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1.
Atsushi Kanno Atsushi Masamune Keiji Hanada Hiroyuki Maguchi Yasuhiro Shimizu Toshiharu Ueki Osamu Hasebe Takao Ohtsuka Masafumi Nakamura Mamoru Takenaka Masayuki Kitano Masataka Kikuyama Toshifumi Gabata Koji Yoshida Tamito Sasaki Masahiro Serikawa Toru Furukawa Akio Yanagisawa Tooru Shimosegawa 《Pancreatology》2018,18(1):61-67
Background/Objectives
The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan.Methods
We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis.Results
Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases.Conclusions
This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas. 相似文献2.
Yosuke Yagi Atsuhiro Masuda Yoh Zen Hideyuki Shiomi Hirochika Toyama Keitaro Sofue Mamoru Takenaka Takashi Kobayashi Takashi Nakagawa Kodai Yamanaka Takuya Ikegawa Namiko Hoshi Masaru Yoshida Yoshifumi Arisaka Yoshihiro Okabe Hiromu Kutsumi Takumi Fukumoto Yonson Ku Takeshi Azuma 《Pancreatology》2018,18(1):54-60
Background
Inflammation-induced carcinogenesis in pancreatic ductal adenocarcinoma (PDAC) has been reported; however, its involvement in PDAC with intraductal papillary mucinous neoplasm (IPMN) remains unclear. We herein investigated the relationship between pancreatic atrophy and inflammation and the incidence of PDAC concomitant with IPMN.Methods
This study included 178 consecutive patients who underwent surgical resection for PDAC with IPMN (N?=?21) and IPMN (N?=?157) between April 2001 and October 2016. A multivariable logistic regression analysis was conducted to assess the relationship between pancreatic inflammation and atrophy and the incidence of PDAC concomitant with IPMN, with adjustments for clinical characteristics and imaging features. Pathological pancreatic inflammation and atrophy were evaluated in resected specimens.Results
High degrees of pancreatic inflammation and atrophy were not associated with the incidence of PDAC with IPMN (multivariable odds ratio [OR]?=?0.5, 95% confidence interval [CI]?=?0.07 to 3.33, P?=?.52, adjusted by clinical characteristics, OR?=?0.9, 95% CI?=?0.10 to 5.86, P?=?.91, adjusted by imaging studies; OR?=?0.2, 95% CI?=?0.009 to 1.31, P?=?.10, adjusted by clinical characteristics, OR?=?0.2, 95% CI?=?0.01 to 1.43, P?=?.12, adjusted by imaging studies, respectively).Conclusions
Pancreatic inflammation and atrophy were not associated with pancreatic cancer concomitant with IPMN. 相似文献3.
Julia Tuchalska-Czuroń Jacek Lenart Justyna Augustyniak Marek Durlik 《Pancreatology》2019,19(1):73-79
Background
The aim of this prospective study was to investigate mitochondrial DNA (mtDNA) copy number in a group of resectable pancreatic cancer (PC) tumor tissues and adjacent normal pancreatic tissues, and to explore the correlation between the mtDNA content in tissues and the clinicopathological parameters and the overall survival.Methods
Relative mtDNA copy number was measured by the quantitative PCR-based assay. The tumors specimens (n?=?43) originated from the patients with pathologically confirmed pancreatic ductal adenocarcinoma who did not receive any neoadjuvant systemic therapy. The adjacent normal pancreatic tissue samples (n?=?31) were obtained from surgical margins.Results
mtDNA copy number was significantly lower in PC tissue (P?<?0.001) compared to adjacent normal pancreatic tissue. Jonckheere-Terpstra trend testing indicated a statistically significant decrease in median mtDNA copy number across the differentiation (adjacent normal pancreatic tissue, low-grade, intermediate-grade, high-grade cancer), P?<?0.001. However, the survival analyses failed to show a significant difference in survival between patients with high and low mtDNA copy number.Conclusions
To the best of our knowledge, we provided the first evidence that mitochondrial DNA copy number was significantly lower in pancreatic cancer tissue (P?<?0.001) compared to adjacent normal pancreatic tissue. Also, we demonstrated that mitochondrial copy number was not a significant marker for predicting prognosis in resectable pancreatic cancer. 相似文献4.
