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Phillips AE, Hughes SJ, Andersen DK, Bell A, Brand R, Coté GA, Cowdin A, Diazgranados N, Dudeja V, Duggan SN, Fogel E, Forsmark CE, Freeman AJ, Gittes G, Hart PA, Jeon C, Nealon W, Neoptolemos J, Palermo TM, Pandol S, Roberts KM, Rosenthal M, Singh VK, Yadav D, Whitcomb DC, Zyromski N. Interventions for Pancreatitis-New Approaches, Knowledge Gaps, and Research Opportunities: Summary of a National Institute of Diabetes and Digestive and Kidney Diseases Workshop. Pancreas 2024; 53:e368-e377. [PMID: 38518063 PMCID: PMC10963039 DOI: 10.1097/mpa.0000000000002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
ABSTRACT There exists no cure for acute, recurrent acute or chronic pancreatitis and treatments to date have been focused on managing symptoms. A recent workshop held by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) focused on interventions that might disrupt or perhaps even reverse the natural course of this heterogenous disease, aiming to identify knowledge gaps and research opportunities that might inform future funding initiatives for NIDDK. The breadth and variety of identified active or planned clinical trials traverses the spectrum of the disease and was conceptually grouped for the workshop into behavioral, nutritional, pharmacologic and biologic, and mechanical interventions. Cognitive and other behavioral therapies are proven interventions for pain and addiction, but barriers exist to their use. Whilst a disease specific instrument quantifying pain is now validated, an equivalent is lacking for nutrition - and both face challenges in ease and frequency of administration. Multiple pharmacologic agents hold promise. Ongoing development of Patient Reported Outcome (PRO) measurements can satisfy Investigative New Drug (IND) regulatory assessments. Despite multiple randomized clinical trials demonstrating benefit, great uncertainty remains regarding patient selection, timing of intervention, and type of mechanical intervention (endoscopic versus surgery). Challenges and opportunities to establish beneficial interventions for patients were identified.
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Affiliation(s)
- Anna Evans Phillips
- From the Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Steven J Hughes
- Division of Surgical Oncology, Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Dana K Andersen
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Adam Bell
- Translational Medicine and Regulatory Affairs, Theraly Fibrosis, Gaithersburg, MD
| | - Randall Brand
- From the Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gregory A Coté
- Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, OR
| | | | - Nancy Diazgranados
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD
| | - Vikas Dudeja
- Division of Surgical Oncology, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Sinead N Duggan
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Evan Fogel
- Digestive and Liver Disorders, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL
| | - A Jay Freeman
- Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, The Ohio State College of Medicine, Columbus, OH
| | - George Gittes
- Pediatric General and Thoracic Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christie Jeon
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - William Nealon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | | | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children's Research Institute, Seattle, WA
| | - Stephen Pandol
- Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kristen M Roberts
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | | | - Vikesh K Singh
- Division of Gastroenterology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dhiraj Yadav
- From the Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Nicholas Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
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2
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Eiseler K, Neppl L, Schmidt AW, Rauscher B, Ewers M, Masson E, Chen JM, Férec C, Rebours V, Grammatikopoulos T, Foskett P, Greenhalf W, Halloran C, Neoptolemos J, Haack TB, Ossowski S, Sturm M, Rosendahl J, Laumen H, Witt H. Genetic and functional analysis of chymotrypsin-like protease (CTRL) in chronic pancreatitis. Pancreatology 2023; 23:957-963. [PMID: 37949771 DOI: 10.1016/j.pan.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Genetic predisposition is crucial in the pathogenesis of early-onset chronic pancreatitis (CP). So far, several genetic alterations have been identified as risk factors, predominantly in genes encoding digestive enzymes. However, many early-onset CP cases have no identified underlying cause. Chymotrypsins are a family of serine proteases that can cleave trypsinogen and lead to its degradation. Because genetic alterations in the chymotrypsins CTRC, CTRB1, and CTRB2 are associated with CP, we genetically and functionally investigated chymotrypsin-like protease (CTRL) as a potential risk factor. METHODS We screened 1005 non-alcoholic CP patients and 1594 controls for CTRL variants by exome sequencing. We performed Western blots and activity assays to analyse secretion and proteolytic activity. We measured BiP mRNA expression to investigate the potential impact of identified alterations on endoplasmic reticulum (ER) stress. RESULTS We identified 13 heterozygous non-synonymous CTRL variants: five exclusively in patients and three only in controls. Functionality was unchanged in 6/13 variants. Four alterations showed normal secretion but reduced (p.G20S, p.G56S, p.G61S) or abolished (p.S208F) activity. Another three variants (p.C201Y, p.G215R and p.C220G) were not secreted and already showed reduced or no activity intracellularly. However, intracellular retention did not lead to ER stress. CONCLUSION We identified several CTRL variants, some showing potent effects on protease function and secretion. We observed these effects in variants found in patients and controls, and CTRL loss-of-function variants were not significantly more common in patients than controls. Therefore, CTRL is unlikely to play a relevant role in the development of CP.
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Affiliation(s)
- Katharina Eiseler
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany
| | - Lea Neppl
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany
| | - Andreas W Schmidt
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany; Department of Internal Medicine I, Martin Luther University (MLU), Halle (Saale), Germany; Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Beate Rauscher
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany
| | - Maren Ewers
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany
| | - Emmanuelle Masson
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France; Service de Génétique Médicale et de Biologie de la Reproduction, CHRU Brest, F-29200, Brest, France
| | - Jian-Min Chen
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Claude Férec
- Univ Brest, Inserm, EFS, UMR 1078, GGB, F-29200, Brest, France
| | - Vinciane Rebours
- Pancreatology and Digestive Oncology Department, Beaujon Hospital, APHP - Clichy, Université Paris Cité, Paris, France
| | - Tassos Grammatikopoulos
- Paediatric Liver, GI & Nutrition Centre and MowatLabs, King's College Hospital NHS Foundation Trust, London, UK; Institute of Liver Studies, King's College London, London, UK
| | - Pierre Foskett
- Institute of Liver Studies, King's College London, London, UK
| | - William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Christopher Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - John Neoptolemos
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tobias B Haack
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Stephan Ossowski
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, Martin Luther University (MLU), Halle (Saale), Germany
| | - Helmut Laumen
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany; Department of Internal Medicine I, Martin Luther University (MLU), Halle (Saale), Germany
| | - Heiko Witt
- Paediatric Nutritional Medicine, Else Kröner Fresenius Center for Nutritional Medicine (EKFZ), Technical University of Munich (TUM), Freising, Germany.
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3
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Springfeld C, Ferrone CR, Katz MHG, Philip PA, Hong TS, Hackert T, Büchler MW, Neoptolemos J. Neoadjuvant therapy for pancreatic cancer. Nat Rev Clin Oncol 2023; 20:318-337. [PMID: 36932224 DOI: 10.1038/s41571-023-00746-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/19/2023]
Abstract
Patients with localized pancreatic ductal adenocarcinoma (PDAC) are best treated with surgical resection of the primary tumour and systemic chemotherapy, which provides considerably longer overall survival (OS) durations than either modality alone. Regardless, most patients will have disease relapse owing to micrometastatic disease. Although currently a matter of some debate, considerable research interest has been focused on the role of neoadjuvant therapy for all forms of resectable PDAC. Whilst adjuvant combination chemotherapy remains the standard of care for patients with resectable PDAC, neoadjuvant chemotherapy seems to improve OS without necessarily increasing the resection rate in those with borderline-resectable disease. Furthermore, around 20% of patients with unresectable non-metastatic PDAC might undergo resection following 4-6 months of induction combination chemotherapy with or without radiotherapy, even in the absence of a clear radiological response, leading to improved OS outcomes in this group. Distinct molecular and biological responses to different types of therapies need to be better understood in order to enable the optimal sequencing of specific treatment modalities to further improve OS. In this Review, we describe current treatment strategies for the various clinical stages of PDAC and discuss developments that are likely to determine the optimal sequence of multimodality therapies by integrating the fundamental clinical and molecular features of the cancer.
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Affiliation(s)
- Christoph Springfeld
- Department of Medical Oncology, National Center for Tumour Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Philip A Philip
- Wayne State University School of Medicine, Department of Oncology, Henry Ford Cancer Institute, Detroit, MI, USA
| | - Theodore S Hong
- Research and Scientific Affairs, Gastrointestinal Service Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - John Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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4
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Ponweera A, Robinson M, Jackson R, Halloran C, Palmer D, Hackert T, Costello E, Greenhalf B, Bϋchler M, Neoptolemos J, Ghaneh P. HPB P10 Evaluation of the prognostic role of aspirin and metformin in the ESPAC 4 randomised trial of adjuvant gemcitabine versus gemcitabine plus capecitabine in patients with resected pancreatic cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Pancreatic cancer is currently the world's seventh most common cancer with it's incidence being equivalent to it's mortality. It is the fourth most common cause of cancer-related mortality and is set to be the second most common by 2030. 5-year overall survival of pancreatic cancer is set at just below 10%, with only approximately 15% - 20% of diagnosed patients being eligible for resection. Patients eligible for resection have a 5-year overall survival improvement of up to 30% over recent years following the combination of resection and adjuvant therapy. The prognostic effects of chemo-preventive agents such as metformin and aspirin have been investigated previously in pancreatic cancer (PC) with variable results. ESPAC-4 was a phase-3 randomised controlled trial which recruited patients with resectable pancreatic cancer and examined the survival benefit between adjuvant monotherapy gemcitabine therapy and adjuvant gemcitabine-capecitabine (GEMCAP) combination therapy. This study aims to evaluate the prognostic impact of aspirin and metformin on survival among PC patients in the ESPAC 4 randomised trial.
Methods
Concomitant medication data was identified from ESPAC-4 trial database. Primary and secondaryoutcome measures were overall survival (OS) and disease-free survival (DFS) respectively for users and non-users of aspirin and metformin. Survival data was analysed using multivariate and univariate Cox-proportional hazard models and log-rank testing.The primary and secondary outcome was to investigate overall survival (OS) and Relapse-Free Survival (RFS) time respectively, between users and non- users of aspirin and metformin in either treatment arm.
Results
We identified 86 patients using aspirin and 55 patients using metformin out of 730 randomised trial patients at baseline . Aspirin usage led to a median OS of 30 months versus 26 months with non-users and a hazard ratio of 0.91 (95% CI:0.68–1.2; p=0.499). Median DFS with and without aspirin usage was 17.9 months versus 13.1 months respectively with a hazard ratio of 0.76 (95% CI: 0.58–0.99, p=0.044). Gemcitabine treatment amongst aspirin users demonstrated a median OS of 42.4 months compared to 24.7 months in non-aspirin users and a hazard ratio of 1.69 with non-users (95% CI:1.06–2.67; p=0.026). Aspirin users randomised to gemcitabine had a median DFS of 37.2 months, compared to non-aspirin users with 11.9 months and a hazard ratio of 2.01 (95% CI:1.31–3.08; p=0.001). Metformin usage resulted in a median OS of 23.8 months versus 27.7 months in non-users with a hazard ratio of 0.95 (95% CI:0.65–1.4; p=0.819). Median DFS with and without metformin usage was 14.7 months versus 12.5 months respectively, with a hazard ratio of 0.88 (95% CI:0.61–1.27; p=0.498). Metformin usage in either treatment arm did not demonstrate a significant survival difference
Conclusions
Though numbers are small, gemcitabine therapy and aspirin usage demonstrated a prognostic benefit in OS and DFS in this study. Further in vivo studies exploring the mechanism of this interaction would be beneficial. There was no survival benefit observed with metformin usage. Standardisation of dosages in chemopreventive agents such as metformin and aspirin in future trials could yield further standardised results.
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Affiliation(s)
- Arachchige Ponweera
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , United Kingdom
| | - Matthew Robinson
- Faculty of Biology, Medicine & Health, University of Manchester , Manchester , United Kingdom
| | - Richard Jackson
- Cancer Division, Liverpool Clinical Trials Centre, University of Liverpool , Liverpool , United Kingdom
| | - Chris Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , United Kingdom
| | - Dan Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , United Kingdom
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg , Heidelberg, Heidelberg , Germany
| | - Eithne Costello
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liveprool , United Kingdom
| | - Bill Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , United Kingdom
| | - Markus Bϋchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg , Heidelberg, Heidelberg , Germany
| | - John Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg , Heidelberg, Heidelberg , Germany
| | - Paula Ghaneh
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , United Kingdom
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5
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Giaccherini M, Farinella R, Gentiluomo M, Mohelnikova-Duchonova B, Kauffmann EF, Palmeri M, Uzunoglu F, Soucek P, Petrauskas D, Cavestro GM, Zykus R, Carrara S, Pezzilli R, Puzzono M, Szentesi A, Neoptolemos J, Archibugi L, Palmieri O, Milanetto AC, Capurso G, van Eijck CHJ, Stocker H, Lawlor RT, Vodicka P, Lovecek M, Izbicki JR, Perri F, Kupcinskaite-Noreikiene R, Götz M, Kupcinskas J, Hussein T, Hegyi P, Busch OR, Hackert T, Mambrini A, Brenner H, Lucchesi M, Basso D, Tavano F, Schöttker B, Vanella G, Bunduc S, Petrányi Á, Landi S, Morelli L, Canzian F, Campa D. Association between a polymorphic variant in the CDKN2B-AS1/ANRIL gene and pancreatic cancer risk. Int J Cancer 2022; 153:373-379. [PMID: 36451333 DOI: 10.1002/ijc.34383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 12/05/2022]
Abstract
Genes carrying high-penetrance germline mutations may also be associated with cancer susceptibility through common low-penetrance genetic variants. To increase the knowledge on genetic pancreatic ductal adenocarcinoma (PDAC) aetiology, the common genetic variability of PDAC familial genes was analysed in our study. We conducted a multiphase study analysing 7745 single nucleotide polymorphisms (SNPs) from 29 genes reported to harbour a high-penetrance PDAC-associated mutation in at least one published study. To assess the effect of the SNPs on PDAC risk, a total of 14 666 PDAC cases and 221 897 controls across five different studies were analysed. The T allele of the rs1412832 polymorphism, that is situated in the CDKN2B-AS1/ANRIL, showed a genome-wide significant association with increased risk of developing PDAC (OR = 1.11, 95% CI = 1.07-1.15, P = 5.25 × 10-9 ). CDKN2B-AS1/ANRIL is a long noncoding RNA, situated in 9p21.3, and regulates many target genes, among which CDKN2A (p16) that frequently shows deleterious somatic and germline mutations and deregulation in PDAC. Our results strongly support the role of the genetic variability of the 9p21.3 region in PDAC aetiopathogenesis and highlight the importance of secondary analysis as a tool for discovering new risk loci in complex human diseases.
