ObjectiveTo investigate the relation between disulfidptosis-related genes (DRGs) and prognosis or immunotherapy response of patients with pancreatic cancer (PC). MethodsThe transcriptome data, somatic mutation data, and corresponding clinical information of the patients with PC in The Cancer Genome Atlas (TCGA) were downloaded. The DRGs mutated in the PC were screened out from the 15 known DRGs. The DRGs subtypes were identified by consensus clustering algorithm, and then the relation between the identified DRGs subtypes and the prognosis of patients with PC, immune cell infiltration or functional enrichment pathway was analyzed. Further, a risk score was calculated according to the DRGs gene expression level, and the patients were categorized into high-risk and low-risk groups based on the mean value of the risk score. The risk score and overall survival of the patients with high-risk and low-risk were compared. Finally, the relation between the risk score and (or) tumor mutation burden (TMB) and the prognosis of patients with PC was assessed. ResultsThe transcriptome data and corresponding clinical information of the 177 patients with PC were downloaded from TCGA, including 161 patients with somatic mutation data. A total of 10 mutated DRGs were screened out. Two DRGs subtypes were identified, namely subtype A and subtype B. The overall survival of PC patients with subtype A was better than that of patients with subtype B (χ2=8.316, P=0.003). The abundance of immune cell infiltration in the PC patients with subtype A was higher and mainly enriched in the metabolic and conduction related pathways as compaired with the patients with subtype B. The mean risk score of 177 patients with PC was 1.921, including 157 cases in the high-risk group and 20 cases in the low-risk group. The risk score of patients with subtype B was higher than that of patients with subtype A (t=14.031, P<0.001). The overall survival of the low-risk group was better than that of the high-risk group (χ2=17.058, P<0.001), and the TMB value of the PC patients with high-risk was higher than that of the PC patients with low-risk (t=5.642, P=0.014). The mean TMB of 161 patients with somatic mutation data was 2.767, including 128 cases in the high-TMB group and 33 cases in the low-TMB group. The overall survival of patients in the high-TMB group was worse than that of patients in the low-TMB group (χ2=7.425, P=0.006). ConclusionDRGs are closely related to the prognosis and immunotherapy response of patients with PC, and targeted treatment of DRGs might potentially provide a new idea for the diagnosis and treatment of PC.
ObjectivesTo evaluate the economic efficacy of nab-paclitaxel (NAB-P) combined with gemcitabine (GEM) versus GEM alone in the treatment of metastatic pancreatic cancer in China.MethodsA Markov model simulating the costs and health outcomes was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The impact of parameter uncertainty on the model was assessed by deterministic one-way sensitivity analysis.ResultsNAB-P combined with GEM was shown superior efficacy compared to gemcitabine monotherapy, however with higher costs. The ICER between the two groups was 964 780.79￥/QALY.ConclusionsCompared with gemcitabine monotherapy, NAB-P combined with GEM is not cost-effective. The conclusion is confirmed by deterministic one-way sensitivity analysis.
ObjectiveTo summarize the current treatment status and progress of neoadjuvant chemotherapy for pancreatic cancer in order to improve the understanding of neoadjuvant chemotherapy and to guide clinical work.MethodThe relevant literatures at home and abroad on neoadjuvant chemotherapy for pancreatic cancer were readed and reviewed.ResultsNeoadjuvant chemotherapy could reduce tumor lesions, increase R0 resection rate, decrease postoperative complication rate, and improve patients’ survival, however, there was currently no high quality evidence-based medicine proof. At present, there was no unified neoadjuvant chemotherapy regimens for pancreatic cancer in the world. FOLFIRINOX, gemcitabine plus S-1, and gencitabine plus Nab-paclitaxel were the three common regimens we used. In addition, the neoadjuvant chemotherapy of pancreatic cancer had no uniform standard, and there were insufficient methods for evaluating therapeutic effects.ConclusionAlthough there are still some core problems need to be solved in neoadjuvant chemotherapy for pancreatic cancer, however, it’s curative effect is gradually recognized and widely used by clinicians, which is beneficial to provide a better prognosis for pancreatic cancer patients.
ObjectiveTo summarize the value of imaging in the evaluation of non-surgical therapy for pancreatic cancer.MethodThe relevant literatures about imaging evaluation of non-surgical therapy for pancreatic cancer were collected to make an review.ResultsAt present, most of the imaging evaluation of non-surgical therapy for pancreatic cancer were based on the assessment of morphological characteristics of tumors, such as contrast-enhanced CT and MRI. However, only morphological changes of tumors could not accurately evaluate the response of pancreatic cancer after non-surgical treatment. A few studies had explored the value of functional imaging and artificial intelligence.ConclusionsNon-surgical therapy provides new treatment opportunities for unresectable pancreatic cancer, especially the proposed of neoadjuvant therapy, which provides the possibility of operation for patients with advanced pancreatic cancer. More imaging indicators with stronger objectivity, higher accuracy, and wider universality need to be improved and developed in the future.