Kohei Yamakawa Atsuhiro Masuda Takashi Nakagawa Hideyuki Shiomi Hirochika Toyama Mamoru Takenaka Arata Sakai Takashi Kobayashi Masahiro Tsujimae Shigeto Ashina Yasutaka Yamada Takeshi Tanaka Shunta Tanaka Ryota Nakano Yu Sato Takuya Ikegawa Manabu Kurosawa Seiji Fujigaki Yuzo Kodama 《Pancreatology》2019,19(3):424-428
Objectives
Pancreatic juice cytology (PJC) for intraductal papillary mucinous neoplasm (IPMN) is a possible tool to enhance preoperative diagnostic ability by improving risk classification for malignant IPMN, but its efficacy is controversial. This study evaluated the efficacy of PJC for risk classification according to international guidelines.Methods
We retrospectively analyzed 127 IPMN patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) preoperatively. PJC was performed in 125 of the 127 cases. High-risk stigmata (HRS, n?=?57), worrisome features (WF, n?=?64), and other characteristics (n?=?6) were classified according to the 2017 international guidelines.Results
Among the 127 IPMN patients, 71 (55.9%) had malignant IPMN (invasive and non-invasive intraductal papillary mucinous carcinoma). The accuracy of WF for classifying malignant IPMN was increased by the addition of PJC, but the accuracy of HRS was not (WF to WF + PJC: 33.1% [42/127] to 48.8% [61/125], HRS to HRS + PJC: 65.4% [83/127] to 52.8% [66/125]). Post-ERCP pancreatitis (PEP) occurred in 32 (25.2%) of 127 IPMN patients. Severe PEP was not detected. Significant risk factors for PEP were female sex, obesity, and endoscopic naso-pancreatic drainage (ENPD) (P = .03, P = .0006, and P = .02, respectively). In patients with ENPD tube placement, a main pancreatic duct size of <5 mm was a significant risk factor for PEP (P = .02).Conclusion
PJC could increase the accuracy of WF for classifying malignant IPMN. The additive effect of PJC for risk classification may be limited, however, and it is not recommended for all IPMN cases due to the high frequency of PEP. 相似文献5.
Yohei Nakashima Takao Ohtsuka So Nakamura Yasuhisa Mori Kohei Nakata Yoshihiro Miyasaka Kosei Ishigami Ryota Matsuda Yoshinao Oda Masafumi Nakamura 《Pancreatology》2019,19(1):50-56
Background/objectives
The biological features of cystic pancreatic neuroendocrine tumors (PNETs) remain unclear. The aim of this study was to clarify the clinicopathological characteristics of non-functioning PNETs (NF-PNETs) with a cystic component.Methods
The medical records of 75 patients with NF-PNETs who had undergone resection in our institution were retrospectively reviewed. Clinicopathological factors were compared between PNETs with and without a cystic component. Expression of somatostatin 2 receptor (SSTR-2) was also analyzed.Results
Cystic PNETs were diagnosed in 14 patients (19%). The proportion of men was significantly higher for cystic than solid PNETs (79% vs. 44%, P?<?0.05) and cystic PNETs were significantly larger than solid PNETs (25?mm vs. 17?mm, P?<?0.01). However, there were no significant differences in the prevalence of lymph node metastases (14% vs. 10%, P?=?0.64), hepatic metastasis (7% vs. 3%, P?=?0.54), or disease-free survival rate (both 86%, P?=?0.29) between PNETs with and without a cystic component. SSTR-2 expression was more frequently observed in PNETs with a cystic component than in those without (100% vs. 70%, P?<?0.01).Conclusions
Although cystic PNETs were larger upon diagnosis than solid PNETs in this study, prognosis after surgical resection did not differ significantly between these types of PNET. Somatostatin receptor scintigraphy and somatostatin analogues may be more useful for diagnosing and treating cystic PNETs, respectively. 相似文献6.