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Affiliation(s)
| | | | | | | | | | - Matteo Palmeri
- General Surgery Unit, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Faik Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pavel Soucek
- Toxicogenomics Unit, Centre of Toxicology and Health Safety, National Institute of Public Health, Prague, Czech Republic
| | - Dalius Petrauskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Romanas Zykus
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Silvia Carrara
- Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Marta Puzzono
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary.,Centre for Translational Medicine, Department of Medicine, University of Szeged, Szeged, Hungary
| | - John Neoptolemos
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - Livia Archibugi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Digestive and Liver Disease Unit, Sant' Andrea Hospital, Rome, Italy
| | - Orazio Palmieri
- Division of Gastroenterology and Research Laboratory, Fondazione IRCCS "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | | | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Digestive and Liver Disease Unit, Sant' Andrea Hospital, Rome, Italy
| | - Casper H J van Eijck
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rita T Lawlor
- ARC-NET: Centre for Applied Research on Cancer, University and Hospital Trust of Verona, Verona, Italy
| | - Pavel Vodicka
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic.,Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Lovecek
- Department of Surgery I, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakob R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Perri
- Division of Gastroenterology and Research Laboratory, Fondazione IRCCS "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | | | - Mara Götz
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Juozas Kupcinskas
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tamás Hussein
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,János Szentágothai Research Center, University of Pécs, Pécs, Hungary.,Center for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Thilo Hackert
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - Andrea Mambrini
- Oncological Department Massa Carrara, Azienda USL Toscana Nord Ovest, Carrara, Italy
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maurizio Lucchesi
- Oncological Department Massa Carrara, Azienda USL Toscana Nord Ovest, Carrara, Italy
| | - Daniela Basso
- Department of Medicine, University of Padova, Padova, Italy
| | - Francesca Tavano
- Division of Gastroenterology and Research Laboratory, Fondazione IRCCS "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Giuseppe Vanella
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Digestive and Liver Disease Unit, Sant' Andrea Hospital, Rome, Italy
| | - Stefania Bunduc
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary.,Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ágota Petrányi
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Stefano Landi
- Department of Biology, University of Pisa, Pisa, Italy
| | - Luca Morelli
- General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
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6
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Bridgewater J, Fletcher P, Palmer DH, Malik HZ, Prasad R, Mirza D, Anthony A, Corrie P, Falk S, Finch-Jones M, Wasan H, Ross P, Wall L, Wadsley J, Evans TR, Stocken D, Stubbs C, Praseedom R, Ma YT, Davidson B, Neoptolemos J, Iveson T, Cunningham D, Garden OJ, Valle JW, Primrose J. Long-Term Outcomes and Exploratory Analyses of the Randomized Phase III BILCAP Study. J Clin Oncol 2022; 40:2048-2057. [PMID: 35316080 DOI: 10.1200/jco.21.02568] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/16/2021] [Accepted: 02/09/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The BILCAP study described a modest benefit for capecitabine as adjuvant therapy for curatively resected biliary tract cancer (BTC), and capecitabine has become the standard of care. We present the long-term data and novel exploratory subgroup analyses. METHODS This randomized, controlled, multicenter, phase III study recruited patients age 18 years or older with histologically confirmed cholangiocarcinoma or muscle-invasive gallbladder cancer after resection with curative intent and an Eastern Cooperative Oncology Group performance status of < 2. Patients were randomly assigned 1:1 to receive oral capecitabine (1,250 mg/m2 twice daily on days 1-14 of a 21-day cycle, for eight cycles) or observation. The primary outcome was overall survival (OS). This study is registered with EudraCT 2005-003318-13. RESULTS Between March 15, 2006, and December 4, 2014, 447 patients were enrolled; 223 patients with BTC resected with curative intent were randomly assigned to the capecitabine group and 224 to the observation group. At the data cutoff of January 21, 2021, the median follow-up for all patients was 106 months (95% CI, 98 to 108). In the intention-to-treat analysis, the median OS was 49.6 months (95% CI, 35.1 to 59.1) in the capecitabine group compared with 36.1 months (95% CI, 29.7 to 44.2) in the observation group (adjusted hazard ratio 0.84; 95% CI, 0.67 to 1.06). In a protocol-specified sensitivity analysis, adjusting for minimization factors, nodal status, grade, and sex, the OS hazard ratio was 0.74 (95% CI, 0.59 to 0.94). We further describe the prognostic impact of R status, grade, nodal status, and sex. CONCLUSION This long-term analysis supports the previous analysis, suggesting that capecitabine can improve OS in patients with resected BTC when used as adjuvant chemotherapy after surgery and should be considered as the standard of care.
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Affiliation(s)
| | | | - Daniel H Palmer
- Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | | | - Raj Prasad
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Darius Mirza
- Birmingham Woman's and Children's NHS Trust, Birmingham, United Kingdom
| | - Alan Anthony
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Pippa Corrie
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stephen Falk
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Meg Finch-Jones
- University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Harpreet Wasan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Paul Ross
- Guys and St Thomas's NHS Trust, London, United Kingdom
| | - Lucy Wall
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | - Deborah Stocken
- Leeds Institute of Clinical Trials Research, Leeds, United Kingdom
| | - Clive Stubbs
- Cancer Clinical Trials Unit, Birmingham, United Kingdom
| | - Raaj Praseedom
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Yuk Ting Ma
- Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | | | | | - Tim Iveson
- University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | | | | | - Juan W Valle
- University of Manchester, Manchester, United Kingdom
| | - John Primrose
- University of Southampton, Southampton, United Kingdom
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7
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Probst P, Hüttner FJ, Meydan Ö, Abu Hilal M, Adham M, Barreto SG, Besselink MG, Busch OR, Bockhorn M, Del Chiaro M, Conlon K, Castillo CFD, Friess H, Fusai GK, Gianotti L, Hackert T, Halloran C, Izbicki J, Kalkum E, Kelemen D, Kenngott HG, Kretschmer R, Landré V, Lillemoe KD, Miao Y, Marchegiani G, Mihaljevic A, Radenkovic D, Salvia R, Sandini M, Serrablo A, Shrikhande S, Shukla PJ, Siriwardena AK, Strobel O, Uzunoglu FG, Vollmer C, Weitz J, Wolfgang CL, Zerbi A, Bassi C, Dervenis C, Neoptolemos J, Büchler MW, Diener MK. Evidence Map of Pancreatic Surgery-A living systematic review with meta-analyses by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2021; 170:1517-1524. [PMID: 34187695 DOI: 10.1016/j.surg.2021.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pancreatic surgery is associated with considerable morbidity and, consequently, offers a large and complex field for research. To prioritize relevant future scientific projects, it is of utmost importance to identify existing evidence and uncover research gaps. Thus, the aim of this project was to create a systematic and living Evidence Map of Pancreatic Surgery. METHODS PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for all randomized controlled trials and systematic reviews on pancreatic surgery. Outcomes from every existing randomized controlled trial were extracted, and trial quality was assessed. Systematic reviews were used to identify an absence of randomized controlled trials. Randomized controlled trials and systematic reviews on identical subjects were grouped according to research topics. A web-based evidence map modeled after a mind map was created to visualize existing evidence. Meta-analyses of specific outcomes of pancreatic surgery were performed for all research topics with more than 3 randomized controlled trials. For partial pancreatoduodenectomy and distal pancreatectomy, pooled benchmarks for outcomes were calculated with a 99% confidence interval. The evidence map undergoes regular updates. RESULTS Out of 30,860 articles reviewed, 328 randomized controlled trials on 35,600 patients and 332 systematic reviews were included and grouped into 76 research topics. Most randomized controlled trials were from Europe (46%) and most systematic reviews were from Asia (51%). A living meta-analysis of 21 out of 76 research topics (28%) was performed and included in the web-based evidence map. Evidence gaps were identified in 11 out of 76 research topics (14%). The benchmark for mortality was 2% (99% confidence interval: 1%-2%) for partial pancreatoduodenectomy and <1% (99% confidence interval: 0%-1%) for distal pancreatectomy. The benchmark for overall complications was 53% (99%confidence interval: 46%-61%) for partial pancreatoduodenectomy and 59% (99% confidence interval: 44%-80%) for distal pancreatectomy. CONCLUSION The International Study Group of Pancreatic Surgery Evidence Map of Pancreatic Surgery, which is freely accessible via www.evidencemap.surgery and as a mobile phone app, provides a regularly updated overview of the available literature displayed in an intuitive fashion. Clinical decision making and evidence-based patient information are supported by the primary data provided, as well as by living meta-analyses. Researchers can use the systematic literature search and processed data for their own projects, and funding bodies can base their research priorities on evidence gaps that the map uncovers.
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Affiliation(s)
- Pascal Probst
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany; The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany.
| | - Felix J Hüttner
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany; The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Ömer Meydan
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Mohammed Abu Hilal
- HPB Department, Southampton General Hospital, Southampton, United Kingdom
| | | | - Savio G Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, Australia; College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, University of Amsterdam, The Netherlands
| | - Olivier R Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Maximillian Bockhorn
- Department of General and Visceral Surgery, University Medical Center Oldenburg, Germany
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kevin Conlon
- Hepato-Pancreatico-Biliary Unit, Department of General Surgery, Trinity College Dublin, Tallaght Hospital, Ireland
| | | | - Helmut Friess
- Department of Hepato-Pancreato-Biliary Surgery, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Giuseppe Kito Fusai
- Institute for Liver and Digestive Health, University College London, United Kingdom
| | - Luca Gianotti
- Pancreatic Surgery Unit, School of Medicine and Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Christopher Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, United Kingdom
| | - Jakob Izbicki
- University Medical Center Hamburg-Eppendorf, Germany
| | - Eva Kalkum
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Dezső Kelemen
- Department of Surgery, Clinical Center, Medical School, University of Pécs, Hungary
| | - Hannes G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Rüdiger Kretschmer
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Vincent Landré
- The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and the Harvard Medical School, Boston, MA
| | - Yi Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
| | - Giovanni Marchegiani
- Department of Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - André Mihaljevic
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany; The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany
| | - Dejan Radenkovic
- Department of Surgery, Clinical Center of Serbia and School of Medicine, University of Belgrade, Serbia
| | - Roberto Salvia
- Department of Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Marta Sandini
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Alejandro Serrablo
- Hepatobiliopancreatic Surgery Unit, General and Digestive Surgery Service, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Parul J Shukla
- Weill Cornell Medical College & New York Presbyterian Hospital, NY
| | - Ajith K Siriwardena
- Department of Surgery, Regional Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, United Kingdom
| | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | | | - Charles Vollmer
- Department of Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jürgen Weitz
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Rozzano (MI), Italy; Humanitas University, Pieve Emanuele (MI), Italy
| | - Claudio Bassi
- Department of Surgery, The Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | | | - John Neoptolemos
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany
| | - Markus K Diener
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Germany; The Study Center of the German Surgical Society (SDGC), University of Heidelberg, Germany. https://twitter.com/evidencemap
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Grant RC, Duan K, Jackson R, Greenhalf W, Costello-Goldring E, Ghaneh P, Halloran C, Palmer D, Hackert T, Buchler M, Hutchison S, Ramotar S, Dodd A, Wilson J, Notta F, O'Kane G, Knox J, Neoptolemos J, Gallinger S, Fischer S. Abstract 1193: Digital quantification of GATA6 expression from immunohistochemistry is associated with overall survival after surgery for pancreatic cancer in the ESPAC trials. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: GATA6, a transcription factor involved in pancreaticogenesis, correlates with major transcriptomic subtypes of pancreatic cancer, and early evidence suggests a potential role as a prognostic biomarker. In this study, we tested whether semi-automated digital quantification of GATA6 immunohistochemistry (IHC) was associated with overall survival (OS) after surgical resection of pancreatic cancer in randomized trials of adjuvant chemotherapy.
Materials and Methods: Tissue microarrays of pancreatic adenocarcinoma specimens were stained for GATA6 expression using IHC. Specimens came from patients in the ESPAC-3 and ESPAC-4 randomized phase III trials comparing adjuvant chemotherapy regimens. Two pathologists blinded to clinical data independently assessed GATA6 protein expression in cores using a customized computer algorithm from the open-source digital pathology software QuPath. Briefly, the digital assistant provided GATA6 IHC semiquantitative scores (0-4) for individual cells, which were made available to the pathologist for review. This semi-automated digital quantification of GATA6 expression was compared to manual quantification as previously reported (Grant et al., AACR Pancreatic Cancer, 2020). Concordance between pathologists across tissue cores was calculated using a weighted kappa statistic for scores 0 through 4, and an unweighted kappa statistic for high (3-4) and low (0-2) expression levels. Discrepancies were resolved through consensus. Median OS was estimated in GATA6 high and low subgroups using Kaplan-Meier curves. OS was compared using Cox proportional hazard regressions adjusting for adjuvant chemotherapy treatment, lymph node status, and post-operative CA-19-9.
Results: GATA6 expression was quantified in 230 patients using the semi-automated digital and manual approaches. Inter-observer concordance markedly improved with digital assistance compared to the manual approach (weighted kappa statistic across all scores 0.69 versus 0.41, unweighted kappa statistic comparing high and low expression 0.71 versus 0.25). GATA6 expression measured using the semi-automated digital approach was significantly associated with OS: median OS was 25.7 months in GATA6 low cancers versus 42.4 months in GATA6 high cancers, with an adjusted hazard ratio of 1.58 (95% confidence interval 1.10-2.28, P=0.014).
Conclusion: GATA6 IHC is a prognostic biomarker for pancreatic cancers treated with surgical resection and adjuvant chemotherapy that can be consistently and reliably quantified using digital assistance.
Citation Format: Robert C. Grant, Kai Duan, Richard Jackson, William Greenhalf, Eithne Costello-Goldring, Paula Ghaneh, Christopher Halloran, Daniel Palmer, Thilo Hackert, Markus Buchler, Shawn Hutchison, Stephanie Ramotar, Anna Dodd, Julie Wilson, Faiyaz Notta, Grainne O'Kane, Jennifer Knox, John Neoptolemos, Steven Gallinger, Sandra Fischer. Digital quantification of GATA6 expression from immunohistochemistry is associated with overall survival after surgery for pancreatic cancer in the ESPAC trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1193.
