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Study on Lymphatic Metastasis of Pancreatic Carcinoma Should be Emphasized

MANAGEMENT OF COMPLICATIONS OF REGIONO-PERFUSIONAL CHEMOTHERAPY OF PANCREATIC ADENOCARCINOMA

Objective To evaluate the effect of regiono-perfusional chemotherapy of pancreatic adenocarcinoma, and to seek the management of its complications. MethodsThirty-six patients with unresectable pancreatic adenocarcinoma received selectively intra-arterial catheterization and perfused with 5-Fu, ADM, DDP. Results Six patients had complete response, 15 partial response, and one underwent radical resection subsequently. Cmplications occurred in 14 patients with 2 patients died of complications.Conclusion Regiono-perfusional chemotherapy of pancreatic adenocarcinoma is effective, but the complications can not be neglected.

Pancreatic Carcinoma: Diagnosis and Preoperative Resectability Assessment by Using Gd-DTPA 3D FSPGR Dynamic MR Imaging

ObjectiveTo study the value of Gd-DTPA three dimension fast spoiled gradientecho (3D FSPGR) dynamic MRI in the diagnosis and preoperative respectability assessment of pancreatic carcinoma.MethodsThirty-two cases of pancreatic carcinoma verified by surgery and pathology were included in this study. All of the cases had MRI examinations two weeks before surgery. MRI protocols involved gradient echo T1 weighted（GRE T1W） with fat suppression, fast spin echo respiratory gating T2 weighted (FSE RG T2W) with fat suppression, MR cholangiopancreatography (MRCP) and gadolinium chelate 3D FSPGR T1W dynamic enhancement. Two radiologists reviewed MRI of the 32 cases retrospectively. Preoperative resectability of pancreatic carcinoma was assessed according to the characteristics of tumor lesions, peripancreatic invasion, vascular invasion, lymph node metastases, and liver metastases. The diagnosis and preoperative resectability assessment of pancreatic carcinoma by MRI was compared with surgical findings. ResultsOf 32 cases, 29 cases diagnosed by MRI were confirmed by surgery and pathology (accuracy of MRI, 90.6%). The sensitivity was 84.4%(27/32) and 93.8%(30/32) respectively for GRE T1W with fat-suppression combining FSE RG T2W and for Gd-DTPA 3D FSPGR dynamic MRI in the detection of pancreatic tumors. The accuracy was 87.5%（21/24）, 87.0%（20/23）, 80.0%（12/15）, 88.9%（8/9） and 83.3%（5/6） respectively for Gd-DTPA 3D FSPGR dynamic MRI in assessing local extension, vascular invasion, lymph node metastases, liver metastases and peritoneal carcinomatosis of pancreatic carcinoma. Eight cases of pancreatic carcinoma were considered to be resectable by enhanced MRI, while the tumors in 7 cases of the 8 cases were resected by surgery. Twentythree cases were confirmed nonresectable by surgery in the 24 cases of pancreatic carcinoma considered to be non-resectable by enhanced MRI. The sensitivity, specificity and accuracy were 87.5%，95.8% and 93.8% resectability for the assessment of respectability of pancreatic carcinoma by using Gd-DTPA 3D FSPGR dynamic MRI. There was no significant difference in the assessment of the resectability of pancreatic carcinoma between enhanced MRI and surgery or pathology （κ=0.83）.ConclusionUsing of Gd-DTPA 3D FSPGR dynamic enhanced MRI improves the detections of pancreatic carcinoma and metastasis. It is also accurate in the assessment of the resectability of pancreatic carcinoma.

Usage of proton pump inhibitors is associated with pancreatic cancer: a systematicreview and meta-analysis

ObjectiveTo further evaluate the relation between usage of proton pump inhibitor (PPI) and the risk of pancreatic cancer. MethodThe observational studies were systematically searched in the databases of PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, CNKI, Wanfang, and VIP. The combined odds ratio (OR) and 95% confidence interval (CI) of pancreatic cancer risk were estimated by the corresponding effect model according to the heterogeneous results, and the subgroup analysis, meta-regression, and sensitivity analysis were performed. In addition, the relation between the defined daily dose (DDD) and usage time of PPI and the pancreatic cancer risk were studied by using restricted cubic spline. ResultsA total of 14 studies were included, including 1 601 430 subjects. The meta-analysis result showed that usage of PPI was positively correlated with the risk of pancreatic cancer [I2=98.9%, OR (95%CI)=1.60 (1.21, 2.11), P<0.001]. The subgroup analysis results showed that usage of PPI would increase the risk of pancreatic cancer in the subgroups of literature published before 2018 [OR (95%CI)=1.88 (1.05, 3.38), P=0.034], non-Asian regions [OR (95%CI)=1.37 (1.04, 1.82), P=0.028], case-control studies [OR (95%CI)=1.59 (1.16, 2.18), P=0.004], cohort studies [OR (95%CI)=1.65 (1.13, 2.39), P=0.009], and high-quality studies [OR (95%CI)=1.62 (1.19, 2.20), P=0.002]. The dose-response curve showed that there was a nonlinear relation between the usage of PPI and the risk of pancreatic cancer (χ2linear=2.27, P=0.132; Pnonlinear=0.039). When the usage of PPI was 800 DDD or less, usage of PPI would increase the risk of pancreatic cancer, but there was no statistical significance when the usage of PPI was more than 800 DDD. The time-effect curve showed that there was a linear relation between the usage time of PPI and the risk of pancreatic cancer (χ2linear=6.92, P=0.009), and the risk of pancreatic cancer would increase by 2.3% if the usage of PPI increased by one month [OR=1.02, 95%CI (1.01, 1.04), P=0.009]. The sensitivity analysis confirmed that the results were stable by gradually eliminating each study, the OR (95%CI) of the risk of pancreatic cancer was 1.37 (1.08, 1.74) to 1.66 (1.22, 2.27), and the publication bias was not found by Egger test (P=0.594).ConclusionsFrom the results of this meta-analysis, usage of PPI will increase the risk of pancreatic cancer, and the dosage of PPI and usage time of PPI may be related to the risk of pancreatic cancer. The clinical usage of PPI should be strictly controlled, and the dosage and usage time should also be carefully considered.

