Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study

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 issues

Incidence of and risk factors for pancreatic cancer in chronic pancreatitis: A cohort of 1656 patients

BackgroundRisk of pancreatic cancer may increase in chronic pancreatitis patients.AimsThis study aimed to identify the incidence of and risk factors for pancreatic cancer in chronic pancreatitis patients.MethodsChronic pancreatitis patients admitted to our center from January 2000 to December 2013 were enrolled. Cumulative rates of pancreatic cancer and survival rates were calculated. The standardized incidence ratio was calculated based on the pancreatic cancer incidence in general population of China. Risk factors for pancreatic cancer were identified.ResultsIn a total of 1656 patients, the median follow-up duration was 8.0 years. Pancreatic cancer was detected in 21 patients (1.3%). The expected number of cases of pancreatic cancer was 1.039, yielding a standardized incidence ratio of 20.22. The standardized incidence ratios for patients with a >60 pack-year smoking history were much higher (145.82). Two risk factors for pancreatic cancer were identified: age at the onset of chronic pancreatitis (hazard ratio, 1.05) and a >60 pack-year smoking history (hazard ratio, 11.83).ConclusionThe risk of pancreatic cancer is markedly increased in chronic pancreatitis patients compared with the general population, especially in patients with an older age at onset and a >60 pack-year smoking history. The high-risk populations were suggested to be followed up closely.     

Association between oral contraceptive use and pancreatic cancer risk: A systematic review and meta-analysis

BACKGROUNDStudies on the association of oral contraceptive (OC) use and pancreatic cancer showed inconsistent findings. AIMTo evaluate the relationship between OC use and pancreatic cancer risk. METHODSA literature search for observational studies (case-control and cohort studies) was conducted up to December 2020. A meta-analysis was performed by calculating pooled relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s chi-square test and I² statistic. Subgroup analyses were performed by study design, source of controls in case-control studies, number of cases of pancreatic cancers, study quality according to Newcastle-Ottawa Scale score, geographical region and menopausal status. All analyses were performed using Review Manager 5.3 (RevMan 5.3).RESULTSA total of 21 studies (10 case-control studies and 11 cohort studies) were finally included in the present meta-analysis, comprising 7700 cases of pancreatic cancer in total. A significant association was observed between the ever use of OC and pancreatic cancer risk in the overall analysis (RR = 0.85; 95%CI = 0.73-0.98; P = 0.03). Duration of OC use (< 1 year, < 5 years, 5-10 years, > 10 years) was not significantly associated with the risk of pancreatic cancer. Subgroup analyses revealed a statistically significant subgroup difference for the geographic region in which the study was conducted (Europe vs Americas vs Asia; P = 0.07). Subgroup analyses showed a statistically significant decrease in pancreatic cancer risk and OC use in high-quality studies, studies conducted in Europe, and in postmenopausal women. CONCLUSIONDespite the suggested protective effects of OC use in this meta-analysis, further epidemiological studies are warranted to fully elucidate the association between the use of OC and pancreatic cancer risk.     

饮食因素与胰腺癌的相关性

目的:探讨多种饮食因素与胰腺癌危险性的关系,为该病防治提供科学依据.方法:2007-09/2009-10在上海部分门诊和医院确诊的97例胰腺癌病例纳入病例组,按年龄、性别配比选择未患肿瘤的人群194例纳入对照组,用统一的调查表以相同的询问方式和态度进行问卷调查.对获取的资料用条件logistic回归进行单因素和多因素分析.结果:经多因素分析结果显示:甜食(OR=4.706)与胰腺癌呈正相关.洋葱(OR=0.068)、山药(OR=0.301)、红薯(OR=0.178)和水果(OR=0.299)与胰腺癌呈负相关.结论:饮食因素在胰腺癌的发生过程中可能起着重要作用.     

Pancreatic cancer: A review of epidemiology,trend, and risk factors

Despite rapid advances in modern medical technology and significant improvements in survival rates of many cancers, pancreatic cancer is still a highly lethal gastrointestinal cancer with a low 5-year survival rate and difficulty in early detection. At present, the incidence and mortality of pancreatic cancer are increasing year by year worldwide, no matter in the United States, Europe, Japan, or China. Globally, the incidence of pancreatic cancer is projected to increase to 18.6 per 100000 in 2050, with the average annual growth of 1.1%, meaning that pancreatic cancer will pose a significant public health burden. Due to the special anatomical location of the pancreas, the development of pancreatic cancer is usually diagnosed at a late stage with obvious clinical symptoms. Therefore, a comprehensive understanding of the risk factors for pancreatic cancer is of great clinical significance for effective prevention of pancreatic cancer. In this paper, the epidemiological characteristics, developmental trends, and risk factors of pancreatic cancer are reviewed and analyzed in detail.     