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Affiliation(s)
| | - Kai Duan
- 2University Health Network, Toronto, Ontario, Canada
| | | | | | | | - Paula Ghaneh
- 3University of Liverpool, Liverpool, United Kingdom
| | | | | | | | | | | | | | - Anna Dodd
- 1Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Julie Wilson
- 5Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Faiyaz Notta
- 5Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Grainne O'Kane
- 1Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jennifer Knox
- 1Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | | | - Sandra Fischer
- 1Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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9
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Grant RC, Duan K, Jackson R, Greenhalf W, Costello-Goldring E, Ghaneh P, Halloran C, Palmer D, Hackert T, Buchler M, Hutchison S, Ramotar S, Dodd A, Wilson J, Notta F, O'Kane G, Knox J, Neoptolemos J, Gallinger S, Fischer S. Abstract PO-005: GATA6 expression is prognostic after surgical resection of pancreatic cancer: results from the ESPAC trials. Cancer Res 2020. [DOI: 10.1158/1538-7445.panca20-po-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction No biomarker is clinically available to predict prognosis after surgical resection of pancreatic cancer beyond CA-19-9, a classical tumor marker. GATA6 is a transcription factor necessary for pancreaticogenesis that associates with the major transcriptomic subtypes of pancreatic cancer. In this study, we evaluated the prognostic utility of GATA6 expression in randomised adjuvant chemotherapy trials. Materials and Methods We retrospectively analyzed resection specimens in tissue microarrays from patients who participated in two international randomized phase III trials of adjuvant chemotherapy after resection of pancreatic ductal adenocarcinoma: ESPAC-3, which compared fluorouracil plus folinic acid with gemcitabine; and ESPAC-4, which compared gemcitabine plus capecitabine with gemcitabine alone. GATA6 expression was measured using immunohistochemistry. Expression levels from 0 to 4 were scored through consensus between two pathologists who were blinded to clinical characteristics and outcome. Concordance on each tissue core was assessed using a weighted kappa score. Overall survival (OS) was assessed using Kaplan-Meier curves and compared between GATA6 expression levels using univariate Cox proportional hazard regression models and multivariate models that adjusted for lymph node status, post-operative CA-19-9, and treatment arms. After an initial analysis of all five levels, expression levels were regrouped into low (0-2) and high (3-4). Our primary objective was to assess for a prognostic association between GATA6 and OS. Secondary analyses considered predictive associations with the addition of capecitabine to gemcitabine using an interaction term, and associations with baseline characteristics using Wilcoxon and Fisher-exact tests. Results: 26 patients from ESPAC-3 and 205 patients from ESPAC-4 were included. 7, 18, 130, 74, and 2 patients had GATA6 expression levels of 0, 1, 2, 3, and 4, respectively. Concordance between pathologists was moderate (weighted kappa 0.41). GATA6 expression was significantly associated with overall survival when regrouped into low (0–2, N=155) and high (3–4, N=76) expression. Low GATA6 expression was associated with shorter OS (median OS 26.1 months, 95% confidence interval (CI) 22.9–30.4 versus 42.4 months, 95% CI 30.2–56.5, univariate hazard ratio (HR) 1.70, 95% CI 1.31–2.41, P=0.002), which persisted after adjustment for potential confounders (multivariate HR 1.57, 95% CI 1.09–2.62, P=0.016). GATA6 expression was not significantly associated with baseline characteristics or predictive of differential benefit from the addition of capecitabine to gemcitabine. Conclusion: Low GATA6 expression is significantly associated with inferior OS after surgical resection of pancreatic cancer. Future research will automate the measurement of GATA6 expression using image analyses.
Citation Format: Robert C. Grant, Kai Duan, Richard Jackson, William Greenhalf, Eithne Costello-Goldring, Paula Ghaneh, Christopher Halloran, Daniel Palmer, Thilo Hackert, Markus Buchler, Shawn Hutchison, Stephanie Ramotar, Anna Dodd, Julie Wilson, Faiyaz Notta, Grainne O'Kane, Jennifer Knox, John Neoptolemos, Steven Gallinger, Sandra Fischer. GATA6 expression is prognostic after surgical resection of pancreatic cancer: results from the ESPAC trials [abstract]. In: Proceedings of the AACR Virtual Special Conference on Pancreatic Cancer; 2020 Sep 29-30. Philadelphia (PA): AACR; Cancer Res 2020;80(22 Suppl):Abstract nr PO-005.
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Affiliation(s)
- Robert C. Grant
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | - Kai Duan
- 2Laboratory Medicine Program, University Health Network, Toronto, Canada,
| | | | | | | | | | | | | | | | | | - Shawn Hutchison
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | - Stephanie Ramotar
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | - Anna Dodd
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | - Julie Wilson
- 5Ontario Institute for Cancer Research, Toronto, Canada
| | - Faiyaz Notta
- 5Ontario Institute for Cancer Research, Toronto, Canada
| | - Grainne O'Kane
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | - Jennifer Knox
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Canada,
| | | | | | - Sandra Fischer
- 2Laboratory Medicine Program, University Health Network, Toronto, Canada,
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10
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Greenhalf W, Lévy P, Gress T, Rebours V, Brand RE, Pandol S, Chari S, Jørgensen MT, Mayerle J, Lerch MM, Hegyi P, Kleeff J, Castillo CFD, Isaji S, Shimosegawa T, Sheel A, Halloran CM, Garg P, Takaori K, Besselink MG, Forsmark CE, Wilcox CM, Maisonneuve P, Yadav D, Whitcomb D, Neoptolemos J. International consensus guidelines on surveillance for pancreatic cancer in chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and European Pancreatic Club. Pancreatology 2020; 20:910-918. [PMID: 32624419 DOI: 10.1016/j.pan.2020.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with chronic pancreatitis (CP) have an increased risk of pancreatic cancer. We present the international consensus guidelines for surveillance of pancreatic cancer in CP. METHODS The international group evaluated 10 statements generated from evidence on 5 questions relating to pancreatic cancer in CP. The GRADE approach was used to evaluate the level of evidence available per statement. The working group voted on each statement for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS In the following domains there was strong consensus: (1) the risk of pancreatic cancer in affected individuals with hereditary pancreatitis due to inherited PRSS1 mutations is high enough to justify surveillance; (2) the risk of pancreatic cancer in patients with CP associated with SPINK1 p. N34S is not high enough to justify surveillance; (3) surveillance should be undertaken in pancreatic specialist centers; (4) surveillance should only be introduced after the age of 40 years and stopped when the patient would no longer be suitable for surgical intervention. All patients with CP should be advised to lead a healthy lifestyle aimed at avoiding risk factors for progression of CP and pancreatic cancer. There was only moderate or weak agreement on the best methods of screening and surveillance in other types of environmental, familial and genetic forms of CP. CONCLUSIONS Patients with inherited PRSS1 mutations should undergo surveillance for pancreatic cancer, but the best methods for cancer detection need further investigation.
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Affiliation(s)
- William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Philippe Lévy
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, 92118 Clichy Cedex, and Université Paris 7, France
| | - Thomas Gress
- Department of Gastroenterology, Endocrinology and Metabolism, University Hospital, Philipps-Universität Marburg, Marburg, Germany
| | - Vinciane Rebours
- Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, DHU UNITY, Hôpital Beaujon, APHP, 92118 Clichy Cedex, and Université Paris 7, France
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 409, Pittsburgh, PA, 15232, USA
| | - Steve Pandol
- Cedars-Sinai Medical Center, Los Angeles, CA, United States Veterans Affairs Greater Los Angeles Healthcare System, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Suresh Chari
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Julia Mayerle
- Department of Medicine II, University Hospital, LMU, Munich, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, D-17475, Greifswald, Germany
| | - Péter Hegyi
- Institute for Translational Medicine &Department of Translational Medicine/1st Department of Medicine, Medical School, Pécs, H-7624, Hungary
| | - Jörg Kleeff
- Department of Surgery, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Shuiji Isaji
- Department of Surgery, Mie University Graduate School of Medicine, Japan.
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Andrea Sheel
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Christopher M Halloran
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Kyoichi Takaori
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Marc G Besselink
- Department of Surgery, Amsterdam Gastroenterology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Chris E Forsmark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | | | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Dhiraj Yadav
- Department of Medicine University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - David Whitcomb
- Department of Medicine University of Pittsburgh and UPMC, Pittsburgh, PA, USA
| | - John Neoptolemos
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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11
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Kempeneers MA, Issa Y, Ali UA, Baron RD, Besselink MG, Büchler M, Erkan M, Fernandez-Del Castillo C, Isaji S, Izbicki J, Kleeff J, Laukkarinen J, Sheel ARG, Shimosegawa T, Whitcomb DC, Windsor J, Miao Y, Neoptolemos J, Boermeester MA. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology 2020; 20:149-157. [PMID: 31870802 DOI: 10.1016/j.pan.2019.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Chronic pancreatitis (CP) is a complex inflammatory disease with pain as the predominant symptom. Pain relief can be achieved using invasive interventions such as endoscopy and surgery. This paper is part of the international consensus guidelines on CP and presents the consensus guideline for surgery and timing of intervention in CP. METHODS An international working group with 15 experts on CP surgery from the major pancreas societies (IAP, APA, JPS, and EPC) evaluated 20 statements generated from evidence on 5 questions deemed to be the most clinically relevant in CP. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the level of evidence available for each statement. To determine the level of agreement, the working group voted on the 20 statements for strength of agreement, using a nine-point Likert scale in order to calculate Cronbach's alpha reliability coefficient. RESULTS Strong consensus was obtained for the following statements: Surgery in CP is indicated as treatment of intractable pain and local complications of adjacent organs, and in case of suspicion of malignant (cystic) lesion; Early surgery is favored over surgery in a more advanced stage of disease to achieve optimal long-term pain relief; In patients with an enlarged pancreatic head, a combined drainage and resection procedure, such as the Frey, Beger, and Berne procedure, may be the treatment of choice; Pancreaticoduodenectomy is the most suitable surgical option for patients with groove pancreatitis; The risk of pancreatic carcinoma in patients with CP is too low (2% in 10 year) to recommend active screening or prophylactic surgery; Patients with hereditary CP have such a high risk of pancreatic cancer that prophylactic resection can be considered (lifetime risk of 40-55%). Weak agreement for procedure choice in patients with dilated duct and normal size pancreatic head: both the extended lateral pancreaticojejunostomy and Frey procedure seems to provide equivalent pain control in patients. CONCLUSIONS This international expert consensus guideline provides evidenced-based statements concerning key aspects in surgery and timing of intervention in CP. It is meant to guide clinical practitioners and surgeons in the treatment of patients with CP.
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Affiliation(s)
- M A Kempeneers
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Y Issa
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - U Ahmed Ali
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - R D Baron
- Department of Surgery, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - M G Besselink
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - M Büchler
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M Erkan
- Department of Surgery, Koc University, Istanbul, Turkey
| | | | - S Isaji
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Japan
| | - J Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - J Kleeff
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Germany
| | - J Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Finland
| | - A R G Sheel
- Institute of Translational Medicine, University of Liverpool, United Kingdom
| | - T Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Japan
| | - D C Whitcomb
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh and UPMC, PA, USA
| | - J Windsor
- HBP/Upper GI Unit, Auckland City Hospital/Department of Surgery, University of Auckland, New Zealand
| | - Y Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, China
| | - J Neoptolemos
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - M A Boermeester
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
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12
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Gentiluomo M, Puchalt García P, Galeotti AA, Talar-Wojnarowska R, Tjaden C, Tavano F, Strobel O, Kupcinskas J, Neoptolemos J, Hegyi P, Costello E, Pezzilli R, Sperti C, Lawlor RT, Capurso G, Szentesi A, Soucek P, Vodicka P, Lovecek M, Hackert T, Cavestro GM, Milanetto AC, Canzian F, Campa D. Genetic variability of the ABCC2 gene and clinical outcomes in pancreatic cancer patients. Carcinogenesis 2020; 40:544-550. [PMID: 30629142 DOI: 10.1093/carcin/bgz006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/11/2018] [Accepted: 01/08/2019] [Indexed: 02/05/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis, caused by various factors, such as the aggressiveness of the disease, the limited therapeutic options and the lack of early detection and risk markers. The ATP binding cassette subfamily C member 2 (ABCC2) protein plays a critical role in response to various drugs and is differentially expressed in gemcitabine sensitive and resistant cells. Moreover, single nucleotide polymorphisms (SNPs) in the gene have been associated with differential outcomes and prognosis in several tumour types. The aim of this study was to investigate the possible association between SNPs in the ABCC2 gene and overall survival (OS) in PDAC patients. We analysed 12 polymorphisms, including tagging-SNPs covering all the genetic variability of the ABCC2 gene and genotyped them in 1415 PDAC patients collected within the Pancreatic Disease ReseArch (PANDoRA) consortium. We tested the association between ABCC2 SNPs and PDAC OS using Cox proportional hazard models. We analysed PDAC patients dividing them by stage and observed that the minor alleles of three SNPs showed an association with worse OS [rs3740067: hazard ratio (HR) = 3.29, 95% confidence interval (CI) = 1.56-6.97, P = 0.002; rs3740073: HR = 3.11, 95% CI = 1.52-6.38, P = 0.002 and rs717620: HR = 2.90, 95% CI = 1.41-5.95, P = 0.004, respectively] in stage I patients. In patients with more advanced PDAC, we did not observe any statistically significant association. Our results suggest that rs3740067, rs3740073 and rs717620 could be promising prognostic markers in stage I PDAC patients.