Guopei Luo Zhiyao Fan He Cheng Kaizhou Jin Meng Guo Yu Lu Chao Yang Kun Fan Qiuyi Huang Jiang Long Liang Liu Jin Xu Renquan Lu Quanxing Ni Andrew L. Warshaw Chen Liu Xianjun Yu 《Pancreatology》2018,18(8):971-976
Background
Carbohydrate antigen 19-9 (CA19-9) is the best-validated biomarker for pancreatic cancer. The National Comprehensive Cancer Network (NCCN) guideline asserts that “CA19-9 will be undetectable in Lewis antigen-negative individuals”. However, reports of CA19-9 secretion and its significance in Lewis (-) patients with pancreatic cancer have been inconsistent. This study was to examine serum CA19-9 levels in patients with pancreatic cancer according to Lewis status.Methods
Patients with pancreatic cancer (1482 cases) were retrieved from a prospectively maintained database. Patients with benign pancreatic disease (210 cases) and normal subjects (315 cases) were used as controls. Lewis genotypes were examined by fucosyltransferase 3 (FUT3) sequencing.Results
In patients with pancreatic cancer, 8.4% of subjects were Lewis (-), but only 41.9% of Lewis (-) subjects had CA19-9 values?≤?2 U/mL. CA19-9 was even elevated (>37 U/mL) in 27.4% of Lewis (-) patients. The area under the receiver operating characteristic (ROC) curve for CA19-9 as a diagnostic biomarker was 0.842 in Lewis (-) patients with pancreatic cancer, which is closing to that of CA19-9 applied in all of patients with pancreatic cancer (0.898). Lewis (-) status was an independent prognostic factor for shorter survival in a multivariable analysis (hazard ratio (HR), 1.30, 95% confidence interval (CI), 1.03–1.64; P?=?0.028).Conclusions
Not all Lewis (-) patients with pancreatic cancer are non-secretors of CA19-9. Contrary to general understanding, CA19-9 can retain its utility as a biomarker in these patients in spite of Lewis (-) genotype. 相似文献7.
Yusuke Kurita Noritoshi Kobayashi Motohiko Tokuhisa Ayumu Goto Kensuke Kubota Itaru Endo Atsushi Nakajima Yasushi Ichikawa 《Pancreatology》2019,19(1):127-135
Background/objectives
FOLFIRINOX is the reliable treatments for pancreatic cancer, but it has a relatively high toxicity and the selection of suitable patients for this regimen remains challenge. On the other hand, sarcopenia is one of the important prognostic factors of pancreatic cancer. The aim of this study was to investigate the effect of sarcopenia on overall survival (OS) and time to treatment failure (TTF) in patients with pancreatic cancer who received FOLFIRINOX.Methods
Clinical data of consecutive patients treated with FOLFIRINOX at our institution from 2011 to 2017 was retrospectively reviewed. Skeletal muscle index (SMI) and adipose tissue index (ATI) at the third lumbar spine level was calculated from computed tomography (CT) images. The association between clinical factors (SMI and ATI), and OS and TTF were determined using univariate and multivariate analyses.Results
We assessed 82 patients. The median OS of sarcopenia and the non-sarcopenia patients were 11.3 and 17.0 months, respectively (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.43–4.32; p?=?0.001). Median TTF was 3.0 and 6.1 months in the sarcopenia and the non-sarcopenia patients, respectively (HR, 1.67; 95% CI, 1.03–2.71; p?=?0.032). Multivariate analyses revealed that sarcopenia (HR, 1.37; 95% CI, 1.01–1.87; p?=?0.045) was an independent prognostic factor of OS. High ATI (p?=?0.022) and sarcopenic obesity (p?=?0.008) were significantly associated with hematologic toxicity.Conclusions
Sarcopenia is an independent indicator of poor prognosis in patients with pancreatic cancer who received FOLFIRINOX, while ATI and sarcopenic obesity predicted severe hematologic toxicity. 相似文献8.