ObjectiveTo summarize the research progress of KRAS mutation in pancreatic tumorigenesis and therapy.MethodThe research progress of KRAS mutation in pancreatic tumorigenesis and therapy were summarized by reading the domestic and international literatures published in recent years.ResultsPancreatic cancer had the title of " king of cancer”. More than 90% of pancreatic cancer patients had KRAS mutation. KRAS had a complex relationship with pancreatic cancer through downstream signaling pathways, including Raf (rapidly accelerated fibrosarcoma)-mitogen-activated protein kinase kinase (MEK)-extracellular signal-regulated kinase (ERK), phosphatidylinositol-4, 5-bisphosphate 3-kinase (PI3K)-protein kinase B (AKT), and RalGDS-Ral. Although basic research on pancreatic cancer was deepening, there was still a lack of effective molecular targeted drugs.ConclusionsKRASgene plays an important role in the occurrence of pancreatic cancer. The treatment associated with KRAS mutation provides a more effective prognostic possibility for pancreatic cancer patients.
ObjectiveTo investigate the current status and research progress of radioactive 125I seed implantation in the treatment of unresectable pancreatic cancer.MethodsReviewed the relevant literatures to summarize and analyze the mechanism of action, indications and contraindications, implantation methods, clinical efficacy, complications, and treatment measures of radioactive 125I seed implantation in the treatment of pancreatic cancer.ResultsThe mechanism of radioactive 125I seed implantation in the treatment of pancreatic cancer had been deeply studied in terms of gene expression and molecular signal level. The procedure was applicable to a wide range of patients; the implantation methods were abundant, CT and ultrasound guidance had their advantages; it could effectively inhibit tumor growth and improve overall survival rate. It was dramatically for pain relief, as well as low overall complication rate, and the complications could be alleviated by symptomatic treatment.ConclusionRadioactive 125I seed implantation in the treatment of unresectable pancreatic cancer has been widely promoted due to its simple operation and small trauma, and it is effective in controlling tumor growth, prolonging survival, and relieving pain.
ObjectiveTo investigative current status and hotspot issues of pancreatic cancer imaging research.MethodsThe literatures focusing on pancreatic cancer and published from 2001 to 2020 were retrieved from the core database of Web of Science. The quantitative analysis of literatures was then conducted by using the CiteSpace software based on the bibliometric method. The research trend was then summarized systematically and the potential research fronts and focuses were explored.ResultsA total of 2111 articles in the field of pancreatic cancer imaging research were retrieved. The clustering of co-citation of pancreatic cancer included vascular resection, irreversible electroporation, autoimmune pancreatitis, sporadic pancreatic cancer, sarcopenia, pancreas, stereotactic body radiation therapy, metastatic pancreatic cancer, familial pancreatic cancer, abdominal ultrasonography, fibroblast, early diagnosis, time trends in survival, radiomics, pancreatitis, gemcitabine, concurrent chemoradiotherapy, adjuvant chemotherapy, and microbubbles. The burst keywords in the field of pancreatic cancer after 2016 included FOLFIRINOX, skeletal muscle, sarcopenia, and texture analysis. The hot keywords clustering had prognosis, fine needle aspiration, positron emission tomography, vascular invasion, angiogenesis, unresectable, liver transplant, extend pancreatectomy, transplantation, paclitaxel, metastatic colorectal cancer, colorectal cancer, microsatellite stable, radiomics, hospital volume, occult metastasis, risk factor.ConclusionIt might be the trend of imaging research to study the prognosis, risk factors, and quantitative sarcopenia of pancreatic cancer by using radiomics.