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Affiliation(s)
- Manuel Gentiluomo
- Department of Biology, University of Pisa, Pisa, Italy.,Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paula Puchalt García
- Department of Biology, University of Pisa, Pisa, Italy.,Universitat Politècnica de Valéncia, Valencia, Spain
| | - Alice Alessandra Galeotti
- Department of Biology, University of Pisa, Pisa, Italy.,Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Christine Tjaden
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Francesca Tavano
- Division of Gastroenterology and Research Laboratory, IRCCS Scientific Institute and Regional General Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy
| | - Oliver Strobel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Juozas Kupcinskas
- Department of Gastroenterology, Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - John Neoptolemos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Péter Hegyi
- Translational Gastroenterology Research Group, Hungarian Academy of Sciences and University of Szeged (MTA-SZTE), Szeged, Hungary.,Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,Department of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Eithne Costello
- National Institute for Health Research Liverpool, Pancreas Biomedical Research Unit, University of Liverpool, United Kingdom
| | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive System, Sant'Orsola-Malpighi Hospital Bologna, Italy
| | - Cosimo Sperti
- Department of Surgery, Gastroenterology and Oncology (DISCOG), University of Padua, Padua, Italy
| | - Rita T Lawlor
- ARC-Net Research Centre, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Gabriele Capurso
- Pancreatico/Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy.,Digestive and Liver Disease Unit, S. Andrea Hospital, Rome, Italy
| | - Andrea Szentesi
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary.,János Szentágothai Research Centre and Centre for Neuroscience, University of Pécs, Pécs, Hungary
| | - Pavel Soucek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Pavel Vodicka
- Institute of Experimental Medicine, Czech Academy of Sciences and Institute of Biology and Medical Genetics, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Lovecek
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Czech Republic
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Giulia Martina Cavestro
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University San Raffaele Scientific Institute, Milan, Italy
| | - Anna Caterina Milanetto
- Department of Surgery, Gastroenterology and Oncology (DISCOG), University of Padua, Padua, Italy
| | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
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13
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Koncz B, Darvasi E, Erdősi D, Szentesi A, Márta K, Erőss B, Pécsi D, Gyöngyi Z, Girán J, Farkas N, Papp M, Fehér E, Vitális Z, Janka T, Vincze Á, Izbéki F, Dunás-Varga V, Gajdán L, Török I, Károly S, Antal J, Zádori N, Lerch MM, Neoptolemos J, Sahin-Tóth M, Petersen OH, Hegyi P. LIFEStyle, Prevention and Risk of Acute PaNcreatitis (LIFESPAN): protocol of a multicentre and multinational observational case-control study. BMJ Open 2020; 10:e029660. [PMID: 31911510 PMCID: PMC6955557 DOI: 10.1136/bmjopen-2019-029660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is a life-threatening inflammatory disease of the exocrine pancreas which needs acute hospitalisation. Despite its importance, we have significant lack of knowledge whether the lifestyle factors elevate or decrease the risk of AP or influence the disease outcome. So far, no synthetising study has been carried out examining associations between socioeconomic factors, dietary habits, physical activity, chronic stress, sleep quality and AP. Accordingly, LIFESPAN identifies risk factors of acute pancreatitis and helps to prepare preventive recommendations for lifestyle elements. METHODS AND ANALYSIS LIFESPAN is an observational, multicentre international case-control study. Participating subjects will create case and control groups. The study protocol was designed according to the SPIRIT guideline. Patients in the case group (n=1700) have suffered from AP (alcohol-induced, n=500; biliary, n=500; hypertriglyceridemiainduced, n=200; other, n=500); the control group subjects have no AP in their medical history. Our study will have three major control groups (n=2200): hospital-based (n=500), population-based (n=500) and aetiology-based (alcohol, n=500; biliary, n=500 and hypertriglyceridemia, n=200). All of them will be matched to the case group individually by gender, age and location of residence. Aggregately, 3900 subjects will be enrolled into the study. The study participants will complete a complex questionnaire with the help of a clinical research administrator/study nurse. Analysis methods include analysis of the continuous and categorical values. ETHICS AND DISSEMINATION The study has obtained the relevant ethical approval (54175-2/2018/EKU) and also internationally registered (ISRCTN25940508). After obtaining the final conclusions, we will publish the data to the medical community and will also disseminate our results via open access. TRIAL REGISTRATION NUMBER ISRCTN25940508; Pre-results.
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Affiliation(s)
- Balázs Koncz
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Erika Darvasi
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Dalma Erdősi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Márta
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Pécsi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - János Girán
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Maria Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Fehér
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Vitális
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Janka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ferenc Izbéki
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Veronika Dunás-Varga
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - László Gajdán
- Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Imola Török
- County Emergency Clinical Hospital - Gastroenterology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Sándor Károly
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Judit Antal
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Markus M Lerch
- Department of Medicine A, Universitatsmedizin Greifswald, Greifswald, Germany
| | - John Neoptolemos
- Department of General Surgery, University of Heidelberg, Heidelberg, Germany
| | - Miklós Sahin-Tóth
- Department of Surgery, University of California, Los Angeles, United States
| | | | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, University of Szeged, Szeged, Hungary
- Division of Translational Medicine, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
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14
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Muller N, Sarantitis I, Rouanet M, de Mestier L, Halloran C, Greenhalf W, Férec C, Masson E, Ruszniewski P, Lévy P, Neoptolemos J, Buscail L, Rebours V. Natural history of SPINK1 germline mutation related-pancreatitis. EBioMedicine 2019; 48:581-591. [PMID: 31628023 PMCID: PMC6838417 DOI: 10.1016/j.ebiom.2019.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The aim was to describe genetic, clinical and morphological features in a large, multicentre European cohort of patients with SPINK1 related pancreatitis, in comparison with patients with idiopathic pancreatitis (IP). METHODS All SPINK1 mutation carriers with pancreatic symptoms from two French and one English centers were included. Patients with IP were included in a control group. Genetic, clinical, radiological and biochemical data were collected. FINDINGS 209 and 302 patients were included in the SPINK1 and control groups (median follow-up: 8.3 years (3.7-17.4) vs 5.3 (2.5-8.8)). The median age at onset of symptoms was 20.1 years (17.5-22.8) in the SPINK1 group versus 41.2 (35.2-45.2). The age of exocrine pancreatic insufficiency (EPI) onset in the SPINK1 group was 49.5 (44.5-54.6) years vs. 65.2 (62.1-68.3), p < 0.001. SPINK1 patients with EPI were 5.3%, 14.7%, 28.3% and 52.4% at 20, 30, 40 and 50 years. Diabetes occurred 37.7 (33.3-42.1) years following the onset of symptoms in the SPINK1 group vs. 30.6 (17.3-43.8) (p = 0.002). SPINK1 patients with diabetes were 7.8%, 13.4%, 26.3% and 43.4% at 30, 40, 50 and 60 years. Seven patients (3.3%) developed pancreatic cancer in the SPINK1 group (versus 3 (0.99%), p = 0.1), at a median age of 60 vs 66 years. The cancer risk was 0.8% before 50 years, 11.9%, 27.7%, 51.8% at 60, 70 and 80 years and was 12 times higher than in controls (Cox HR 12.0 (3.0-47.8), p < 0.001). INTERPRETATION SPINK1 related pancreatitis is associated with earlier onset and pancreatic insufficiencies. p.N34S SPINK1 may well be associated with cancer.
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Affiliation(s)
- Nelly Muller
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, Clichy, and Paris-Diderot University, Paris, France
| | - Ioannis Sarantitis
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Royal Liverpool University Hospital, Liverpool, England United Kingdom
| | - Marie Rouanet
- Department of Gastroenterology and Pancreatology, INSERM U1037, University of Toulouse 3, CHU Rangueil, Toulouse, France
| | - Louis de Mestier
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, Clichy, and Paris-Diderot University, Paris, France
| | - Christopher Halloran
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Royal Liverpool University Hospital, Liverpool, England United Kingdom
| | - William Greenhalf
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Royal Liverpool University Hospital, Liverpool, England United Kingdom
| | - Claude Férec
- UMR1078 Génétique, Génomique Fonctionnelle et Biotechnologies, INSERM, EFS - Bretagne, Université de Brest, CHRU Brest, Brest, France
| | - Emmanuelle Masson
- UMR1078 Génétique, Génomique Fonctionnelle et Biotechnologies, INSERM, EFS - Bretagne, Université de Brest, CHRU Brest, Brest, France
| | - Philippe Ruszniewski
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, Clichy, and Paris-Diderot University, Paris, France
| | - Philippe Lévy
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, Clichy, and Paris-Diderot University, Paris, France
| | - John Neoptolemos
- Department of General Surgery and transplantation, University of Heidelberg, Heidelberg, Germany
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, INSERM U1037, University of Toulouse 3, CHU Rangueil, Toulouse, France
| | - Vinciane Rebours
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, APHP, Clichy, and Paris-Diderot University, Paris, France.
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15
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Mikó A, Erőss B, Sarlós P, Hegyi Jr P, Márta K, Pécsi D, Vincze Á, Bódis B, Nemes O, Faluhelyi N, Farkas O, Papp R, Kelemen D, Szentesi A, Hegyi E, Papp M, Czakó L, Izbéki F, Gajdán L, Novák J, Sahin-Tóth M, Lerch MM, Neoptolemos J, Petersen OH, Hegyi P. Observational longitudinal multicentre investigation of acute pancreatitis (GOULASH PLUS): follow-up of the GOULASH study, protocol. BMJ Open 2019; 9:e025500. [PMID: 31481363 PMCID: PMC6731920 DOI: 10.1136/bmjopen-2018-025500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is an inflammatory condition that can lead to late consequences. Recurrent AP (RAP) develops in 20% of patients and chronic pancreatitis (CP) occurs in 7%-12.8%. However, we do not have sufficient information to establish an evidence-based statement to define early CP, or how to prevent its development. AIM The aim of this study was to understand the influencing factors and to determine which parameters should be measured or used as a biomarker to detect the early phase of CP. METHODS/DESIGN This is an observational prospective follow-up study of the GOULASH-trial (ISRTCN 63827758) in which (1) all severity of pancreatitis are included; (2) patients receive only therapeutic modalities which are accepted by the evidence based medicine (EBM) guideline; (3) whole blood, serum and plasma samples are stored in our biobank; and (4) large amount of variables are collected and kept in our electronic database including anamnestic data, physical examination, laboratory parameters, imaging, therapy and complications. Therefore, this fully characterised patient cohort are well suitable for this longitudinal follow-up study. Patients' selection: patients enrolled in the GOULASH study will be offered to join to the longitudinal study. The follow-up will be at 1, 2, 3, 4, 5 and 6 years after the episode of AP. Anamnestic data will be collected by questionnaires: (1) diet history questionnaire, (2) 36-Item Short-Form Health Survey, (3) physical activity questionnaire and (4) stress questionnaire. Genetic tests will be performed for the genes associated with CP. The exocrine and endocrine pancreatic, liver and kidney functions will be determined by laboratory tests, stool sample analyses and imaging. Cost-effectiveness will be analysed to examine the relationship between events of interest and health-related quality of life or to explore subgroup differences. CONCLUSION This study will provide information about the risk and influencing factors leading to CP and identify the most useful measurable parameters. TRIAL REGISTRATION NUMBER ISRCTN63396106.
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Affiliation(s)
- Alexandra Mikó
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Péter Hegyi Jr
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
- Gastroenterological Clinic, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Katalin Márta
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Dániel Pécsi
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Division of Gastroenterology, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Beáta Bódis
- Division of Endocrinology and Metabolism, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Orsolya Nemes
- Division of Endocrinology and Metabolism, First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Nándor Faluhelyi
- Department of Radiology, Medical School, University of Pécs, Pécs, Hungary
| | - Orsolya Farkas
- Department of Radiology, Medical School, University of Pécs, Pécs, Hungary
| | - Róbert Papp
- Surgery Clinic, University of Pécs, Pécs, Hungary
| | | | - Andrea Szentesi
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Eszter Hegyi
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Mária Papp
- Department of Internal Medicine, Division of Gastroenterology, University of Debrecen, Debrecen, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Izbéki
- First Department of Gastroenterology, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - László Gajdán
- First Department of Gastroenterology, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - János Novák
- First Department of Gastroenterology, Pándy Kálmán Hospital of Békés County, Gyula, Hungary
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Henry M Goldman School of Dental Medicine Boston University, Boston, Massachusetts, UK
| | - Markus M Lerch
- Department of Medicine A, Universitatsmedizin Greifswald, Greifswald, Germany
| | - John Neoptolemos
- Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | | | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
- Surgery Clinic, University of Pécs, Pécs, Hungary
- Hungarian Academy of Sciences- University of Szeged, Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary
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16
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Kucserik LP, Márta K, Vincze Á, Lázár G, Czakó L, Szentkereszty Z, Papp M, Palatka K, Izbéki F, Altorjay Á, Török I, Barbu S, Tantau M, Vereczkei A, Bogár L, Dénes M, Németh I, Szentesi A, Zádori N, Antal J, Lerch MM, Neoptolemos J, Sahin-Tóth M, Petersen OH, Kelemen D, Hegyi P. Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial. BMJ Open 2019; 9:e025551. [PMID: 31289058 PMCID: PMC6629406 DOI: 10.1136/bmjopen-2018-025551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER ISCRTN 10667869; Pre-results.
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Affiliation(s)
- Levente Pál Kucserik
- Division of Surgery, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Katalin Márta
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- Division of Gastroenterology, First Department of Internal Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Ferenc Izbéki
- Divison of Gastroenterology, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Áron Altorjay
- Division of Surgery, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Imola Török
- Division of Gastroenterology, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Sorin Barbu
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Marcel Tantau
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - András Vereczkei
- Department for Surgery, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Lajos Bogár
- Department of Anaesthesiology and Intensive Therapy, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Márton Dénes
- Second Department of Surgery, County Hospital Targu Mures, Targu Mures, Romania
| | - Imola Németh
- Data-Management, Pre-Clinical and Clinical Biostatistics, Adware Research Developing and Consulting Ltd, Balatonfüred, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem, Pecs, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szegedi Tudomanyegyetem, Szeged, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Judit Antal
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Markus M Lerch
- Department of Medicine A, Universitatsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - John Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Liverpool, UK
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Ole H Petersen
- School of Biosciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Dezső Kelemen
- Surgery Clinic, Pecsi Tudomanyegyetem, Pecs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- MTA-SZTE, Translational Gastroenterology Research Group, Szeged, Hungary
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17
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Mann K, Gilbert T, Cicconi S, Jackson R, Whelan P, Campbell F, Halloran C, Neoptolemos J, Ghaneh P. Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma. Langenbecks Arch Surg 2019; 404:439-449. [PMID: 30972486 PMCID: PMC6614162 DOI: 10.1007/s00423-019-01779-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/20/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is limited published evidence on duodenal carcinoma due to its rarity. This study aimed to evaluate gastric outlet obstruction and obstructive jaundice along with pathological variables as survival factors in patients with duodenal adenocarcinoma following resection. METHODS Survival factor analysis was undertaken in patients undergoing duodenal cancer surgery from 1997 to 2015 in a single centre. RESULTS There were 57 patients of whom 18 had gastric outlet obstruction and 14 had obstructive jaundice. Fifty-three had a partial pancreatoduodenectomy and four had palliative bypass. Perioperative mortality and morbidity were 4% (2/53) and 47% (25/53) respectively in resected patients. With a median (95% confidence interval, CI) follow-up of 72 (57-86) months, median overall and recurrence-free survival was 38 months (95% CI 28-113) and 27 months (95% CI 18-83) respectively. The 1 and 3-year overall survival rates were 84% (95% CI 74-95) and 52% (95% CI 39-69) respectively. Median overall survival was 19 months in patients with gastric outlet obstruction vs 53 months in those without (p = 0.026) and 28 months in patients with obstructive jaundice vs 38 months in those without (p = 0.611). Univariate analysis revealed that tumour stage, resection margin status, pre-operative albumin status, gastric outlet obstruction and age were associated with poorer overall and recurrence-free survival but multivariate analysis confirmed only tumour stage and resection margin status to be significant. CONCLUSION Whereas gastric outlet obstruction in duodenal cancer appeared to be an important survival factor following partial pancreatoduodenectomy, multivariate analysis showed that only tumour stage and resection margin status were the key independent survival factors. Further multicentre studies are required to elucidate further characteristics of duodenal carcinoma and develop neoadjuvant/adjuvant management strategies.
