International Journal of Molecular Sciences,
Год журнала:
2024,
Номер
25(17), С. 9555 - 9555
Опубликована: Сен. 3, 2024
Pancreatic
cancer
comprises
different
subtypes,
where
most
cases
include
ductal
adenocarcinoma
(PDAC).
It
is
one
of
the
deadliest
tumor
types,
with
a
poor
prognosis.
In
majority
patients,
disease
has
already
spread
by
time
diagnosis,
making
full
recovery
unlikely
and
increasing
mortality
risk.
Despite
developments
in
its
detection
management,
including
chemotherapy,
radiotherapy,
targeted
therapies
as
well
advances
immunotherapy,
only
about
13%
PDAC
patients
does
overall
survival
exceed
5
years.
This
may
be
attributed,
at
least
part,
to
highly
desmoplastic
microenvironment
(TME)
that
acts
barrier
limiting
perfusion,
drug
delivery,
immune
cell
infiltration
contributes
establishment
immunologically
‘cold’
conditions.
Therefore,
there
an
urgent
need
unravel
complexity
TME
promotes
progression
decipher
mechanisms
pancreatic
tumors’
resistance
immunotherapy.
this
review,
we
provide
overview
major
cellular
non-cellular
components
TME,
their
biological
interplays.
We
also
discuss
current
state
therapeutic
treatments
focus
on
ongoing
future
immunotherapy
efforts
multimodal
aiming
remodeling
improve
efficacy.
Oncologists
face
increasingly
complex
clinical
decision-making
processes
as
new
cancer
therapies
are
approved
and
treatment
guidelines
revised
at
an
unprecedented
rate.
With
the
aim
of
improving
oncologists'
efficiency
supporting
their
adherence
to
most
recent
recommendations,
we
evaluated
use
large
language
model
generative
pretrained
transformer
4
(GPT-4)
interpret
from
American
Society
Clinical
Oncology
European
for
Medical
Oncology.
The
ability
GPT-4
answer
clinically
relevant
questions
regarding
management
patients
with
pancreatic
cancer,
metastatic
colorectal
hepatocellular
carcinoma
was
assessed.
We
also
assessed
outputs
without
retrieval-augmented
generation
(RAG),
which
provided
additional
knowledge
model,
then
manually
compared
results
original
guideline
documents.
RAG
correct
responses
in
84%
cases
(of
218
statements,
184
were
correct,
30
inaccurate,
wrong).
only
57%
163
93
29
41
showed
that
GPT-4,
when
enhanced
information
through
RAG,
can
accurately
identify
detailed
similarities
disparities
diagnostic
proposals
across
different
authoritative
sources.
Annals of Surgery,
Год журнала:
2024,
Номер
unknown
Опубликована: Фев. 26, 2024
Objective:
The
REDISCOVER
consensus
conference
aimed
at
developing
and
validate
guidelines
on
the
perioperative
care
of
patients
with
borderline
resectable
(BR-)
locally
advanced
(LA)
pancreatic
ductal
adenocarcinoma
(PDAC).
Summary
Background
Data:
Coupled
improvements
in
chemotherapy
radiation,
contemporary
approach
to
surgery
supports
resection
BR-PDAC
and,
a
lesser
extent,
LA-PDAC.
Guidelines
outlining
selection
for
these
are
lacking.
Methods:
Scottish
Intercollegiate
Network
(SIGN)
methodology
was
used
develop
create
recommendations.
Delphi
reach
(agreement
≥80%)
among
experts.
Recommendations
were
approved
after
debate
vote
international
experts
cancer
management.
A
Validation
Committee
AGREE
II-GRS
tool
assess
methodological
quality
guidelines.
Moreover,
an
independent
multidisciplinary
advisory
group
revised
statements
ensure
adherence
non-surgical
Results:
Overall,
34
recommendations
created
targeting
centralization,
training,
staging,
patient
surgery,
possibility
uncommon
scenarios,
timing
avoidance
vascular
reconstruction,
details
resection/reconstruction,
arterial
divestment,
frozen
section
histology
perivascular
tissue,
extent
lymphadenectomy,
anticoagulation
prophylaxis
role
minimally
invasive
surgery.
level
evidence
however
low
29
clinical
questions.
Participants
agreed
that
most
conducive
mean
promptly
advance
our
understanding
this
field
is
establish
registry
addressing
population
(https://rediscover.unipi.it/)
Conclusions:
provide
pertaining
pancreatectomy
BR-
LA-PDAC,
serve
as
basis
new
population.
JAMA Surgery,
Год журнала:
2024,
Номер
159(10), С. 1139 - 1139
Опубликована: Июль 24, 2024
There
are
currently
no
clinically
relevant
criteria
to
predict
a
futile
up-front
pancreatectomy
in
patients
with
anatomically
resectable
pancreatic
ductal
adenocarcinoma.
