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Current status and future prospect of surgical treatment for pancreatic cancer

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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 89-91页

作者： yinmo yang Department of General Surgery Peking University First HospitalBeijing 100034China

Pancreatic cancer is one of the most deadly malignancies, and the incidence of this dismal disease has been reported to rise yearly in a global range. Currently, the cancer-related mortality rate for pancreatic cancer ranks the fourth in western countries. However, it is predicted that by 2030, the cancer-related death rate of pancreatic cancer will rise to the second place in the United States, and the third place in Europe (1). The main reason for this change is that the treatment efficacy of top-ranking cancers, such as breast, prostate and colorectal cancer, has accomplished a significant improvement recently, while the progress in pancreatic cancer treatment is still evolving slowly. Situations of the diagnosis, treatment and prognosis of pancreatic cancer in China are similar. Overall, the treatment of pancreatic cancer is still extremely challenging, and radical resection remains the only curative therapy. Although some progress has been achieved recently in both adjuvant and neoadjuvant therapies, there is still a long way to go to improve the long-term prognosis of patients with pancreatic cancer. In this mini-review we summarize current status focusing on major advancements in surgical treatment of pancreatic cancer during the past 20 years, and highlights future prospects in the field.

关键词： treatment diagnosis mortality

The management strategy of pancreatic cancer in the era of systemic therapy-“Surgery First” or “Surgery Last”?

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Hepatobiliary Surgery and Nutrition 2022年第4期11卷 597-600页

作者： yinmo yang Xiaodong Tian Department of General Surgery Peking University First HospitalBeijingChina

With the development of chemotherapy,targeted therapy and immunotherapy,the management of solid tumors has evolved from a single discipline to multi-disciplinary comprehensive treatment in recent *** outcome of patients with malignant tumors,including several gastrointestinal cancers,has been continuously improved,along with a significant improvement in long-term survival ***,as a common malignant tumor of the digestive system,pancreatic cancer(PC)is still correlated with a very poor prognosis,characterized by the close parallel between incidence and mortality.

关键词： Surgery cancer chemotherapy

美国国立综合癌症网络临床实践指南:胰腺癌(2025.V1)更新解读

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临床外科杂志 2025年第1期33卷 49-51页

作者：侯钰坤汪兴龙杨尹默田孝东北京大学第一医院肝胆胰外科 100034

胰腺癌是恶性程度极高的消化系统恶性肿瘤,其发生率及死亡率均呈逐年升高趋势,在全球癌症发病率中位列第12位,肿瘤相关死亡率位居第6位[1]。目前,胰腺癌仍存在早期诊断困难、手术切除率低、药物治疗效果不理想的困境,病人总体5年生存率... 详细信息

胰腺癌是恶性程度极高的消化系统恶性肿瘤,其发生率及死亡率均呈逐年升高趋势,在全球癌症发病率中位列第12位,肿瘤相关死亡率位居第6位[1]。目前,胰腺癌仍存在早期诊断困难、手术切除率低、药物治疗效果不理想的困境,病人总体5年生存率仅为13%左右,预计在2030年将上升为癌症相关死亡的第二大原因[2-3]。

关键词：美国国立综合癌症网络胰腺癌指南解读

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Molecular characterization of circulating tumor cells in pancreatic ductal adenocarcinoma:potential diagnostic and prognostic significance in clinical practice

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Hepatobiliary Surgery and Nutrition 2021年第6期10卷 796-810,I0006,I0007页

作者： Xudong Zhao Yongsu Ma Xiu Dong Zhengkui Zhang Xiaodong Tian Xiaohang Zhao yinmo yang Department of General Surgery Peking University First HospitalBeijingChina State Key Laboratory of Molecular Oncology National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijingChina

Background:The clinical value of heterogeneous sub-populations of circulating tumor cells(CTCs)in pancreatic ductal adenocarcinoma(PDAC)remains ***:Peripheral blood samples were obtained from 67 PDAC *** were isolated by employing CD45 negative enrichment technique and further characterized for epithelial to mesenchymal transition(EMT)or human equilibrative nucleoside transporter-1(hENT-1).The relationships between CTCs sub-phenotypes with clinicopathological factors or post-operative recurrence in PDAC patients were ***:EMT related CTCs could be isolated and identified from the 81%of patients(54/67),and both the total count(median:5 vs.17/mL,P<0.0001)and M-CTC percentage(median:0.2 vs.0.345,P=0.0244)of CTCs could differentiate local/regional with metastatic *** analysis showed that both AJCC stage(P=0.025)and M-CTC percentage(P=0.001)were independent prognostic indicators of recurrence free survival(RFS)in resected ***,Kaplan-Meier survival analysis showed that M-CTC after 2 courses of chemotherapy was significantly associated with inferior RFS(49.5 weeks ***,P=0.0288).No significant correlation in hENT-1 expression was found between CTCs and matched tumor tissues,and further multivariate analysis suggested hENT-1 expression in CTCs as independent prognostic factor for RFS(P=0.016).Patients with low hENT-1 expression in CTCs had decreased RFS(32 weeks ***,P=0.0337).Conclusions:CTCs could be the promising diagnostic biomarkers in PDAC patients,and phenotypic profiling of CTCs based on EMT or hENT-1 could help establish novel prognostic biomarkers in resected patients undergoing adjuvant gemcitabine-based chemotherapy.