Takuya Ikegawa Atsuhiro Masuda Arata Sakai Hirochika Toyama Yoh Zen Keitaro Sofue Takashi Nakagawa Hideyuki Shiomi Mamoru Takenaka Takashi Kobayashi Masaru Yoshida Yoshifumi Arisaka Yoshihiro Okabe Hiromu Kutsumi Takumi Fukumoto Takeshi Azuma 《Pancreatology》2018,18(4):399-406
Objectives
The present study was conducted in order to elucidate the relationship between the number of cyst-existing regions and incidence of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN), which currently remains unclear.Methods
Subjects comprised 141 patients undergoing resection for IPMN (Non-invasive IPMN (IPMN with low-to high-grade dysplasia): N?=?94, invasive IPMN: N?=?31, and PDAC concomitant with IPMN: N?=?16) between November 2000 and February 2017. A logistic regression analysis was performed to assess the relationship between the number of cyst-existing regions (one region/two or more regions) and incidence of PDAC concomitant with IPMN, adjusted by clinical characteristics. Cyst-existing regions were defined by the number of anatomical parts of the pancreas: the head/body/tail of the pancreas.Results
Multiple cyst-existing regions (two or more regions) correlated with the incidence of PDAC concomitant with IPMN (PDAC concomitant with IPMN in one region vs. two or more regions: 3/66 vs. 13/75, multivariable odds ratio [OR]?=?4.11, 95% confidence interval [CI]?=?1.22 to 18.8, P?=?0.02). In contrast, multiple cyst-existing regions did not correlate with the incidence of IPMN (invasive IPMN in one region vs. two or more regions: 13/66 vs. 18/75, OR?=?1.19, 95% CI?=?0.52 to 2.76, P?=?0.67).Conclusions
Multifocal cysts correlated with the incidence of PDAC concomitant with IPMN, and may be a high-risk factor for PDAC concomitant with IPMN. 相似文献9.
Zachary E. Stiles Sheema Khan Kurt T. Patton Meena Jaggi Stephen W. Behrman Subhash C. Chauhan 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):87-95
Background
Intraductal papillary mucinous neoplasms (IPMN) are currently managed based on imaging characteristics and cyst fluid sampling. This study was designed to determine if MUC13, a glycoprotein aberrantly overexpressed in pancreatic adenocarcinoma, might aid in distinguishing high-risk lesions (high grade dysplasia/invasive disease) from low-grade lesions.Methods
MUC13 immunohistochemical staining was performed on surgically resected formalin-fixed tissue specimens from 49 IPMNs and 23 non-mucinous cysts. Membranous MUC13 expression was measured by H-score, which quantifies staining intensity and the percentage of cells involved (range 0–300).Results
MUC13 expression was detected in all IPMNs and was significantly greater than in non-mucinous cysts (median 210 vs 40, p < 0.001). MUC13 expression was similar among main (n = 26), branch (n = 15), and mixed (n = 8) duct lesions (median 210, 200, 225, respectively). The highest expression was observed in tumors with intestinal and pancreatobiliary histologic features (both median 225) and the lowest in gastric type lesions (median 200). MUC13 expression was significantly greater in high-risk lesions (n = 21) compared to those with low-grade dysplasia (n = 28) (median 250 vs 195, p < 0.001).Conclusion
MUC13 expression was significantly greater in high-risk IPMNs in this analysis. The preoperative assessment of MUC13 in cyst fluid samples warrants further investigation. 相似文献10.
J. Enrique Dominguez-Munoz Asbjørn M. Drewes Björn Lindkvist Nils Ewald László Czakó Jonas Rosendahl J. Matthias Löhr 《Pancreatology》2018,18(8):847-854
Background
In collaboration with United European Gastroenterology, the working group on ‘Harmonizing diagnosis and treatment of chronic pancreatitis across Europe’ (HaPanEU) developed European guidelines for the management of chronic pancreatitis using an evidence-based approach.Methods
Recommendations of multidisciplinary review groups based on systematic literature reviews to answer predefined clinical questions are summarised. Recommendations are graded using the Grading of Recommendations Assessment, Development and Evaluation system.Results
Recommendations covered topics related to the clinical management of chronic pancreatitis: aetiology, diagnosis of chronic pancreatitis with imaging, diagnosis of pancreatic exocrine insufficiency, surgical therapy, medical therapy, endoscopic therapy, treatment of pancreatic pseudocysts, pancreatic pain, nutrition and malnutrition, diabetes mellitus and the natural course of the disease and quality of life.Conclusions
The HaPanEU/United European Gastroenterology guidelines provide evidence-based recommendations concerning key aspects of the medical and surgical management of chronic pancreatitis based on current available evidence. These recommendations should serve as a reference standard for existing management of the disease and as a guide for future clinical research. This article summarises the HaPanEU recommendations and statements. 相似文献11.