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Affiliation(s)
- Kulbir Mann
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.
| | - T Gilbert
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - S Cicconi
- Statistics and Bioinformatics Unit, Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - R Jackson
- Statistics and Bioinformatics Unit, Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - P Whelan
- Department of Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - C Halloran
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - J Neoptolemos
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Ghaneh
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
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18
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O'Reilly D, Fou L, Hasler E, Hawkins J, O'Connell S, Pelone F, Callaway M, Campbell F, Capel M, Charnley R, Corrie P, Elliot D, Goodburn L, Jewell A, Joharchi S, McGeeney L, Mukherjee S, Oppong K, Whelan P, Primrose J, Neoptolemos J. Diagnosis and management of pancreatic cancer in adults: A summary of guidelines from the UK National Institute for Health and Care Excellence. Pancreatology 2018; 18:962-970. [PMID: 30292643 DOI: 10.1016/j.pan.2018.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 12/11/2022]
Abstract
To enable standardisation of care of pancreatic cancer patients and facilitate improvement in outcome, the United Kingdom's National Institute for Health and Care Excellence (NICE) developed a clinical guideline for the diagnosis and management of pancreatic cancer in adults. Systematic literature searches, systematic review and meta-analyses were undertaken. Recommendations were drafted on the basis of the group's interpretation of the best available evidence of clinical and cost effectiveness. There was patient involvement and public consultation. Recommendations were made on: diagnosis; staging; monitoring of inherited high risk; psychological support; pain; nutrition management; and the specific management of people with resectable-, borderline-resectable- and unresectable-pancreatic cancer. The guideline committee also made recommendations for future research into neoadjuvant therapy, cachexia interventions, minimally invasive pancreatectomy, pain management and psychological support needs. These NICE guidelines aim to promote best current practice and support and stimulate research and innovation in pancreatic cancer.
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Affiliation(s)
- Derek O'Reilly
- Manchester Royal Infirmary, Central Manchester NHS Foundation Trust and University of Manchester, United Kingdom.
| | - Linyun Fou
- National Institute for Health and Care Excellence, United Kingdom
| | - Elise Hasler
- National Institute for Health and Care Excellence, United Kingdom
| | - James Hawkins
- National Institute for Health and Care Excellence, United Kingdom
| | - Susan O'Connell
- National Institute for Health and Care Excellence, United Kingdom
| | - Ferruccio Pelone
- National Institute for Health and Care Excellence, United Kingdom
| | - Mark Callaway
- Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, United Kingdom
| | - Fiona Campbell
- University of Liverpool, The Royal Liverpool & Broadgreen University Hospital NHS Trust, United Kingdom
| | | | | | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, United Kingdom
| | - Dawn Elliot
- Northumbria Healthcare Foundation Trust, United Kingdom
| | - Lesley Goodburn
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Anna Jewell
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Suzanne Joharchi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Laura McGeeney
- Cambridge University Hospitals NHS Foundation Trust and University of Cambridge, United Kingdom
| | - Somnath Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford & Churchill Hospital, United Kingdom
| | - Kofi Oppong
- Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Phil Whelan
- University of Liverpool, The Royal Liverpool & Broadgreen University Hospital NHS Trust, United Kingdom
| | - John Primrose
- University of Southampton, Southampton General Hospital, United Kingdom
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19
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Harrison Palmer D, Ross P, Silcocks P, Greenhalf W, Faluyi O, Ma Y, Wadsley J, Rawcliffe C, Neoptolemos J, Valle J, Wasan H, Starling N, Patel K, Bridgewater J. ACELARATE: A randomised phase III, open label, clinical study comparing NUC-1031 with gemcitabine in patients with metastatic pancreatic carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Martinelli P, Carrillo-de Santa Pau E, Cox T, Sainz B, Dusetti N, Greenhalf W, Rinaldi L, Costello E, Ghaneh P, Malats N, Büchler M, Pajic M, Biankin AV, Iovanna J, Neoptolemos J, Real FX. GATA6 regulates EMT and tumour dissemination, and is a marker of response to adjuvant chemotherapy in pancreatic cancer. Gut 2017; 66:1665-1676. [PMID: 27325420 PMCID: PMC5070637 DOI: 10.1136/gutjnl-2015-311256] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/03/2016] [Accepted: 05/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS The role of GATA factors in cancer has gained increasing attention recently, but the function of GATA6 in pancreatic ductal adenocarcinoma (PDAC) is controversial. GATA6 is amplified in a subset of tumours and was proposed to be oncogenic, but high GATA6 levels are found in well-differentiated tumours and are associated with better patient outcome. By contrast, a tumour-suppressive function of GATA6 was demonstrated using genetic mouse models. We aimed at clarifying GATA6 function in PDAC. DESIGN We combined GATA6 silencing and overexpression in PDAC cell lines with GATA6 ChIP-Seq and RNA-Seq data, in order to understand the mechanism of GATA6 functions. We then confirmed some of our observations in primary patient samples, some of which were included in the ESPAC-3 randomised clinical trial for adjuvant therapy. RESULTS GATA6 inhibits the epithelial-mesenchymal transition (EMT) in vitro and cell dissemination in vivo. GATA6 has a unique proepithelial and antimesenchymal function, and its transcriptional regulation is direct and implies, indirectly, the regulation of other transcription factors involved in EMT. GATA6 is lost in tumours, in association with altered differentiation and the acquisition of a basal-like molecular phenotype, consistent with an epithelial-to-epithelial (ET2) transition. Patients with basal-like GATA6low tumours have a shorter survival and have a distinctly poor response to adjuvant 5-fluorouracil (5-FU)/leucovorin. However, modulation of GATA6 expression in cultured cells does not directly regulate response to 5-FU. CONCLUSIONS We provide mechanistic insight into GATA6 tumour-suppressive function, its role as a regulator of canonical epithelial differentiation, and propose that loss of GATA6 expression is both prognostic and predictive of response to adjuvant therapy.
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Affiliation(s)
- Paola Martinelli
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Center-CNIO, Madrid, Spain
- Cancer Progression and Metastasis Group, Institute for Cancer Research, Medical University Wien, Vienna, Austria
| | | | - Trevor Cox
- Cancer Research UK Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
- NIHR Liverpool Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Bruno Sainz
- Department of Preventive Medicine, Public Health and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nelson Dusetti
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Parc Scientifique et Technologique de Luminy, Marseille, France
| | - William Greenhalf
- NIHR Liverpool Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Lorenzo Rinaldi
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Center-CNIO, Madrid, Spain
- Institute for Research in Biomedicine (IRB), Barcelona, Spain
| | - Eithne Costello
- Cancer Research UK Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
| | - Paula Ghaneh
- Cancer Research UK Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
- NIHR Liverpool Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center-CNIO, Madrid, Spain
| | - Markus Büchler
- Department for General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Marina Pajic
- Cancer Division, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
| | - Andrew V Biankin
- Cancer Division, The Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, Australia
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
- South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool, Australia
| | - Juan Iovanna
- Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068, CNRS UMR 7258, Aix-Marseille Université and Institut Paoli-Calmettes, Parc Scientifique et Technologique de Luminy, Marseille, France
| | - John Neoptolemos
- Cancer Research UK Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK
- NIHR Liverpool Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Francisco X Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Center-CNIO, Madrid, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
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21
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Totti S, Vernardis SI, Meira L, Pérez-Mancera PA, Costello E, Greenhalf W, Palmer D, Neoptolemos J, Mantalaris A, Velliou EG. Designing a bio-inspired biomimetic in vitro system for the optimization of ex vivo studies of pancreatic cancer. Drug Discov Today 2017; 22:690-701. [PMID: 28153670 DOI: 10.1016/j.drudis.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/16/2016] [Accepted: 01/18/2017] [Indexed: 12/13/2022]
Abstract
Pancreatic cancer is one of the most aggressive and lethal human malignancies. Drug therapies and radiotherapy are used for treatment as adjuvants to surgery, but outcomes remain disappointing. Advances in tissue engineering suggest that 3D cultures can reflect the in vivo tumor microenvironment and can guarantee a physiological distribution of oxygen, nutrients, and drugs, making them promising low-cost tools for therapy development. Here, we review crucial structural and environmental elements that should be considered for an accurate design of an ex vivo platform for studies of pancreatic cancer. Furthermore, we propose environmental stress response biomarkers as platform readouts for the efficient control and further prediction of the pancreatic cancer response to the environmental and treatment input.
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Affiliation(s)
- Stella Totti
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Spyros I Vernardis
- Biological Systems Engineering Laboratory (BSEL), Department of Chemical Engineering, Imperial College London, SW7 2AZ London, UK
| | - Lisiane Meira
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford GU2 7XH, UK
| | - Pedro A Pérez-Mancera
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK
| | - Eithne Costello
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK; NIHR Liverpool Pancreas Biomedical Research Unit, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK
| | - William Greenhalf
- NIHR Liverpool Pancreas Biomedical Research Unit, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK
| | - Daniel Palmer
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK
| | - John Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK; NIHR Liverpool Pancreas Biomedical Research Unit, University of Liverpool,Daulby Street, Liverpool L69 3GA, UK
| | - Athanasios Mantalaris
- Biological Systems Engineering Laboratory (BSEL), Department of Chemical Engineering, Imperial College London, SW7 2AZ London, UK
| | - Eirini G Velliou
- Bioprocess and Biochemical Engineering Group (BioProChem), Department of Chemical and Process Engineering, University of Surrey, Guildford GU2 7XH, UK.
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22
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Jais B, Rebours V, Malleo G, Salvia R, Fontana M, Maggino L, Bassi C, Manfredi R, Moran R, Lennon AM, Zaheer A, Wolfgang C, Hruban R, Marchegiani G, Fernández Del Castillo C, Brugge W, Ha Y, Kim MH, Oh D, Hirai I, Kimura W, Jang JY, Kim SW, Jung W, Kang H, Song SY, Kang CM, Lee WJ, Crippa S, Falconi M, Gomatos I, Neoptolemos J, Milanetto AC, Sperti C, Ricci C, Casadei R, Bissolati M, Balzano G, Frigerio I, Girelli R, Delhaye M, Bernier B, Wang H, Jang KT, Song DH, Huggett MT, Oppong KW, Pererva L, Kopchak KV, Del Chiaro M, Segersvard R, Lee LS, Conwell D, Osvaldt A, Campos V, Aguero Garcete G, Napoleon B, Matsumoto I, Shinzeki M, Bolado F, Fernandez JMU, Keane MG, Pereira SP, Acuna IA, Vaquero EC, Angiolini MR, Zerbi A, Tang J, Leong RW, Faccinetto A, Morana G, Petrone MC, Arcidiacono PG, Moon JH, Choi HJ, Gill RS, Pavey D, Ouaïssi M, Sastre B, Spandre M, De Angelis CG, Rios-Vives MA, Concepcion-Martin M, Ikeura T, Okazaki K, Frulloni L, Messina O, Lévy P. Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2016; 65:305-12. [PMID: 26045140 DOI: 10.1136/gutjnl-2015-309638] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER IRB 00006477.
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Affiliation(s)
- B Jais
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - V Rebours
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - G Malleo
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - M Fontana
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - L Maggino
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - C Bassi
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Manfredi
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Moran
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A M Lennon
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Zaheer
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Wolfgang
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Hruban
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G Marchegiani
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C Fernández Del Castillo
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Brugge
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Y Ha
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M H Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - I Hirai
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - W Kimura
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - J Y Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - S W Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - W Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - H Kang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - S Y Song
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - C M Kang
- Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - W J Lee
- Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - S Crippa
- Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy
| | - I Gomatos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J Neoptolemos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A C Milanetto
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - C Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - C Ricci
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R Casadei
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M Bissolati
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Balzano
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I Frigerio
- Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - R Girelli
- Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - M Delhaye
- Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - B Bernier
- Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - H Wang
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - K T Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - D H Song
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - M T Huggett
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - K W Oppong
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - L Pererva
- National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine
| | - K V Kopchak
- National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - R Segersvard
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - L S Lee
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D Conwell
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Osvaldt
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - V Campos
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - B Napoleon
- Hôpital Privé Mermoz, Gastroentérologie, Lyon, France
| | - I Matsumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - M Shinzeki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - F Bolado
- Gastroenterology Department, Hospital de Navarra, Pamplona, Spain
| | | | - M G Keane
- Department of Gastroenterology and Hepatology, University College Hospital, London, UK
| | - S P Pereira
- Department of Gastroenterology and Hepatology, University College Hospital, London, UK
| | - I Araujo Acuna
- Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E C Vaquero
- Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M R Angiolini
- Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Zerbi
- Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Tang
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - R W Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - A Faccinetto
- Radiological Department, General Hospital Cá Foncello, Treviso, Italy
| | - G Morana
- Radiological Department, General Hospital Cá Foncello, Treviso, Italy
| | - M C Petrone
- Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy
| | - P G Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy
| | - J H Moon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - H J Choi
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - R S Gill
- Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - D Pavey
- Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - M Ouaïssi
- Department of Digestive Surgery, Timone Hospital, Marseille, France
| | - B Sastre
- Department of Digestive Surgery, Timone Hospital, Marseille, France
| | - M Spandre
- Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy
| | - C G De Angelis
- Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy
| | - M A Rios-Vives
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Concepcion-Martin
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Ikeura
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - K Okazaki
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - L Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - O Messina
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - P Lévy
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
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23
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Radon TP, Massat NJ, Jones R, Alrawashdeh W, Dumartin L, Ennis D, Duffy SW, Kocher HM, Pereira SP, Guarner posthumous L, Murta-Nascimento C, Real FX, Malats N, Neoptolemos J, Costello E, Greenhalf W, Lemoine NR, Crnogorac-Jurcevic T. Identification of a Three-Biomarker Panel in Urine for Early Detection of Pancreatic Adenocarcinoma. Clin Cancer Res 2015; 21:3512-21. [PMID: 26240291 PMCID: PMC4539580 DOI: 10.1158/1078-0432.ccr-14-2467] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Noninvasive biomarkers for early detection of pancreatic ductal adenocarcinoma (PDAC) are currently not available. Here, we aimed to identify a set of urine proteins able to distinguish patients with early-stage PDAC from healthy individuals. EXPERIMENTAL DESIGN Proteomes of 18 urine samples from healthy controls, chronic pancreatitis, and patients with PDAC (six/group) were assayed using GeLC/MS/MS analysis. The selected biomarkers were subsequently validated with ELISA assays using multiple logistic regression applied to a training dataset in a multicenter cohort comprising 488 urine samples. RESULTS LYVE-1, REG1A, and TFF1 were selected as candidate biomarkers. When comparing PDAC (n = 192) with healthy (n = 87) urine specimens, the resulting areas under the receiver-operating characteristic curves (AUC) of the panel were 0.89 [95% confidence interval (CI), 0.84-0.94] in the training (70% of the data) and 0.92 (95% CI, 0.86-0.98) in the validation (30% of the data) datasets. When comparing PDAC stage I-II (n = 71) with healthy urine specimens, the panel achieved AUCs of 0.90 (95% CI, 0.84-0.96) and 0.93 (95% CI, 0.84-1.00) in the training and validation datasets, respectively. In PDAC stage I-II and healthy samples with matching plasma CA19.9, the panel achieved a higher AUC of 0.97 (95% CI, 0.94-0.99) than CA19.9 (AUC = 0.88; 95% CI, 0.81-0.95, P = 0.005). Adding plasma CA19.9 to the panel increased the AUC from 0.97 (95% CI, 0.94-0.99) to 0.99 (95% CI, 0.97-1.00, P = 0.04), but did not improve the comparison of stage I-IIA PDAC (n = 17) with healthy urine. CONCLUSIONS We have established a novel, three-protein biomarker panel that is able to detect patients with early-stage pancreatic cancer in urine specimens.