关键词： Circulating tumor cells(CTCs) Pancreatic ductal adenocarcinoma(PDAC) Epithelial to mesenchymal transition(EMT) human equilibrative nucleoside transporter-1(hENT-1)

Validation and modification of the AJCC 8th TNM staging system for pancreatic ductal adenocarcinoma in a Chinese cohort:A nationwide pancreas data center analysis

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Chinese Journal of Cancer Research 2021年第4期33卷 457-469页

作者： Hao Hu Chang Qu Bingjun Tang Weikang Liu Yongsu Ma Yiran Chen Xuehai Xie Yan Zhuang Hongqiao Gao Xiaodong Tian yinmo yang Department of General Surgery Peking University First HospitalBeijing 100034China Department of Hepatobiliary Surgery Aerospace Center HospitalBeijing 100049China

Objective:To validate the 8 th edition of the American Joint Committee on Cancer(AJCC)staging system for pancreatic ductal adenocarcinoma(PDAC)in a Chinese cohort of radically resected patients and to develop a refined staging system for ***:Data were collected from the China Pancreas Data Center(CPDC)for patients with resected PDAC in 2016 and 2017,and cancer-specific survival(CSS)was evaluated using the Kaplan-Meier method and log-rank *** and multivariate analyses based on Cox regression were performed to identify prognostic *** recursive partitioning analysis(RPA),Kaplan-Meier method,and log-rank test were performed on the training dataset to generate a proposed modification for the 8 th TNM staging system utilizing the preoperative carbohydrate antigen(CA)19-9 *** was performed for both staging systems in the validation ***:A total of 1,676 PDAC patients were retrieved,and the median CSS was significantly different between the 8 th TNM groupings,with no significant difference in survival between stage IB and *** analysis of T and N stages demonstrated a better prognostic value in the N *** analysis showed that the preoperative serum CA19-9 level was the strongest prognostic indicator among all the independent risk *** patients with CA19-9>500 U/mL had similar survival,and we proposed a new staging system by combining IB and IIA and stratifying all patients with high CA19-9 into stage *** modified staging system had a better performance for predicting CSS than the 8 th AJCC staging ***:The 8 th AJCC staging system for PDAC is suitable for a Chinese cohort of resected patients,and the N category has a better prognostic value than the T *** modified staging system has superior accuracy in predicting survival than the 8 th AJCC TNM staging system.

关键词： CA19-9 cancer-specific survival CPDC pancreatic ductal adenocarcinoma prognosis TNM staging

Recent advances in the treatment of pancreatic cancer

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Holistic Integrative Oncology 2024年第1期3卷 346-351页

作者： Yongsu Ma Fusheng Zhang yinmo yang Department of Hepatobiliary and Pancreatic Surgery Peking University First HospitalBeijing 100034China

Pancreatic cancer(PC)is one of the most aggressive gastrointestinal malignancies,characterized by rapid progres-sion and early onset of metastasis,leading to a dismal prognosis for *** the recent past,substantial progress has been conducted recently in managing PC,encompassing various treatment modalities such as chemotherapy,neoadjuvant therapy,targeted therapy,and *** in 2023,several noteworthy studies have contributed to optimizing neoadjuvant treatment regimens and exploring novel approaches that involve targeted therapies and immunotherapies for *** advancements hold promise for improving overall survival outcomes and enhancing quality of life for patients with pancreatic *** commentary summarizes the new advances in systemic therapy for pancreatic cancer in 2023.