胰腺癌相关危险因素研究及高危评分模型的建立

目的 探索胰腺癌相关危险因素，建立胰腺癌高危评分模型。方法 采用病例对照研究，收集2002年1月至2004年4月胰腺癌患者119例，正常对照238名。对所有研究对象进行流行病学问卷调查，通过两组比较确定胰腺癌相关危险因素。选择相关危险因素和症状进行多元Logistic回归分析，计算各变量的权重分数，建立高危评分模型。结果 高剂量吸烟（〉17包年）人群发生胰腺癌的风险增加（OR 1．98；95％CI 1．11～3．49），尤其是男性高剂量吸烟者（OR 2．11；95％CI 1．18～3．78）；饮酒对胰腺癌的危险性主要表现在高剂量饮洒中（OR 3．681；95％CI 1．604～8．443）。胰腺癌患者中以肉食为主者占31．03％，而对照组中仅为7．61％（P〈0．0001）；有糖尿病史的胰腺癌患者占18．49％，而对照组仅为5．77％（P=0．0003），胰腺癌组中患糖尿病时间中位数为0．5年，对照组为4年；临床症状中厌食、上腹痛、腹胀、黄疽及体重下降两组间差异有统计学意义。根据高危评分模型对两组进行评分，胰腺癌组和对照组平均分分别为80．6（95％CI，74．9～86．3）和7．4（95％CI 6．0～8．7），P〈0．001。初步确定≥45分为胰腺癌高危人群筛查界值。结论 高剂量吸烟、高剂量饮酒、肉食、糖尿病史为汉族人群的胰腺癌相关危险因素。该评分模型町用于胰腺癌高危人群的初筛．可能有助于发现早期胰腺癌患者，但还需进一步验证。     

Diabetes mellitus and risk of pancreatic cancer in China: A meta-analysis based on 26 case-control studies

AimsThe relationship between diabetes mellitus and pancreatic cancer risk from is uncertain based on the results of existing publications. The current report updated and re-evaluated the possible association between diabetes mellitus and pancreatic cancer risk in China.MethodsSix databases (PubMed, Embase, Web of Science, the Cochrane Library, the Chinese Biomedical Database, and the Chinese National Knowledge Infrastructure) were used for the literature search up to October 2017.ResultsTwenty-six case-control studies involving 7702 pancreatic cancer cases and 10186 controls were screened out. The overall summary estimate for the relationship between diabetes and pancreatic cancer was 3.69 (95% CI, 3.12–4.37). The subgroup analysis indicated positive associations among northern and southern Chinese, as well as studies with healthy population or hospital controls. In addition, the risk of developing pancreatic cancer was inversely associated with the duration of diabetes, with the highest risk of pancreatic cancer occurring among patients with diabetes <2 years. Individuals who had diabetes <2 years had a >2-fold higher risk of developing pancreatic cancer than individuals who had diabetes for 2–4 years or 5–10 years (OR, 4.92; 95% CI, 4.16–5.80 vs. OR, 1.92; 95% CI, 1.30–2.85/OR, 2.14; 95% CI, 1.49–3.09).ConclusionsThis meta-analysis strongly supports that an association exists between diabetes and an increased risk of pancreatic cancer in China, which should be confirmed with other ethnic groups.     

Efficacy of pancreatic exocrine replacement therapy for patients with unresectable pancreatic cancer in a randomized trial

BackgroundWeight loss in pancreatic cancer is associated with maldigestion due to pancreatic duct obstruction. Pancreatic exocrine replacement therapy (PERT) may significantly improve fat and protein absorption.ObjectivesThis prospective, double-blind, randomized, placebo-controlled phase II trial assessed whether PERT could reduce or prevent weight loss in patients with unresectable pancreatic cancer.MethodsSixty seven patients with unresectable pancreatic cancer were randomized to receive enteric coated PERT, consisting of 6–9 capsules of pancreatin (457.7 mg/capsule), or placebo. Patients took two capsules each three times daily during main meals and one capsule each up to three times daily when having between-meal snacks. The primary endpoint was the percentage change in body weight at eight weeks.ResultsThe mean percentage change in body weight (1.49% [1.12 kg] vs. 2.99% [1.63 kg], P = 0.381) and the mean percent change in Patient-Generated Subjective Global Assessment (PG-SGA) score (8.85% vs. 15.69%, p = 0.18) did not differ significantly between the PERT and placebo groups. There was no improvement in quality of life and overall survival did not differ significantly between the PERT and placebo groups (5.84 months vs 8.13 months, p = 0.744).ConclusionsPERT did not reduce weight loss in patients with unresectable pancreatic cancer. Larger randomized trials are needed to identify those patients who may benefit from PERT.Trial registration: ClinicalTrials.gov Number NCT01587534.     