ObjectiveTo retrospectively investigate the correlation between tumor immune nutritional indexes and the resectability in patients with pancreatic cancer.MethodsWe selected pancreatic patients with pathological diagnosis who admitted to Xuanwu Hospital of Capital Medical University from January 2015 to December 2018. The clinical data of patients were retrospectively analyzed. Nutritional and inflammatory hematological parameters at one week before operation were carefully collected, the parameters including: the neutrophil count, lymphocyte count, monocyte count, hemoglobin (Hb), platelet count, albumin (Alb), prealbumin (PA), cholesterol, and serum tumor markers (CEA and CA19-9). The ratio of neutrophil count to lymphocyte count (NLR), ratio of platelet count to lymphocyte count (PLR), ratio of lymphocyte count to monocyte count (LMR), prognostic nutrition index (PNI), nutritional risk score (GNIR), and controlled nutritional status score (COUNT) were calculated. The receiver working characteristic curve (ROC curve) was used to evaluate the predictive value of various indexes in radical resection of pancreatic cancer.ResultsOf the 55 patients with pancreatic cancer, 22 received radical surgery and 33 did not. There was no significant difference in gender, BMI, neutrophil count, monocyte count, platelet count, hemoglobin, albumin, prealbumin, cholesterol, and tumor location between the radical operation group and the non-radical operation group (P>0.05), but there were significant differences in age, lymphocyte count, CEA, and CA19-9 between the two groups (P<0.05). There was no significant difference in the area under the curve (AUC) of neutrophil count, lymphocyte count, monocyte count, hemoglobin, platelet count, albumin, prealbumin, cholesterol, NLR, PLR, LMR, PNI, and GNIR to predict the resectability of pancreatic cancer (P>0.05), but there was statistical significance in COUNT score, CEA, and CA19-9 (P<0.05). The AUC values of COUNT, CEA, and CA19-9 were 0.700, 0.705, and 0.739 respectively, the sensitivity corresponding to the best critical point cutoff value were 59.09%, 80.00%, and 100%, as well as the specificity were 87.88%, 66.67%, and 42.42%, respectively. The specificity of COUNT was high, but the sensitivity was poor. The sensitivity of CEA and CA19-9 were high and the specificity were poor.ConclusionsThe COUNT is a simple and useful predictor to predict the resectability of pancreatic cancer. The combination of COUNT and serum tumor markers of CEA and CA19-9 can help to better predict the surgical indications of pancreatic cancer.
Objective To investigate safety and therapeutic effect of total pancreatectomy plus splenectomy for patient with pancreatic cancer. Methods The preoperative clinical data, surgical treatment, and postoperative conditions of 1 patient with pancreatic cancer who underwent the total pancreatectomy plus splenectomy in the Affiliated Hospital of Qinghai University in January 2018 were retrospectively analyzed. Results Combination of the patient clinical history, physical examination, laboratory and radiologic results, the patient was diagnosed with the pancreatic cancer. Then the patient underwent the Whipple procedure. During the operation, it was found that the texture of the pancreas was hard, and the spleen arteriovenous were considered to be invaded, and the multiple frozen section analysis during the operation showed that the surgical margin was positive. Eventually, the total pancreatectomy plus splenectomy was performed. The postoperative pathological analysis results revealed to the well-moderately differentiated tubular adenocarcinoma. When the condition of patient became stable, the pancreatin and insulin were required for long time. No severe complications occurred. The patient survived well after the surgery and no recurrence was observed for following-up of 3 months. Conclusion With improvement of surgical techniques and enhancement of postoperative management, total pancreatectomy can be used as a treatment for pancreatic cancer and it is still safe and feasible.
ObjectiveTo summarize the latest research of long non-coding RNA (lncRNA) as competitive endogenous RNA (ceRNA) and its targeting technology in pancreatic cancer, so as to provide new ideas for lncRNA targeted intervention or as an early diagnostic marker of pancreatic cancer. MethodThe domestic and foreign literature on researches of lncRNA as ceRNA and its targeting technology in the pancreatic cancer was searched and reviewed. ResultsAt present, the growing number of evidences showed that in pathological states such as tumors, the abundance of intracellular lncRNAs was sufficient to trigger ceRNA crosstalk. The lncRNA played a role like “sponge” through the complementary binding of incomplete base of miRNA with miRNA response elements, then adsorbed miRNA, and thus changed the activity and effectiveness of miRNA. It also regulated the expression of downstream target genes. Moreover, a large number of studies had identified that the lncRNA-mediated ceRNA regulatory network, namely lncRNA/miRNA/mRNA axis, played a role in promoting or inhibiting the occurrence and progression of pancreatic cancer through a variety of cellular functions. In addition, many technologies targeting lncRNA, such as small interfering RNA, antisense oligonucleotides, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9, and small molecule inhibitors, etc. had been widely studied and acquired important results in preclinical research. ConclusionsThe ceRNA hypothesis is a functional complex composed by non-coding RNAs and mRNAs with non-coding properties, forming a ceRNA network of multi-level and cross-regulatory on the transcriptome. Epigenetic modification and key post-transcriptional regulation of lncRNA have been achieved through ceRNA network mechanism, which has become a successful paradigm for exploring the function of lncRNA. The tumor suppressive and promoting effects and mechanisms of many lncRNAs in the occurrence and development of pancreatic cancer are explored in many studies. Moreover, the continuous progress of targeted lncRNA technology provides conditions for study of lncRNA. LncRNA has a potential to be used as a biomarker for precancerous diagnosis and prognosis of pancreatic cancer.