关键词： Pancreatic cancer Neoadjuvant therapy Chemotherapy Targeted therapy Immunotherapy

保留十二指肠的胰头切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的系统分析

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中华外科杂志 2021年第7期59卷 608-617页

作者： Hans G.Beger Benjamin Mayer yinmo yang Bertram Poch c/o University of Ulm Albert-Einstein-Allee 2389081 UlmGermany Institute for Epidemiology and Medical Biometry University of UlmGermany Department of Surgery Peking University First HospitalBeijing 100034China Center for Oncologic Endocrine and Minimal Invasive SurgeryDonau-Klinikum Neu-UlmGermany

背景保留十二指肠的胰头切除术是替代胰十二指肠切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的可行之选。方法检索Pubmed、Embase及Cochrane数据库中保留十二指肠胰头切除术的研究结果。根据手术指征、围手术期并发症及微创应用等纳入1... 详细信息

背景保留十二指肠的胰头切除术是替代胰十二指肠切除术治疗良性肿瘤、囊性肿瘤及神经内分泌瘤的可行之选。方法检索Pubmed、Embase及Cochrane数据库中保留十二指肠胰头切除术的研究结果。根据手术指征、围手术期并发症及微创应用等纳入1994年1月至2021年3月的38项队列研究共702例患者的临床资料。结果共702例患者分别因良性肿瘤、癌前病变、囊性肿瘤、胰腺神经内分泌肿瘤、十二指肠乳头周围腺瘤等行保留十二指肠的胰头切除术。702例患者中,214例(30.5%)行保留十二指肠的部分胰头切除术,488例(69.5%)行保留十二指肠的全胰头切除术,后者中微创手术占17.3%。两种术式的术后早期严重并发症发生率(术后B及C级胰瘘、胆瘘、腹腔出血及腹腔脓肿)均2 cm的有或无功能的良性内分泌肿瘤外科治疗的首选术式。

关键词：胰腺肿瘤外科手术系统分析

MicroRNAs as potential therapeutic targets for pancreatic cancer

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Chinese Medical Journal 2022年第1期135卷 4-10页

作者： Xiangyu Chu Dan Wei Xinxin Liu Di Long Xiaodong Tian yinmo yang Department of General Surgery Peking University First HospitalBeijing 100034China

Pancreatic cancer is one of the most aggressive malignancies. The poor prognosis of pancreatic cancer patients is mainly attributed to low diagnostic rate at the early stage, highly aggressive nature coupled with the inadequate efficacy of current chemotherapeutic regimens. Novel therapeutic strategies are urgently needed for pancreatic cancer. MicroRNAs (miRNAs) play an important regulatory role in key processes of cancer development. The aberrant expression of miRNAs is often involved in the initiation, progression, and metastasis of pancreatic cancer. The discovery of tumor suppressor miRNAs provides prospects for the development of a novel treatment strategy for pancreatic cancer. We reviewed recent progress on the understanding of the role of miRNAs in pancreatic cancer, highlighted the efficient application of miRNAs-based therapies for pancreatic cancer in animal models and clinical trials, and proposed future prospects. This review focuses on the promise of integrating miRNAs into the treatment of pancreatic cancer and provides guidance for the development of precision medicine for pancreatic cancer.

关键词： Pancreatic cancer MicroRNA MicroRNA carriers Precision medicine

当下可为未来可期:胰腺癌外科治疗若干热点问题

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中华外科杂志 2023年第1期61卷 1-6页

作者：杨尹默北京大学第一医院外科北京100034

近20年来,胰腺外科手术理念与技术有了巨大的更新和进步,在显著提高胰腺癌手术安全性与切除率的同时,也衍生出对手术指征、手术时机、切除范围等传统外科问题的再审视与思考。患者预后改善是判断手术指征的“金标准”,传统形态学“不可... 详细信息

近20年来,胰腺外科手术理念与技术有了巨大的更新和进步,在显著提高胰腺癌手术安全性与切除率的同时,也衍生出对手术指征、手术时机、切除范围等传统外科问题的再审视与思考。患者预后改善是判断手术指征的“金标准”,传统形态学“不可切除”的标准将不断被突破,可否切除的判断将从“能否切除”过渡到“应否切除”。在临床研究之外,提倡进行标准范围的淋巴结清扫。对于新辅助治疗后的交界可切除及局部进展期胰腺癌,可行扩大范围的淋巴结清扫。各种手术入路皆为可行之选,入路服从于解剖的需要,解剖服从于根治的需要,根治服从于预后改善的需要。对于部分局部进展期胰腺癌患者,动脉鞘剥除及“海德堡三角”清扫有助于提高切除率,降低局部复发率,但对远期预后的影响尚有待进一步临床观察。胰肠吻合质量较吻合方式对胰瘘发生率的影响更大。对于开展样本量大、临床经验丰富的术者,腹腔镜或机器人辅助手术具有微创优势,但对胰头癌行胰十二指肠切除,尚无充分证据证明其肿瘤学优势。

关键词：胰腺肿瘤外科手术胰十二指肠切除术