Sara Massironi Stefano Partelli Maria C. Petrone Alessandra Zilli Dario Conte Massimo Falconi Paolo G. Arcidiacono 《Pancreatology》2018,18(7):792-798
Background/Objectives
The pancreatic localization of serotonin-staining neuroendocrine neoplasms is extremely rare. This is a retrospective study aimed at analyzing the endoscopic ultrasound appearance of pancreatic serotoninoma.Methods
Between 2010 and 2016, all consecutive patients with histologically proven pancreatic serotoninoma who had undergone endoscopic ultrasound were enrolled.Results
Eight patients (six F, median age 68.5 years) had a diagnosis of pancreatic serotoninoma and underwent endoscopic ultrasound examinations. Median diameter of the lesion was ten mm. The nodule echotexture was hypoechoic in seven out of eight cases. The most frequent localization was the pancreatic neck (four); in three cases, the tumor was located in the pancreatic head and in one in the body. In seven cases the tumor caused a main pancreatic duct dilation; in three cases also the secondary ducts were dilated. In one case a dilation of the common bile duct was observed. At contrast-enhanced endoscopic ultrasound no one showed the typical contrast-enhancement. Elastography (available in two patients) showed a rigid pattern of the lesion.Conclusions
From this case series a specific endoscopic ultrasound appearance resulted for pancreatic serotoninoma, different from other types of pancreatic neuroendocrine neoplasm, but it is difficult to differentiate it from a pancreatic adenocarcinoma or an intraductal papillary mucinous neoplasm. 相似文献12.
Background
Serous cystadenomas are benign lesions of the pancreas. Usually they are diagnosed incidentally on cross-sectional imaging studies. Endosonography is a valuable tool in the diagnosis and follow-up of these cystic lesions. Given its benign nature, surgical resection is advised only in symptomatic patients. The interval and length of surveillance is not well established.Methods
A retrospective single center study was done. All the patients with a pancreatic serous cystadenoma sent for an endosonographic evaluation, between December 2008 and December 2015 were included. The lesions were follow-up endosonographically at least once, in a 12 months interval. Volume was measured with the formula π/6 × (d1 x d1 x d2). Two groups were evaluated: patients with a volume under 10?mL (Group 1) and those with a volume of 10?mL or more at presentation (Group 2). Growth rate between these two groups was compared.Results
Thirty-one patients were analyzed, with a mean age of 58.2 years. Patients were mainly women (87%). Twenty-four patients in Group 1 had a mean enlargement of 0.67?ml per year, whereas patients in Group 2 had a mean enlargement of 9.8?ml per year. The growth rate difference between these two groups was statistically significant (p?=?0.0001).Conclusion
Asymptomatic patients with pancreatic serous cystadenomas should be follow-up for enlargement. Small volume lesions have a low risk of enlargement compared with high volume and macrocystic serous cystadenomas. Volume at presentation is a feature to analyze when defining surveillance interval. 相似文献13.
Bobby Tingstedt Bodil Andersson Claes Jönsson Victoria Formichov Svein-Olav Bratlie Mikael Öhman Britt-Marie Karlsson Christophe Ansorge Ralf Segersvärd Thomas Gasslander 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(1):34-42
Background
Despite improvements in therapy regimens over the past decades, overall survival rates for pancreatic and periampullary cancer are poor. Specific cancer registries are set up in various nations to regional differences and to enable larger prospective trials. The aim of this study was to describe the Swedish register, including possibilities to improve diagnostic work-ups, treatment, and follow-up by means of the register.Methods
Since 2010, all patients with pancreatic and periampullary cancer (including also patients who have undergone pancreatic surgery due to premalignant or benign lesions) have been registered in the Swedish National Periampullary and Pancreatic Cancer registry.Results
In total 9887 patients are listed in the registry; 8207 of those have malignant periampullary cancer. Approximately one-third (3282 patients) have had resections performed, including benign/premalignant resections. 30-day and 90-day mortality after pancreatoduodenectomy is 1.5% and 3.5%, respectively. The overall 3-year survival for resected pancreatic ductal adenocarcinoma is 35%. Regional variations decreased over the studied period, but still exist.Conclusion
Results from the Swedish National Registry are satisfactory and comparable to international standards. Trends over time show increasing resection rates and some improved results. Better collaboration and openness within pancreatic surgeons is an important side effect. 相似文献14.
Nicolas Santucci Olivier Facy Pablo Ortega-Deballon Jean-Baptiste Lequeu Paul Rat Patrick Rat 《Pancreatology》2018,18(6):666-670
Background
Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.Aim of the study
To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients.Methods
All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19–9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19–9 was calculated. In jaundiced patients, a CA 19–9 adjusted for bilirubinemia was also evaluated.Results
Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19–9 as a predictor of resectability was 0.886 (95%CI:[0.832–0.932]); in jaundiced patients it was 0.880 (95% CI [0.798–0.934]. A cut-off in CA 19–9?at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19–9 (r?=?0.149).Conclusion
Serum CA 19–9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease. 相似文献15.