Nutritional factors and risk of pancreatic cancer: a population-based case-control study based on direct interview in Japan

Background Few epidemiologic studies have examined the role of nutrient intake in the development of pancreatic cancer in Japan. We addressed this association in a population-based case-control study.Methods The cases were 109 patients who were newly diagnosed with pancreatic cancer between January 2000 and March 2002, and controls were selected by a random procedure from the general population. Data on dietary intake were collected by in-person interview, with the use of a food-frequency questionnaire. The risk of pancreatic cancer associated with nutrient intake was estimated by using the odds ratios (ORs) and 95% confidence intervals (CIs) derived from a conditional logistic model.Results A statistically positive trend in risk was observed with increasing cholesterol intake, with subjects in the highest tertile experiencing a two fold increased risk (OR, 2.06; 95% CI, 1.11–3.85; Ptrend = 0.02). Vitamin C intake was negatively associated with risk of pancreatic cancer. The OR was 0.45 (95% CI, 0.22–0.94) for subjects in the highest tertile compared to the lowest tertile (Ptrend = 0.04).Conclusions Our study indicates that high cholesterol intake is significantly associated with an increased risk of pancreatic cancer and that high vitamin C intake decreases the risk of pancreatic cancer.     

A case-control study on risk factors for scleroderma

Abstract

We conducted a case-control study to evaluate the contribution of some risk factors to the development of scleroderma. Fifty-seven patients with scleroderma (seven males and 50 females) were interviewed with a structured questionnaire at Saga Medical School Hospital from 1993 to 1995. Fifty-seven controls, who were individually sex and age matched with each case, were also interviewed with the same questionnaire during the same period. Eight individuals of parents or siblings of the scleroderma patients had Raynaud’s phenomenon, as compared to none of the controls ( P<0.01). Four siblings of the cases had been affected by autoimmune connective tissue diseases, as compared to none of the controls ( P<0.05). The percentage of the cases who had experience in the work exposed to hand-arm stress or vibration was larger than that of the controls ( P<0.05). These findings may reflect familial or environmental factors operating in the development of scleroderma.     

A case-control study on risk factors for scleroderma

We conducted a case-control study to evaluate the contribution of some risk factors to the development of scleroderma. Fifty-seven patients with scleroderma (seven males and 50 females) were interviewed with a structured questionnaire at Saga Medical School Hospital from 1993 to 1995. Fifty-seven controls, who were individually sex and age matched with each case, were also interviewed with the same questionnaire during the same period. Eight individuals of parents or siblings of the scleroderma patients had Raynaud’s phenomenon, as compared to none of the controls (P<0.01). Four siblings of the cases had been affected by autoimmune connective tissue diseases, as compared to none of the controls (P<0.05). The percentage of the cases who had experience in the work exposed to hand-arm stress or vibration was larger than that of the controls (P<0.05). These findings may reflect familial or environmental factors operating in the development of scleroderma.     

Burden of pancreatic cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030

ObjectivesUnderstanding epidemiology trends and patterns of pancreatic cancer in China from 1990 to 2019 and predicting the burden to 2030 will provide foundations for future policies development.MethodsWe collected incidence, mortality, and disability-adjusted life-years (DALYs) data of pancreatic cancer in China from 1990 to 2019 based on the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change (EAPC) to depict the trends of pancreatic cancer burden and predicted the incidence and mortality in the next decade by using a Bayesian age-period-cohort analysis.ResultsThe number of incident cases sharply increased from 26.77 thousand in 1990 to 114.96 thousand in 2019, the age-standardized incidence rate (ASIR) nearly doubled from 3.17 per 100,000 in 1990 to 5.78 per 100,000 in 2019, with an EAPC of 2.32 (95% confidence interval [CI]: 2.12, 2.51). The mortality and DALYs presented a similar pattern with incidence. The dominant risk factor for pancreatic cancer was smoking, but the contribution of high body-mass index increased from 1990 to 2019. We projected that the incident cases and deaths of pancreatic cancer would increase to 218.79 thousand and 222.97 thousand, respectively, in 2030 with around 2 times growth.ConclusionsDuring the past three decades, the incidence, mortality and DALYs of pancreatic cancer gradually increased in China, and the absolute number and rate of pancreatic cancer burden would continue to rise over the next decade. Comprehensive policies and strategies need to be implemented to reduce the incidence and mortality.     