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Affiliation(s)
- Tomasz P Radon
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Nathalie J Massat
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | | | - Wasfi Alrawashdeh
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Laurent Dumartin
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Darren Ennis
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Hemant M Kocher
- Centre for Tumour Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, University College London, London, United Kingdom
| | | | | | - Francisco X Real
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Núria Malats
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - John Neoptolemos
- The NIHR Liverpool Pancreas Biomedical Research Unit, Liverpool, United Kingdom
| | - Eithne Costello
- The NIHR Liverpool Pancreas Biomedical Research Unit, Liverpool, United Kingdom
| | - William Greenhalf
- The NIHR Liverpool Pancreas Biomedical Research Unit, Liverpool, United Kingdom
| | - Nick R Lemoine
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Tatjana Crnogorac-Jurcevic
- Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.
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24
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Abstract
Pancreatic ductal adenocarcinoma is an aggressive malignancy with a 5-year survival rate of approximately 5%. The lack of established strategies for early detection contributes to this poor prognosis. Although several novel candidate biomarkers have been proposed for earlier diagnosis, none have been adopted into routine clinical use. In this review, the authors examine the challenges associated with finding new pancreatic cancer diagnostic biomarkers and explore why translation of biomarker research for patient benefit has thus far failed. The authors also review recent progress and highlight advances in the understanding of the biology of pancreatic cancer that may lead to improvements in biomarker detection and implementation.
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Affiliation(s)
- Claire Jenkinson
- Department of Molecular and Clinical Cancer Medicine, National Institute for Health Research Liverpool Pancreas Biomedical Research Unit, University of Liverpool, Daulby Street, Liverpool L69 3GA, UK
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25
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Hidalgo M, Cascinu S, Kleeff J, Labianca R, Löhr JM, Neoptolemos J, Real FX, Van Laethem JL, Heinemann V. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology 2015; 15:8-18. [PMID: 25547205 DOI: 10.1016/j.pan.2014.10.001] [Citation(s) in RCA: 344] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 12/11/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), which accounts for more than 90% of all pancreatic tumours, is a devastating malignancy with an extremely poor prognosis, as shown by a 1-year survival rate of around 18% for all stages of the disease. The low survival rates associated with PDAC primarily reflect the fact that tumours progress rapidly with few specific symptoms and are thus at an advanced stage at diagnosis in most patients. As a result, there is an urgent need to develop accurate markers of pre-invasive pancreatic neoplasms in order to facilitate prediction of cancer risk and to help diagnose the disease at an earlier stage. However, screening for early diagnosis of prostate cancer remains challenging and identifying a highly accurate, low-cost screening test for early PDAC for use in clinical practice remains an important unmet need. More effective therapies are also crucial in PDAC, since progress in identifying novel therapies has been hampered by the genetic complexity of the disease and treatment remains a major challenge. Presently, the greatest step towards improved treatment efficacy has been made in the field of palliative chemotherapy by introducing FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan and oxaliplatin) and gemcitabine/nab-paclitaxel. Strategies designed to raise the profile of PDAC in research and clinical practice are a further requirement in order to ensure the best treatment for patients. This article proposes a number of approaches that may help to accelerate progress in treating patients with PDAC, which, in turn, may be expected to improve the quality of life and survival for those suffering from this devastating disease.
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Affiliation(s)
- Manuel Hidalgo
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.
| | - Stefano Cascinu
- Department of Medical Oncology, University of Ancona, Ancona, Italy
| | - Jörg Kleeff
- Department of General Surgery, Technische Universität München, Munich, Germany
| | | | - J-Matthias Löhr
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - John Neoptolemos
- National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit and Cancer Research UK Liverpool Clinical Trials Unit Director, University of Liverpool and Royal Liverpool University Hospital, Liverpool, UK
| | - Francisco X Real
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid and Universitat Pompeu Fabra, Barcelona, Spain
| | - Jean-Luc Van Laethem
- Department of Gastroenterology-GI Cancer Unit, Erasme University Hospital, Brussels, Belgium
| | - Volker Heinemann
- Comprehensive Cancer Centre Munich, Klinikum der Universität München, Munich, Germany
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26
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Bonnetain F, Bonsing B, Conroy T, Dousseau A, Glimelius B, Haustermans K, Lacaine F, Van Laethem JL, Aparicio T, Aust D, Bassi C, Berger V, Chamorey E, Chibaudel B, Dahan L, De Gramont A, Delpero JR, Dervenis C, Ducreux M, Gal J, Gerber E, Ghaneh P, Hammel P, Hendlisz A, Jooste V, Labianca R, Latouche A, Lutz M, Macarulla T, Malka D, Mauer M, Mitry E, Neoptolemos J, Pessaux P, Sauvanet A, Tabernero J, Taieb J, van Tienhoven G, Gourgou-Bourgade S, Bellera C, Mathoulin-Pélissier S, Collette L. Guidelines for time-to-event end-point definitions in trials for pancreatic cancer. Results of the DATECAN initiative (Definition for the Assessment of Time-to-event End-points in CANcer trials). Eur J Cancer 2014; 50:2983-93. [PMID: 25256896 DOI: 10.1016/j.ejca.2014.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Using potential surrogate end-points for overall survival (OS) such as Disease-Free- (DFS) or Progression-Free Survival (PFS) is increasingly common in randomised controlled trials (RCTs). However, end-points are too often imprecisely defined which largely contributes to a lack of homogeneity across trials, hampering comparison between them. The aim of the DATECAN (Definition for the Assessment of Time-to-event End-points in CANcer trials)-Pancreas project is to provide guidelines for standardised definition of time-to-event end-points in RCTs for pancreatic cancer. METHODS Time-to-event end-points currently used were identified from a literature review of pancreatic RCT trials (2006-2009). Academic research groups were contacted for participation in order to select clinicians and methodologists to participate in the pilot and scoring groups (>30 experts). A consensus was built after 2 rounds of the modified Delphi formal consensus approach with the Rand scoring methodology (range: 1-9). RESULTS For pancreatic cancer, 14 time to event end-points and 25 distinct event types applied to two settings (detectable disease and/or no detectable disease) were considered relevant and included in the questionnaire sent to 52 selected experts. Thirty experts answered both scoring rounds. A total of 204 events distributed over the 14 end-points were scored. After the first round, consensus was reached for 25 items; after the second consensus was reached for 156 items; and after the face-to-face meeting for 203 items. CONCLUSION The formal consensus approach reached the elaboration of guidelines for standardised definitions of time-to-event end-points allowing cross-comparison of RCTs in pancreatic cancer.
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Affiliation(s)
- Franck Bonnetain
- Methodology and Quality of Life Unit in Cancer, EA 3181, University Hospital of Besançon and CTD-INCa Gercor, UNICNCER GERICO, Besançon, France.
| | - Bert Bonsing
- Leiden University Medical Center, Leiden, Netherlands
| | - Thierry Conroy
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France
| | | | - Bengt Glimelius
- Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden
| | | | | | | | - Thomas Aparicio
- Gastroenterology Department, Avicenne Hospital, Paris 13, Bobigny, France
| | - Daniela Aust
- Institute for Pathology, University Hospital Carl-Gustav-Carus, Dresden, Germany
| | - Claudio Bassi
- Surgical and Gastroenterological Department, Endocrine and Pancreatic Unit, Hospital of 'G.B.Rossi', University of Verona, Italy
| | - Virginie Berger
- Institut de Cancérologie de l'Ouest - Centre Paul Papin Centre de Lutte Contre le Cancer (CLCC), Angers, France
| | | | - Benoist Chibaudel
- Oncology Department, Hôpital Saint-Antoine & CTD-INCa GERCOR, Assistance Publique des Hôpitaux de Paris, UPMC Paris VI, Paris, France
| | - Laeticia Dahan
- Gastroenterology Department, Hopital la Timone, Assitance publique des Hopitaux de Marseille, Marseille, France
| | - Aimery De Gramont
- Oncology Department, Hôpital Saint-Antoine & CTD-INCa GERCOR, Assistance Publique des Hôpitaux de Paris, UPMC Paris VI, Paris, France
| | | | | | - Michel Ducreux
- Department of Gastroenterology, Institut Gustave Roussy, Villejuif, France
| | - Jocelyn Gal
- Biostatistician, Biostatistics Unit, Centre Antoine Lacassagne, Nice, France
| | - Erich Gerber
- Department of Radiotherapy, Institut fuer Radioonkologie, Vienna, Austria
| | - Paula Ghaneh
- Department of Surgical Oncology, Royal Liverpool Hospital, United Kingdom
| | - Pascal Hammel
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Alain Hendlisz
- Digestive Oncology and Gastro-enterology Department, Jules Bordet Institute, Brussels, Belgium
| | | | - Roberto Labianca
- Medical Oncology Unit, Ospedali Riuniti di Bergamo, Bergame, Italy
| | - Aurelien Latouche
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Biostatistics Team, Villejuif, France
| | - Manfred Lutz
- Gastroenterology Department, Caritas Hospital, Saarbrücken, Germany
| | - Teresa Macarulla
- Department of the Gastrointestinal Tumors and Phase I Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - David Malka
- Department of Gastroenterology, Institut Gustave Roussy, Villejuif, France
| | | | - Emmanuel Mitry
- Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France
| | - John Neoptolemos
- Division of Surgery and Oncology at the University of Liverpool and Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Patrick Pessaux
- Department of Digestive Surgery, Universitu Hospital Strasbourg, France
| | - Alain Sauvanet
- Department of Hepato-pancreatic and Biliary Surgery, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Josep Tabernero
- Department of the Gastrointestinal Tumors and Phase I Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Julien Taieb
- Department of Hepato-gastroenterology and Digestive Oncology, Georges Pompidou European hospital, Paris, France
| | - Geertjan van Tienhoven
- Department of Radiation Oncology, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Sophie Gourgou-Bourgade
- Institut Du Cancer de Montpellier, Comprehensive Cancer Centre, and Data Center for Cancer Clinical Trials, CTD-INCa, Montpellier, France
| | - Carine Bellera
- Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Centre, Bordeaux, France; Data Center for Cancer Clinical Trials, CTD-INCa, Bordeaux, France; INSERM, Centre d'Investigation Clinique - Épidémiologie Clinique CIC-EC 7, F-33000 Bordeaux, France
| | - Simone Mathoulin-Pélissier
- Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Centre, Bordeaux, France; Data Center for Cancer Clinical Trials, CTD-INCa, Bordeaux, France; INSERM, Centre d'Investigation Clinique - Épidémiologie Clinique CIC-EC 7, F-33000 Bordeaux, France
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27
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Sultana A, Jackson RJ, Cox T, Palmer D, Neoptolemos J, Ghaneh P. Chemotherapy, radiotherapy, chemoradiotherapy and combination therapy in localised and locally advanced pancreatic cancer. Hippokratia 2014. [DOI: 10.1002/14651858.cd011044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Asma Sultana
- University of Liverpool; Department of Molecular and Clinical Cancer Medicine; Liverpool UK
| | - Richard J Jackson
- Liverpool University; North West Surgical Trials Centre; Brownlow Street Liverpool UK L69 3GL
| | - Trevor Cox
- University of Liverpool; Liverpool Cancer Research UK Cancer Trials Unit; Liverpool UK
| | - Daniel Palmer
- University of Liverpool; Department of Molecular and Clinical Cancer Medicine; Liverpool UK
| | - John Neoptolemos
- University of Liverpool; Department of Molecular and Clinical Cancer Medicine; Liverpool UK
| | - Paula Ghaneh
- University of Liverpool; Department of Molecular and Clinical Cancer Medicine; Liverpool UK
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28
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Middleton G, Silcocks P, Cox T, Valle J, Wadsley J, Propper D, Coxon F, Ross P, Madhusudan S, Roques T, Cunningham D, Falk S, Wadd N, Harrison M, Corrie P, Iveson T, Robinson A, McAdam K, Eatock M, Evans J, Archer C, Hickish T, Garcia-Alonso A, Nicolson M, Steward W, Anthoney A, Greenhalf W, Shaw V, Costello E, Naisbitt D, Rawcliffe C, Nanson G, Neoptolemos J. Gemcitabine and capecitabine with or without telomerase peptide vaccine GV1001 in patients with locally advanced or metastatic pancreatic cancer (TeloVac): an open-label, randomised, phase 3 trial. Lancet Oncol 2014; 15:829-40. [PMID: 24954781 DOI: 10.1016/s1470-2045(14)70236-0] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to assess the efficacy and safety of sequential or simultaneous telomerase vaccination (GV1001) in combination with chemotherapy in patients with locally advanced or metastatic pancreatic cancer. METHODS TeloVac was a three-group, open-label, randomised phase 3 trial. We recruited patients from 51 UK hospitals. Eligible patients were treatment naive, aged older than 18 years, with locally advanced or metastatic pancreatic ductal adenocarcinoma, and Eastern Cooperative Oncology Group performance status of 0-2. Patients were randomly assigned (1:1:1) to receive either chemotherapy alone, chemotherapy with sequential GV1001 (sequential chemoimmunotherapy), or chemotherapy with concurrent GV1001 (concurrent chemoimmunotherapy). Treatments were allocated with equal probability by means of computer-generated random permuted blocks of sizes 3 and 6 in equal proportion. Chemotherapy included six cycles of gemcitabine (1000 mg/m(2), 30 min intravenous infusion, at days 1, 8, and 15) and capecitabine (830 mg/m(2) orally twice daily for 21 days, repeated every 28 days). Sequential chemoimmunotherapy included two cycles of combination chemotherapy, then an intradermal lower abdominal injection of granulocyte-macrophage colony-stimulating factor (GM-CSF; 75 μg) and GV1001 (0·56 mg; days 1, 3, and 5, once on weeks 2-4, and six monthly thereafter). Concurrent chemoimmunotherapy included giving GV1001 from the start of chemotherapy with GM-CSF as an adjuvant. The primary endpoint was overall survival; analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN4382138. FINDINGS The first patient was randomly assigned to treatment on March 29, 2007, and the trial was terminated on March 27, 2011. Of 1572 patients screened, 1062 were randomly assigned to treatment (358 patients were allocated to the chemotherapy group, 350 to the sequential chemoimmunotherapy group, and 354 to the concurrent chemoimmunotherapy group). We recorded 772 deaths; the 290 patients still alive were followed up for a median of 6·0 months (IQR 2·4-12·2). Median overall survival was not significantly different in the chemotherapy group than in the sequential chemoimmunotherapy group (7·9 months [95% CI 7·1-8·8] vs 6·9 months [6·4-7·6]; hazard ratio [HR] 1·19, 98·25% CI 0·97-1·48, p=0·05), or in the concurrent chemoimmunotherapy group (8·4 months [95% CI 7·3-9·7], HR 1·05, 98·25% CI 0·85-1·29, p=0·64; overall log-rank of χ(2)2df=4·3; p=0·11). The commonest grade 3-4 toxic effects were neutropenia (68 [19%] patients in the chemotherapy group, 58 [17%] patients in the sequential chemoimmunotherapy group, and 79 [22%] patients in the concurrent chemoimmunotherapy group; fatigue (27 [8%] in the chemotherapy group, 35 [10%] in the sequential chemoimmunotherapy group, and 44 [12%] in the concurrent chemoimmunotherapy group); and pain (34 [9%] patients in the chemotherapy group, 39 [11%] in the sequential chemoimmunotherapy group, and 41 [12%] in the concurrent chemoimmunotherapy group). INTERPRETATION Adding GV1001 vaccination to chemotherapy did not improve overall survival. New strategies to enhance the immune response effect of telomerase vaccination during chemotherapy are required for clinical efficacy. FUNDING Cancer Research UK and KAEL-GemVax.