Biomolecules,
Год журнала:
2024,
Номер
14(3), С. 364 - 364
Опубликована: Март 19, 2024
Pancreatic
cancer
(PC)
is
the
most
lethal
type
of
cancer;
it
has
lowest
5-year
survival
rate
among
all
other
types
cancers.
More
than
half
PC
cases
are
diagnosed
at
an
advanced
stage
due
to
PC’s
insidious
and
non-specific
symptoms.
Surgery
remains
efficacious
treatment
option
currently
available,
but
only
10–20%
resectable
upon
diagnosis.
As
now,
sole
biomarker
approved
by
United
States
Food
Drug
Administration
(US-FDA)
for
carbohydrate
antigen
19-9
(CA19-9);
however,
its
use
limited
early
An
increasing
number
studies
have
investigated
a
combination
biomarkers.
Lately,
there
been
considerable
interest
in
application
liquid
biopsy,
including
utilization
microRNAs
(miRNAs),
circulating
tumor
DNA
(ctDNA),
cells
(CTCs).
Screening
indicated
high-risk
patients;
on
new
diagnostic
models
combined
with
biomarkers
detection
also
shown
promising
results
terms
ability
these
aid
clinicians
deciding
whether
start
screening.
This
review
seeks
provide
concise
overview
advancements
relation
existing
explore
novel
strategies
PC.
Abstract
Background
Current
diagnostic
imaging
modalities
have
limited
ability
to
differentiate
between
malignant
and
benign
pancreaticobiliary
disease,
lack
accuracy
in
detecting
lymph
node
metastases.
18
F-Prostate-Specific
Membrane
Antigen
(PSMA)
PET/CT
is
an
modality
used
for
staging
of
prostate
cancer,
but
has
incidentally
also
identified
PSMA-avid
pancreatic
lesions,
histologically
characterized
as
ductal
adenocarcinoma
(PDAC).
This
phase
I/II
study
aimed
assess
the
feasibility
F-PSMA
detect
PDAC.
Methods
Seventeen
patients
with
clinically
resectable
PDAC
underwent
prior
surgical
resection.
Images
were
analyzed
both
visually
(semi)quantitatively
by
deriving
maximum
standardized
uptake
value
(SUV
max
)
tumor-to-background
ratio
(TBR).
TBR
was
defined
SUV
primary
tumor
divided
aortic
blood
pool.
Finally,
tracer
on
PET
correlated
tissue
expression
PSMA
specimens.
Results
Out
17
scans,
13
scans
demonstrated
positive
uptake,
a
mean
5.0
±
1.3.
The
suspected
detectable
(TBR
≥
2)
3.3
For
confirmed
PDAC,
4.9
1.2
1.5,
respectively.
Although
eight
had
regional
metastases
two
distant
metastases,
none
these
uptake.
There
no
correlation
Conclusions
able
several
cancers,
including
However,
generally
low,
not
specific
observed
or
added
this
setting
appears
be
limited.
Trial
registration
trial
registered
PANSCAN-2
European
Clinical
Trials
Database
(EudraCT
number:
2020–002185-14).
Graphical
Importance
The
effect
of
adjuvant
chemotherapy
following
resection
pancreatic
adenocarcinoma
after
preoperative
(m)FOLFIRINOX
(combination
leucovorin
calcium
[folinic
acid],
fluorouracil,
irinotecan
hydrochloride,
and
oxaliplatin
in
full
or
modified
dosing)
on
overall
survival
(OS)
is
unclear
because
current
studies
do
not
account
for
the
number
cycles
regimen.
Objective
To
investigate
association
with
OS,
taking
into
Design,
Setting,
Participants
This
retrospective
cohort
study
included
patients
localized
treated
2
to
11
followed
by
across
48
centers
20
countries
from
2010
2018.
Patients
who
died
within
3
months
surgery
were
excluded
(landmark).
Data
analyzed
February
1
December
31,
2023.
Exposures
Preoperative
eventually
chemotherapy.
Main
Outcomes
Measures
primary
outcome
was
calculated
3-month
landmark.
Cox
regression
analysis,
including
interaction
analyses,
performed
OS.
Results
Overall,
767
(median
[IQR]
age,
62
[55-67]
years;
404
[52.7%]
male).
Adjuvant
independently
associated
prolonged
OS
(hazard
ratio
[HR],
0.66;
95%
CI,
0.49-0.87),
confirmed
adjusted
curves.
analysis
assess
estimated
treatment
subgroups
statistically
significant.
forest
plot
test
suggest
that
lower
among
receiving
8
more
(m)FOLFIRINOX,
those
had
radiological
response,
ypN0
disease.
Compared
no
chemotherapy,
both
(HR,
0.57;
0.40-0.80)
other
multiagent
regimens
0.61;
0.41-0.92)
whereas
single-agent
0.75;
0.55-1.03).
Conclusions
Relevance
In
this
study,
improved
not.
impact
may
be
such
as
having
ypN0.