Objectives
This study aimed to explore double-negative T (DNT) cell cytotoxicity to pancreatic cancer and the effect of the Fas (CD95, APO-1)/FasL (CD178) signaling pathway on this process.Methods
DNT cells from the peripheral blood of healthy volunteers were expanded in vitro. The inhibitory effect of DNT cells on pancreatic cancer cells was investigated using a CCK-8 assay and nude mouse tumor model. A mechanistic study was performed using pathway blocking assays.Results
DNT cells were amplified in vitro with >90% purity, and the growth of pancreatic cancer in vitro was significantly inhibited by DNT cells. After coculture with DNT cells, Fas, caspase-8 and cleaved caspase-8 showed increased expression in pancreatic cancer cells. When blocking agent decoy receptor 3 (DcR3) was added, the antitumor effect of DNT cells and the expression of Fas, caspase-8 and cleaved caspase-8 were reduced in pancreatic cancer cells. In the nude mouse tumor model, the tumor volume and weight were lower in the DNT cell group and gemcitabine group than in the blank control group. Additionally, the expression of Fas, caspase-8 and cleaved caspase-8 was higher in the DNT cell group than in the blank control group. Moreover, DNT cells promoted apoptosis in cancer cells and animal model tissues.Conclusion
DNT cells inhibited the growth of pancreatic cancer, and the Fas/FasL signaling pathway was involved in this process. 相似文献16.
Background
Pancreatic exocrine insufficiency (PEI) and malnutrition are prevalent among patients with pancreatic adenocarcinoma. Pancreatic enzyme replacement therapy (PERT) can correct PEI but its use among patients with pancreatic cancer is unclear as are effects upon survival. This population-based study sought to address these issuesMethods
Subjects with pancreatic adenocarcinoma were identified from the UK Clinical Practice Research Datalink (CPRD). Propensity score matching generated matched pairs of subjects who did and did not receive PERT. Progression to all-cause mortality was compared using parametric survival models that included a range of relevant co-variablesResults
PERT use among the whole cohort (987/4554) was 21.7%. Some 1614 subjects generated 807 matched pairs. This resulted in a total, censored follow-up period of 1643 years. There were 1403 deaths in total, representing unadjusted mortality rates of 748 and 994 deaths per 1000 person-years for PERT-treated cases and their matched non-PERT-treated controls, respectively. With reference to the observed survival in pancreatic adenocarcinoma patients, adjusted median survival time was 262% greater in PERT-treated cases (survival time ratio (STR)?=?2.62, 95% CI 2.27–3.02) when compared with matched, non-PERT-treated controls. Survival remained significantly greater among subjects receiving PERT regardless of the studied subgroup with respect to use of surgery or chemotherapyConclusions
This population based study observes that the majority of patients with pancreatic adenocarcinoma do not receive PERT. PERT is associated with increased survival among patients with pancreatic adenocarcinoma suggesting a lack of clinical awareness and potential benefit of addressing malnutrition among these patients 相似文献17.
Ekaterina Petrova Hryhoriy Lapshyn Dirk Bausch Jan D&#x;Haese Jens Werner Thomas Klier Natascha C. Nüssler Jochen Gaedcke Michael Ghadimi Waldemar Uhl Orlin Belyaev Olga Kantor Marshall Baker Tobias Keck Ulrich F. Wellner 《Pancreatology》2019,19(1):17-25
Background
Postoperative pancreatic fistula (POPF) is a major factor for morbidity and mortality after pancreatic resection. Risk stratification for POPF is important for adjustment of treatment, selection of target groups in trials and quality assessment in pancreatic surgery. In this study, we built a risk-prediction model for POPF based on a large number of predictor variables from the German pancreatic surgery registry StuDoQ|Pancreas.Methods
StuDoQ|Pancreas was searched for patients, who underwent pancreatoduodenectomy from 2014 to 2016. A multivariable logistic regression model with elastic net regularization was built including 66 preoperative und intraoperative parameters. Cross-validation was used to select the optimal model. The model was assessed via area under the ROC curve (AUC) and calibration slope and intercept.Results
A total of N?=?2488 patients were included. In the optimal model the predictors selected were texture of the pancreatic parenchyma (soft versus hard), body mass index, histological diagnosis pancreatic ductal adenocarcinoma and operation time. The AUC was 0.70 (95% CI 0.69–0.70), the calibration slope 1.67 and intercept 1.12. In the validation set the AUC was 0.65 (95% CI 0.64–0.66), calibration slope and intercept were 1.22 and 0.42, respectively.Conclusion
The model we present is a valid measurement instrument for POPF risk based on four predictor variables. It can be applied in clinical practice as well as for risk-adjustment in research studies and quality assurance in surgery. 相似文献18.