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Affiliation(s)
| | - Paul Silcocks
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Trevor Cox
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Juan Valle
- Manchester Academic Health Sciences Centre, Christie Hospital NHS Foundation Trust and University of Manchester, Manchester UK
| | - Jonathan Wadsley
- Weston Park Hospital, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - David Propper
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Fareeda Coxon
- Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Paul Ross
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tom Roques
- Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - David Cunningham
- The Royal Marsden, The Royal Marsden NHS Foundation Trust, London, UK
| | - Stephen Falk
- Bristol Haematology And Oncology Centre, University Hospital Bristol NHS Foundation Trust, Bristol, UK
| | - Nick Wadd
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middleborough, UK
| | - Mark Harrison
- Mount Vernon Hospital, The Hillingdon Hospitals NHS Foundation Trust, Northwood, UK
| | - Pippa Corrie
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tim Iveson
- Southampton General Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Angus Robinson
- Conquest Hospital, East Sussex Healthcare NHS Trust, The Ridge, St Leonards-on-Sea, East Sussex, UK
| | - Karen McAdam
- Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Edith, Cavell Campus, Peterborough, UK
| | - Martin Eatock
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Jeff Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Caroline Archer
- Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, UK
| | - Tamas Hickish
- Royal Bournemouth Hospital, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | | | | | - William Steward
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Alan Anthoney
- St James University Hospital, The Leeds Teaching Hospital Trust, Beckett Street, Leeds, UK
| | - William Greenhalf
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Victoria Shaw
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Eithne Costello
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Dean Naisbitt
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Charlotte Rawcliffe
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - Gemma Nanson
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK
| | - John Neoptolemos
- Liverpool Cancer Research UK Cancer Trials Unit and GCLP Facility, University of Liverpool, Liverpool, UK.
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Athwal T, Huang W, Mukherjee R, Latawiec D, Chvanov M, Clarke R, Smith K, Campbell F, Merriman C, Criddle D, Sutton R, Neoptolemos J, Vlatković N. Expression of human cationic trypsinogen (PRSS1) in murine acinar cells promotes pancreatitis and apoptotic cell death. Cell Death Dis 2014; 5:e1165. [PMID: 24722290 PMCID: PMC5424103 DOI: 10.1038/cddis.2014.120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 12/17/2013] [Accepted: 12/19/2013] [Indexed: 02/05/2023]
Abstract
Hereditary pancreatitis (HP) is an autosomal dominant disease that displays the features of both acute and chronic pancreatitis. Mutations in human cationic trypsinogen (PRSS1) are associated with HP and have provided some insight into the pathogenesis of pancreatitis, but mechanisms responsible for the initiation of pancreatitis have not been elucidated and the role of apoptosis and necrosis has been much debated. However, it has been generally accepted that trypsinogen, prematurely activated within the pancreatic acinar cell, has a major role in the initiation process. Functional studies of HP have been limited by the absence of an experimental system that authentically mimics disease development. We therefore developed a novel transgenic murine model system using wild-type (WT) human PRSS1 or two HP-associated mutants (R122H and N29I) to determine whether expression of human cationic trypsinogen in murine acinar cells promotes pancreatitis. The rat elastase promoter was used to target transgene expression to pancreatic acinar cells in three transgenic strains that were generated: Tg(Ela-PRSS1)NV, Tg(Ela-PRSS1*R122H)NV and Tg(Ela-PRSS1*N29I)NV. Mice were analysed histologically, immunohistochemically and biochemically. We found that transgene expression is restricted to pancreatic acinar cells and transgenic PRSS1 proteins are targeted to the pancreatic secretory pathway. Animals from all transgenic strains developed pancreatitis characterised by acinar cell vacuolisation, inflammatory infiltrates and fibrosis. Transgenic animals also developed more severe pancreatitis upon treatment with low-dose cerulein than controls, displaying significantly higher scores for oedema, inflammation and overall histopathology. Expression of PRSS1, WT or mutant, in acinar cells increased apoptosis in pancreatic tissues and isolated acinar cells. Moreover, studies of isolated acinar cells demonstrated that transgene expression promotes apoptosis rather than necrosis. We therefore conclude that expression of WT or mutant human PRSS1 in murine acinar cells induces apoptosis and is sufficient to promote spontaneous pancreatitis, which is enhanced in response to cellular insult.
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Affiliation(s)
- T Athwal
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - W Huang
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK
- Sichuan Provincial Pancreatitis Centre, West China Hospital, Sichuan University, Chengdu, China
| | - R Mukherjee
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK
| | - D Latawiec
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK
| | - M Chvanov
- Department of Cellular and Molecular Physiology, Institute for Translational Medicine, University of Liverpool, Liverpool, UK
| | - R Clarke
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - K Smith
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK
| | - C Merriman
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - D Criddle
- Department of Cellular and Molecular Physiology, Institute for Translational Medicine, University of Liverpool, Liverpool, UK
| | - R Sutton
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK
| | - J Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
- Liverpool NIHR Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool, UK
| | - N Vlatković
- Department of Molecular and Clinical Cancer Medicine, Institute for Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
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Burdyga A, Conant A, Haynes L, Zhang J, Jalink K, Sutton R, Neoptolemos J, Costello E, Tepikin A. cAMP inhibits migration, ruffling and paxillin accumulation in focal adhesions of pancreatic ductal adenocarcinoma cells: effects of PKA and EPAC. Biochim Biophys Acta 2013; 1833:2664-2672. [PMID: 23797058 PMCID: PMC3898478 DOI: 10.1016/j.bbamcr.2013.06.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 12/11/2022]
Abstract
We demonstrated that increasing intracellular cAMP concentrations result in the inhibition of migration of PANC-1 and other pancreatic ductal adenocarcinoma (PDAC) cell types. The rise of cAMP was accompanied by rapid and reversible cessation of ruffling, by inhibition of focal adhesion turnover and by prominent loss of paxillin from focal adhesions. All these phenomena develop rapidly suggesting that cAMP effectors have a direct influence on the cellular migratory apparatus. The role of two primary cAMP effectors, exchange protein activated by cAMP (EPAC) and protein kinase A (PKA), in cAMP-mediated inhibition of PDAC cell migration and migration-associated processes was investigated. Experiments with selective activators of EPAC and PKA demonstrated that the inhibitory effect of cAMP on migration, ruffling, focal adhesion dynamics and paxillin localisation is mediated by PKA, whilst EPAC potentiates migration.
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Affiliation(s)
- Alex Burdyga
- Department of Cellular and Molecular Physiology, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK
| | - Alan Conant
- Department of Cellular and Molecular Physiology, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK
| | - Lee Haynes
- Department of Cellular and Molecular Physiology, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK
| | - Jin Zhang
- The Johns Hopkins University School of Medicine, Department of Neuroscience, 725 North Wolfe Street, Baltimore, MD 21205, USA
| | - Kees Jalink
- The Netherlands Cancer Institute, Cell Biology I, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Robert Sutton
- NIHR Liverpool Pancreas Biomedical Research Unit, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK
| | - John Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, 6th Floor, Duncan Building, Daulby Street, Liverpool, L69 3GA, UK
| | - Eithne Costello
- NIHR Liverpool Pancreas Biomedical Research Unit, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK; Department of Molecular and Clinical Cancer Medicine, 6th Floor, Duncan Building, Daulby Street, Liverpool, L69 3GA, UK
| | - Alexei Tepikin
- Department of Cellular and Molecular Physiology, The University of Liverpool, Crown Street, Liverpool L69 3BX, UK.
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Rachakonda S, Bauer A, Canzian F, Scarpa A, Neoptolemos J, Werner J, Giese N, Heller A, Hoheisel J, Kumar R. 703 K-Ras and CDKN2a Mutations in Pancreatic Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bauer AS, Keller A, Costello E, Greenhalf W, Bier M, Borries A, Beier M, Neoptolemos J, Büchler M, Werner J, Giese N, Hoheisel JD. Diagnosis of pancreatic ductal adenocarcinoma and chronic pancreatitis by measurement of microRNA abundance in blood and tissue. PLoS One 2012; 7:e34151. [PMID: 22511932 PMCID: PMC3325244 DOI: 10.1371/journal.pone.0034151] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 02/22/2012] [Indexed: 01/03/2023] Open
Abstract
A solid process for diagnosis could have a substantial impact on the successful treatment of pancreatic cancer, for which currently mortality is nearly identical to incidence. Variations in the abundance of all microRNA molecules from peripheral blood cells and pancreas tissues were analyzed on microarrays and in part validated by real-time PCR assays. In total, 245 samples from two clinical centers were studied that were obtained from patients with pancreatic ductal adenocarcinoma or chronic pancreatitis and from healthy donors. Utilizing the minimally invasive blood test, receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC) analysis demonstrated very high sensitivity and specificity of a distinction between healthy people and patients with either cancer or chronic pancreatitis; respective AUC values of 0.973 and 0.950 were obtained. Confirmative and partly even more discriminative diagnosis could be performed on tissue samples with AUC values of 1.0 and 0.937, respectively. In addition, discrimination between cancer and chronic pancreatitis was achieved (AUC = 0.875). Also, several miRNAs were identified that exhibited abundance variations in both tissue and blood samples. The results could have an immediate diagnostic value for the evaluation of tumor reoccurrence in patients, who have undergone curative surgical resection, and for people with a familial risk of pancreatic cancer.
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Affiliation(s)
- Andrea S Bauer
- Division of Functional Genome Analysis, Deutsches Krebsforschungszentrum, Heidelberg, Germany
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Abstract
Follow the guidelines on how to do this properly
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Affiliation(s)
- E Costello
- National Institute for Health Research Pancreas Biomedical Research Unit and Division of Surgery and Oncology, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 3GA, UK
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Tonack S, Patel S, Jalali M, Nedjadi T, Jenkins RE, Goldring C, Neoptolemos J, Costello E. Tetracycline-inducible protein expression in pancreatic cancer cells: Effects of CapG overexpression. World J Gastroenterol 2011; 17:1947-60. [PMID: 21528072 PMCID: PMC3082747 DOI: 10.3748/wjg.v17.i15.1947] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/19/2010] [Accepted: 10/26/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish stable tetracycline-inducible pancreatic cancer cell lines.
METHODS: Suit-2, MiaPaca-2, and Panc-1 cells were transfected with a second generation reverse tetracycline-controlled transactivator protein (rtTA2S-M2), under the control of either a cytomegalovirus (CMV) or a chicken β-actin promoter, and the resulting clones were characterised.
RESULTS: Use of the chicken (β-actin) promoter proved superior for both the production and maintenance of doxycycline-inducible cell lines. The system proved versatile, enabling transient inducible expression of a variety of genes, including GST-P, CYP2E1, S100A6, and the actin capping protein, CapG. To determine the physiological utility of this system in pancreatic cancer cells, stable inducible CapG expressors were established. Overexpressed CapG was localised to the cytoplasm and the nuclear membrane, but was not observed in the nucleus. High CapG levels were associated with enhanced motility, but not with changes to the cell cycle, or cellular proliferation. In CapG-overexpressing cells, the levels and phosphorylation status of other actin-moduating proteins (Cofilin and Ezrin/Radixin) were not altered. However, preliminary analyses suggest that the levels of other cellular proteins, such as ornithine aminotransferase and enolase, are altered upon CapG induction.
CONCLUSION: We have generated pancreatic-cancer derived cell lines in which gene expression is fully controllable.
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Ripka S, Neesse A, Riedel J, Bug E, Aigner A, Poulsom R, Fulda S, Neoptolemos J, Greenhalf W, Barth P, Gress TM, Michl P. CUX1: target of Akt signalling and mediator of resistance to apoptosis in pancreatic cancer. Gut 2010; 59:1101-10. [PMID: 20442202 DOI: 10.1136/gut.2009.189720] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS The transcription factor CUX1 is known as a regulator of cell differentiation and cell cycle progression. Previously, CUX1 was identified as a modulator of invasiveness in various cancers. Based on expression profiles suggesting a role for CUX1 in mediating chemoresistance, the aim of this study was to characterise the effect of CUX1 on apoptosis as well as its regulation by signalling pathways modulating drug resistance in pancreatic cancer. METHODS The effect of CUX1 on TRAIL- (tumour necrosis factor-related apoptosis-inducing ligand) and drug-induced apoptosis was analysed using overexpression and knock-down strategies. Regulation of CUX1 by phosphatidylinositol-3-kinase (PI3K)/Akt signalling was examined at the mRNA and protein level. The effect of CUX1 knock-down by nanoparticle-complexed small interfering RNA (siRNA) in vivo was analysed in a murine xenograft model. Furthermore, CUX1 RNA and protein expression was evaluated in human pancreatic cancer and adjacent normal tissues. RESULTS Knock-down of CUX1 resulted in significantly enhanced TRAIL- and drug-induced apoptosis, associated with increased PARP (poly ADP-ribose polymerase) cleavage and caspase activity. Vice versa, overexpression of CUX1 inhibited apoptosis. CUX1 expression was induced by activation of Akt/protein kinase B signalling, and decreased by PI3K inhibitors. The antiapoptotic effect of CUX1 was associated with upregulation of BCL2 and downregulation of tumour necrosis factor alpha. CUX1 was significantly overexpressed in pancreatic cancers, as analysed by in situ hybridisation and immunohistochemistry. In vivo, silencing of CUX1 by intratumourally administered polyethylenimine-complexed siRNA led to reduced tumour growth and increased apoptosis in pancreatic cancer xenografts. CONCLUSION CUX1 was identified as an important mediator of tumour cell survival in pancreatic cancer in vitro and in vivo.
