PC cells. EIF4A1 expression was also downregulated by curcumin, and EIF4A1 overexpression abolished the suppressive functions of curcumin. Moreover, EIF4A overexpression or miR-522-3p inhibition counteracted the anti-tumor effects of circ_0079440 depletion on PC development. To sum up, curcumin suppresses PC development by targeting the circ_0079440/miR-522-3p/EIF4A1 pathway, which might provide novel therapeutic targets for treatment of PC.

Pancreatic ductal adenocarcinoma (PDAC): clinical progress in the last five years

INTRODUCTION

Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy with limited therapeutic options and poor overall survival. In recent years, advances in genomic profiling have revealed the complex molecular and cellular heterogeneity of PDAC, offering new avenues for therapeutic intervention.

AREAS COVERED

This review explores emerging therapeutic strategies targeting dysregulated molecular pathways, along with the tumor microenvironment, that have shown promise in overcoming drug resistance. Novel immunotherapy strategies, such as immune checkpoint inhibitors and CAR T-cell therapies, are currently being explored in an attempt to modulate PDAC immugnosuppressive microenvironment. Additionally, we highlight recent clinical trials over the last 5 years and innovative therapeutic strategies aiming to improve outcomes in PDAC.

EXPERT OPINION

Significant progress in genomic profiling, targeted therapies, and immunotherapy is shaping the treatment of PDAC. Despite challenges posed by its dense stroma and immune suppressive microenvironment, novel strategies such as IL 6 and CD137 inhibitors, CAR-T, and therapeutic cancer vaccines are promising. KRAS targeted therapies are expanding beyond G12C inhibitors, with novel drugs in development that will further improve treatment options. Additionally, tumor treating fields (TTF) are being investigated in locally advanced PDAC, with the PANOVA-3 trial potentially integrating this modality into future treatment strategies. Continued advancements in these areas will significantly enhance PDAC outcomes.