Chirag S. Desai Jennifer S. Vonderau Rebecca McCall Khalid M. Khan Todd H. Baron 《Pancreatology》2018,18(7):700-704
Background
Patients with cystic fibrosis (CF) and a CFTR gene mutation may present with a variety of pancreatic disorders. The presence of multiple macrocysts (>1?cm) replacing the entire pancreatic parenchyma is termed pancreatic cystosis. Lack of clear data makes clinical decision making challenging and controversial. The aim of this review is to perform a qualitative systematic analysis of the literature with intention to evaluate management plans.Methods
Electronic databases MEDLINE, Embase, and Scopus were searched for relevant studies, and 19 studies describing patients with pancreatic cystosis were included and analyzed for clinical features and therapy offered.Results
The data of 24 patients were collected from included studies. Eight cases (33%) had a documented CFTR gene mutation and 10 (42%) were symptomatic at presentation. Imaging modalities included ultrasound in 18 (75%), CT in 12 (50%), and MRI in 8 (33%) cases. An average size of the largest cyst was 5.4?cm. 6 (25%) patients were offered therapy that described surgical (3), endoscopic (1), or medical therapy (2). Surgeries offered included total pancreatectomy, partial pancreatic resection of uncertain extent, and complex cyst resection. Endoscopic treatment was cystogastrostomy. Novel medical treatment was utilized with Doxepin, Propantheline, and Clonidine, resulting in reduction in cyst size and overall clinical improvement.Conclusion
Patients with pancreatic cystosis should not be denied treatment when necessary. This literature review is the most comprehensive thus far of cystic fibrosis and pancreatic cystosis, and it did not provide identification of a definitive treatment plan or demonstrate contraindication to specific therapies. 相似文献19.
Jongho Kim Erika D. Feller Wengen Chen Yuanyuan Liang Vasken Dilsizian 《JACC: Cardiovascular Imaging》2019,12(4):722-729
Objectives
The feasibility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for the diagnosis of left ventricular assist device (LVAD) infection has been demonstrated. Beyond the diagnoses of LVAD infection, the authors hypothesized that the pattern and site of the infection along its various components may significantly impact clinical management and patient outcome.Background
In patients with end-stage heart failure, the clinical use of LVAD for destination therapy is on the rise, accompanied by a higher prevalence of infections and serious complications.Methods
FDG PET/CT was performed in 35 heart failure patients with LVAD, 24 with and 11 without clinical suspicion of infection. Microbiology and/or clinical follow-up were used as the final diagnosis standard. Survival rates were compared in patients with and without FDG evidence of infection, and in relation to peripheral (exit wound site or driveline) versus central (cannula or pump) device infection.Results
Of 35 patients, 28 (80%) showed metabolic evidence of LVAD infection: 5 limited to the periphery and 23 with extension to the central components of the device. The remaining 7 patients showed no metabolic evidence of infection, which was confirmed by microbiology and clinical follow-up. When CT images were interpreted independently from the FDG PET and clinical information, only 4 of 35 (11%) suggested the possibility of infection. Fourteen of 28 (50%) infected patients died during a mean of 23 months of follow-up after the diagnosis by FDG PET/CT: 12 (86%) with central infection and only 2 with peripheral infection. By contrast, none of the 7 (0%) noninfected patients died (p = 0.03).Conclusions
FDG PET/CT is a useful technique for identifying LVAD infection and determining the site and pattern of the infection. The latter has clinical management and patient outcome implications. 相似文献20.
Pierpaolo Cavallo Luna Carpinelli Fabiana Zingone Immacolata Sepe Mario De Santis Carolina Ciacci 《Pancreatology》2019,19(3):409-413