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Affiliation(s)
- S Ripka
- Department of Gastroenterology and Endocrinology, University Hospital, Philipps-University, Marburg, Germany
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Neoptolemos J. A49 Latest developments in pancreatic cancer. Eur J Oncol Nurs 2010. [DOI: 10.1016/s1462-3889(10)70060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Shukla PJ, Barreto SG, Fingerhut A, Bassi C, Büchler MW, Dervenis C, Gouma D, Izbicki JR, Neoptolemos J, Padbury R, Sarr MG, Traverso W, Yeo CJ, Wente MN. Toward improving uniformity and standardization in the reporting of pancreatic anastomoses: A new classification system by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2010; 147:144-53. [DOI: 10.1016/j.surg.2009.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 09/09/2009] [Indexed: 12/19/2022]
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Neoptolemos J, Büchler M, Stocken DD, Ghaneh P, Smith D, Bassi C, Moore M, Cunningham D, Dervenis C, Goldstein D. ESPAC-3(v2): A multicenter, international, open-label, randomized, controlled phase III trial of adjuvant 5-fluorouracil/folinic acid (5-FU/FA) versus gemcitabine (GEM) in patients with resected pancreatic ductal adenocarcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.18_suppl.lba4505] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4505 Background: Adjuvant 5-FU/FA (ESPAC-1 trial) and GEM (CONKO-001 trial) provide improved survival for patients with resected pancreatic cancer compared to no chemotherapy. The aim of the ESPAC-3 (v2) trial was to compare 5FU/FA vs GEM to identify if either adjuvant chemotherapy was associated with a significantly better survival. Methods: Patients with an R0/R1 resection for pancreatic ductal adenocarcinoma were randomized (stratified for resection margin status and country) <8 weeks of surgery to receive either 5FU/FA (FA, 20 mg/m2, iv bolus injection followed by 5-FU, 425 mg/m2, iv bolus injection given 1–5d every 28 days) or GEM (1,000mg/m2 iv infusion 1d, 8d and 15d every 4 weeks) for 6 months. The primary outcome measure was overall survival; the secondary measures were toxicity, progression free survival and quality of life. 1,030 patients were needed to detect a 10% difference in 2-year survival rates with 90% power. Results: 1,088 patients from 16 countries were randomized from July 2000 to Jan 2007 (5FU/FA = 551, GEM = 537). Median (range) age was 63 (31–85) years; 598 (55%) were men. Median tumor size was 30 (20–350) mm; 384 (35%) were R1 resections; 777 (72%) were node positive; and 263 (25%) were poorly differentiated tumors. Final analysis was carried out on an intention to treat basis with a minimum of 2 years follow-up after 753 (69%) patients had died. Median (IQR) follow-up of 335 alive patients was 34.2 (27.1–43.4) months, equal across treatment groups. Median survival from resection of patients treated with 5FU/FA was 23.0 (95% CI: 21.1, 25.0) months and for patients treated with GEM this was 23.6 (95%CI: 21.4, 26.4) months. Log-rank analysis revealed no statistically significant difference in survival estimates between the treatment groups (c2LR=0.7, p=0.39, HRGEM=0.94 (95%CI: 0.81, 1.08)). There was no significant difference in the effect of treatment across subgroups according to R status (test of heterogeneity c21=0.3, p=0.56). Conclusions: This is the largest adjuvant trial ever conducted for pancreatic ductal adenocarcinoma and showed no significant difference in survival between adjuvant 5FU/FA and adjuvant GEM. [Table: see text]
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Affiliation(s)
- J. Neoptolemos
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - M. Büchler
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. D. Stocken
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - P. Ghaneh
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Smith
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - C. Bassi
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - M. Moore
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Cunningham
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - C. Dervenis
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Goldstein
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
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Neoptolemos J, Büchler M, Stocken DD, Ghaneh P, Smith D, Bassi C, Moore M, Cunningham D, Dervenis C, Goldstein D. ESPAC-3(v2): A multicenter, international, open-label, randomized controlled phase III trial of adjuvant 5-fluorouracil/folinic acid (5-FU/FA) versus gemcitabine (GEM) in patients with resected pancreatic ductal adenocarcinoma. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.lba4505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4505 The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology. [Table: see text]
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Affiliation(s)
- J. Neoptolemos
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - M. Büchler
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. D. Stocken
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - P. Ghaneh
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Smith
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - C. Bassi
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - M. Moore
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Cunningham
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - C. Dervenis
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
| | - D. Goldstein
- University of Liverpool, Liverpool, United Kingdom; University of Heidelberg, Heidelberg, Germany; University of Birmingham, Birmingham, United Kingdom; Clatterbridge Centre for Oncology, Wirral, United Kingdom; University of Verona, Verona, Italy; Princess Margaret Hospital, Toronto, ON, Canada; Royal Marsden Hospital, London, United Kingdom; Agia Olga Hospital, Athens, Greece; Prince of Wales Hospital, Sydney, Australia
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Abstract
PURPOSE OF REVIEW To discuss how to recognise and manage high-risk individuals. RECENT FINDINGS Publication of initial results of screening for pancreatic cancer from US centres. Several masses and premalignant lesions have been detected, but the detection of the first pancreatic cancer through an organised study of screening has yet to be published. There has been progress in risk stratification; the role of diabetes in predisposing for cancer has been characterised and molecular modalities have been published which could be used in conjunction with imaging in a screening programme. A mutation in the palladin gene was found to segregate with the disease in a family with a clear predisposition for pancreatic cancer, though this has yet to be found in other such kindreds. SUMMARY Significant challenges remain to be solved in screening for early pancreatic cancer. Risk stratification needs to be improved and high-risk patients included in research-based screening programmes. It will be impossible to confirm that screening can detect cancers early enough for curative treatment until the results of these prospective studies become available.
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Affiliation(s)
- W Greenhalf
- Division of Surgery, University of Liverpool, Liverpool, UK
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Abstract
PURPOSE To describe the need for multinational registries of families at high risk of pancreatic cancer and the issues surrounding identification of such families. RESULTS A consensus position was published describing surveillance of individuals at high risk of pancreatic cancer. Hereditary pancreatitis patients, people with Peutz-Jeghers syndrome, individuals with CDKN2A or BRCA1/2 mutations with a family history of pancreatic cancer and kindred with multiple pancreatic cancers were considered suitable for research-based screening. Mutations responsible for familial predisposition are mostly unknown, although BRCA2 mutations have been identified in some families and a mutation in the palladin gene has been shown to segregate with pancreatic cancer in one kindred. Specific autosomal dominant inheritance of pancreatic cancer risk seems to involve anticipation; this finding aids identification of families and determination of individual risk. Diabetes mellitus is an early symptom of pancreatic cancer, but recent publications suggest that it may not be a significant predisposing factor; this remains controversial. However, in the context of hereditary pancreatitis, diabetes probably does predispose to pancreatic cancer as shown in a recent description of French families. CONCLUSION Appropriate inclusion of patients within registries of high-risk families provides a framework for secondary screening and research on risk stratification and early tumorigenesis. and IAP.
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Affiliation(s)
- William Greenhalf
- Division of Surgery, University of Liverpool, Royal Liverpool University Hospital, Liverpool, UK.
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Abstract
Progress in the diagnosis and management plan for this pancreatic neoplasm
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/surgery
- Biomarkers, Tumor/analysis
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Cell Transformation, Neoplastic/pathology
- Humans
- Neoplasm Invasiveness
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Treatment Outcome
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Affiliation(s)
- Paula Ghaneh
- Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Royal Liverpool University Hospital, Liverpool L69 3GA, UK
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Abstract
Pancreatic cancer is a largely chemo-resistant disease with a poor prognosis. Despite the adoption of gemcitabine monotherapy as a standard of care, outcomes remain poor. Until recently randomized phase III studies have not demonstrated superiority of various cytotoxic combinations or a number of the newer biologic targeted drugs. The situation has changed with capecitabine and erlotinib, either of which in combination with gemcitabine produces a small increase in survival. Erlotinib is a small molecule tyrosine kinase inhibitor against epidermal growth factor receptor which has an important role in the molecular pathogenesis of pancreatic cancer. In both pre-clinical and early clinical evaluation it has shown anti-tumor activity against pancreatic cancer in combination with gemcitabine. A randomized phase III study in locally advanced and metastatic pancreatic cancer has shown a survival advantage for the combination of gemcitabine plus erlotinib over gemcitabine alone. The rationale for the clinical development of erlotinib in combination with gemcitabine in pancreatic cancer culminating in this randomized trial, together with pharmacologic, toxicity and patient selection considerations form the focus of this review.
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Affiliation(s)
| | - John Neoptolemos
- School of Cancer Studies, University of Liverpool, Royal Liverpool University HospitalLiverpool, UK
| | - David Cunningham
- Gastrointestinal and Lymphoma Units, Royal Marsden HospitalSutton, Surrey, UK
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Abstract
Pancreatic cancer is a difficult cancer to treat effectively. Only a small proportion of patients are suitable for resection. The long-term survival following resection alone is between 10 and 18%. Adjuvant therapy aims to improve this outcome. There have been five fully reported adjuvant trials in pancreatic cancer. The largest study is the ESPAC-1 trial which demonstrated a significant survival benefit for 5-fluorouracil chemotherapy and no survival benefit for adjuvant chemoradiotherapy. A meta-analysis of these trials has confirmed the survival benefit for chemotherapy and thus adjuvant chemotherapy is recommended as the standard of care following pancreatic resection. There are further large studies which will also help to further define the optimum adjuvant chemotherapy in these patients.
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Affiliation(s)
- Paula Ghaneh
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Abstract
Exocrine pancreatic cancer (pancreatic ductal adenocarcinoma) is one of the leading causes of cancer deaths in the western world, accounting for 5% of all cancer-related deaths. Only a small percentage of patients with pancreatic cancer are able to undergo potentially curative resection, even in specialized centres, and prognosis remains poor after successful surgery. Over the last few years efforts have been directed towards the development of adjuvant therapies in attempts to improve outcome. The main trials of adjuvant chemotherapy, chemoradiotherapy and chemoradiotherapy with follow-on chemotherapy are described in this paper, followed by the results of the ESPAC-1 trial and the status of ESPAC-2 and -3 trials.
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Affiliation(s)
- Asma Sultana
- Division of Surgery and Oncology, University of LiverpoolLiverpoolUK
| | - John Neoptolemos
- Division of Surgery and Oncology, University of LiverpoolLiverpoolUK
| | - Paula Ghaneh
- Division of Surgery and Oncology, University of LiverpoolLiverpoolUK
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Neoptolemos J. Diseases of the gastrointestinal tract and liver. 2nd ed. D. J. C. Shearman, N. D. C. Finlayson, D. C. Carter. 280 × 230 mm. Pp. 1356. Illustrated. Edinburgh: Churchill Livingstone. £95.00. Br J Surg 2005. [DOI: 10.1002/bjs.1800770342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Neoptolemos
- Department of Surgery, Dudley Road Hospital, Birmingham B18 7QH, UK
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Neoptolemos J. Intraoperative radiation therapy. R. R. Dobelbewer, M. Abe. 260 × 185 mm. Pp. 405. Illustrated. USA: CRC Press. £127.50 hardback. Br J Surg 2005. [DOI: 10.1002/bjs.1800770838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Crnogorac-Jurcevic T, Gangeswaran R, Bhakta V, Capurso G, Lattimore S, Akada M, Sunamura M, Prime W, Campbell F, Brentnall TA, Costello E, Neoptolemos J, Lemoine NR. Proteomic analysis of chronic pancreatitis and pancreatic adenocarcinoma. Gastroenterology 2005; 129:1454-63. [PMID: 16285947 DOI: 10.1053/j.gastro.2005.08.012] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 08/03/2005] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS Markers to differentiate among pancreatic adenocarcinoma, chronic pancreatitis, and normal pancreas would be of significant clinical utility. This study was therefore designed to analyze the proteome of such specimens and identify new candidate proteins for differential diagnosis. METHODS A PowerBlot analysis with more than 900 well-characterized antibodies was performed with tissue specimens from patients with chronic pancreatitis, pancreatic adenocarcinoma, and normal pancreas. Differential expression of selected proteins was confirmed on a larger scale by quantitative reverse transcription-polymerase chain reaction and immunohistochemistry using tissue arrays. RESULTS A total of 30 and 102 proteins showed significant deregulation between normal pancreas when compared with chronic pancreatitis and pancreatic adenocarcinoma, respectively, and although a substantial proportion were found similarly dysregulated in both chronic pancreatitis and pancreatic adenocarcinoma, several proteins were identified as potential disease-specific markers. CONCLUSIONS A large number of proteins are differentially expressed in chronic pancreatitis and pancreatic adenocarcinoma compared with normal pancreas. Among these, expression analysis of UHRF1, ATP7A, and aldehyde oxidase 1 in combination could potentially provide a useful additional diagnostic tool for fine-needle aspirated or cytological specimens obtained during endoscopic investigations.
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Affiliation(s)
- Tatjana Crnogorac-Jurcevic
- Molecular Oncology Unit, Cancer Research UK, Barts and The London School of Medicine and Dentistry, John Vane Science Centre, Charterhouse Square, London, United Kingdom.
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Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005. [PMID: 16003309 DOI: 10.1016/j.surg.2005.05.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is still regarded as a major complication. The incidence of POPF varies greatly in different reports, depending on the definition applied at each surgical center. Our aim was to agree upon an objective and internationally accepted definition to allow comparison of different surgical experiences. METHODS An international panel of pancreatic surgeons, working in well-known, high-volume centers, reviewed the literature on the topic and worked together to develop a simple, objective, reliable, and easy-to-apply definition of POPF, graded primarily on clinical impact. RESULTS A POPF represents a failure of healing/sealing of a pancreatic-enteric anastomosis or a parenchymal leak not directly related to an anastomosis. An all-inclusive definition is a drain output of any measurable volume of fluid on or after postoperative day 3 with an amylase content greater than 3 times the serum amylase activity. Three different grades of POPF (grades A, B, C) are defined according to the clinical impact on the patient's hospital course. CONCLUSIONS The present definition and clinical grading of POPF should allow realistic comparisons of surgical experiences in the future when new techniques, new operations, or new pharmacologic agents that may impact surgical treatment of pancreatic disorders are addressed.
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Affiliation(s)
- Claudio Bassi
- Surgical and Gastroenterological Department, Hospital G.B. Rossi, University of Verona, Italy.
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