Review of screening for pancreatic cancer in high risk individuals

Pancreatic cancer is difficult to diagnose at an early stage and is associated with a very poor survival.Ten percent of pancreatic cancers result from genetic susceptibility and/or familial aggregation.Individuals from families with multiple affected first-degree relatives and those with a known cancer-causing genetic mutation have been shown to be at much higher risk of developing pancreatic cancer.Recent efforts have focused on detecting disease at an earlier stage to improve survival in these high-risk g...     

RNAi技术在胰腺癌中的应用

RNA干扰(RNAi)是双链RNA介导的转录后基因沉默的过程,是一种高效、高特异性的抑制基因表达的新途径。现将RNAi技术的作用机制及RNAi在胰腺癌中的应用作一综述。     

血管抑制素基因治疗人胰腺癌的实验研究

目的;探讨应用脂质体介导血管抑制素（angiostatin,AG) 基因治疗实验性人胰腺癌细胞系SW1990的价值。方法：血管抑制素AG基因被定向克隆入真核表达载体pRC／CMV中。运用脂质体将重组体pRC/CMV-AG转入胰腺癌细胞系SW1990中,进行抗肿瘤研究。结果：构建的真核表达载体pRC/CMV-AG经酶切证实正确。Western blot和药敏试验均证实血管抑制素基因已整合到靶细胞DNA中并可分泌表达AG,且可抑制血管内皮细胞的生长。动物模型显示,所构建的载体能在肿瘤内表达,且可有效抑制荷瘤裸鼠人胰腺癌细胞的微血管形成及肿瘤生长。结论：脂质体介导的重组体pRC／CMV－AG有体内治疗胰腺癌的作用,可作为胰腺癌基因治疗的可能方法之一。     

Selection criteria in resectable pancreatic cancer: A biological and morphological approach

Pancreatic ductal adenocarcinoma (PDA) remains one of the most aggressive tumors with a low rate of survival. Surgery is the only curative treatment for PDA, although only 20% of patients are resectable at diagnosis. During the last decade there was an improvement in survival in patients affected by PDA, possibly explained by the advances in cancer therapy and by improve patient selection by pancreatic surgeons. It is necessary to select patients not only on the basis of surgical resectability, but also on the basis of the biological nature of the tumor. Specific preoperative criteria can be identified in order to select patients who will benefit from surgical resection. Duration of symptoms and level of carbohydrate antigen 19.9 in resectable disease should be considered to avoid R1 resection and early relapse. Radiological assessment can help surgeons to distinguish resectable disease from borderline resectable disease and locally advanced pancreatic cancer. Better patient selection can increase survival rate and neoadjuvant treatment can help surgeons select patients who will benefit from surgery.     

Association of metabolic syndromes and risk factors with ampullary tumors development: A case-control study in China

AIM: To evaluate the risk factors for ampullary adenoma and ampullary cancer.METHODS: This case-control study included ampullary tumor patients referred to Peking Union Medical College Hospital. Controls were randomly selected from an existing database of healthy individuals at the Health Screening Center of the same hospital. Data on metabolic syndromes, medical conditions, and family history were collected by retrospective review of the patients’ records and health examination reports, or by interview.RESULTS: A total of 181 patients and 905 age- and sex-matched controls were enrolled. We found that a history of diabetes, cholecystolithiasis, low-density lipoprotein, and apolipoprotein A were significantly related to ampullary adenomas. Diabetes, cholecystolithiasis, chronic pancreatitis, total cholesterol, high-density lipoprotein, and apolipoprotein A were also significantly related to ampullary cancer.CONCLUSION: Some metabolic syndrome components and medical conditions are potential risk factors for the development of ampullary tumors. Cholelithiasis, diabetes, and apolipoprotein A may contribute to the malignant transformation of benign ampullary adenomas into ampullary cancer.