Imaging response evaluation of non-surgical therapy for pancreatic cancer

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.

Construction of Recombinant Caspase3 Gene and the Observation of It’s Apoptotic Activity in Pancreatic Carcinoma

ObjectiveTo explore the new gene therapy method for tumor, the recombinant Caspase3 gene (rcaspase3) eukaryotic expression plasmid was constructed by molecular biologic method. MethodsThe eukaryotic expression plasmid pcDNA3.1(+)/rCaspase3 was constructed by rearrangement of the large subunit and small subunit of Caspase3　and it was transfected into pancreatic carcinoma cells(PCⅡ). After being transfected, the expression of rCaspase3 mRNA in pancreatic carcinoma cells was detected by RTPCR and it’s apoptotic activity was detected by FCM. ResultsThe sequence of rCaspase3 showed that the recombinant molecules (rCaspase3) now had its’ small subunit preceding its’ large subunit. After pancreatic carcinoma cells being transfected with the pcDNA3.1(+)/rCaspase3 by liposomes, a 894 bp strap was observed by RTPCR. No strap was found in control groups. A transparent hypodiploid karyotype peak was found by FCM.ConclusionThe plasmid of pcDNA3.1(+)/rCaspase3 has been constructed successfully. rCaspase3 has apoptotic activity and can be used as target gene in gene therapy for pancreatic carcinoma.

Research status and progress of nutritional support therapy for pancreatic cancer

ObjectiveTo summarize the current status and progress of nutritional support therapy for pancreatic cancer in order to improve the understanding of the impact of nutritional support treatment on pancreatic cancer and guide clinical work.MethodThe literatures about nutritional support and chemotherapy for pancreatic cancer at home and abroad were read and reviewed.ResultsFor most patients with malignant pancreatic tumors, nutritional risk or malnutrition might accompany them for a lifetime. Regular nutritional risk screening, timely nutritional assessment and necessary nutritional treatment played an extremely important role in the process of comprehensive anti-tumor treatment.ConclusionAlthough there are still some core problems to be solved in nutritional support therapy and chemotherapy for pancreatic cancer, its efficacy is gradually recognized and widely used by clinical workers, which might be helpful to improve the prognosis of patients with pancreatic cancer.

Values of CA199, CA242, CEA, and CA125 in Diagnosis and Prognosis for Pancreatic Cancer

ObjectiveTo explore the values of CA19-9, CA242, CEA, and CA125 single or combined detection on clinical diagnosis and prognosis for patients with pancreatic cancer. MethodsSerum tumor markers CA199, CA242, CEA, and CA125 of 63 patients with pancreatic cancer, 33 patients with cancer of bile duct, and 27 patients with benign pancreatic disease were detected, and those patients were followed up after operation. ResultsThe levels of CA19-9, CA242, CEA, and CA125 in patients with pancreatic cancer were significantly higher than those in patients with benign pancreatic disease and cancer of bile duct (Plt;0.05). The sensitivity of CA19-9 alone was the highest in the four tumor markers for the patients with pancreatic cancer 〔79.4% (50/63)〕, but the specificity (61.9%) was lower than that of CA242 (83.3%) and CEA (80.0%). The specificity of combined detection of CA199+CA242+CEA was the highest 〔93.3% (56/60)〕. The level of CA19-9 in carcinoma of body/tail of pancreas was significantly higher than that of carcinoma of pancreas head or whole pancreas (Plt;0.05). The serum levels of CA19-9 and CA242 in patients with stage Ⅳ were significantly higher than those in stage Ⅰ or Ⅱ/Ⅲ (Plt;0.05). Fifteen patients were lost to follow up, 48 patients were followed up 2－12 months with an average 6 months. The levels of CA242 and CA199 in patients with pancreatic cancer on 0.5 month and 3 months after operation were lower than those before operation (Plt;0.05). ConclusionsSingle detection of CA19-9 can improve the diagnostic sensitivity, and combined detection of tumor markers CA199+CA242+CEA can improve the diagnostic specificity. CA19-9 or CA242 is a valuable marker for evaluating treatment effects and estimating prognosis.

Experimental Study of the Therapeutic Effect and Mechanism of Photodynamic therapy to Pancreatic Cancer by Intratumoral Injecting Photosensitizer

bjectiveTo study the therapeutic effect and mechanism of photodynamic therapy (PDT) to the nude mice model of pancreatic cancer by intratumoral injecting photosensitizers hematoporphyrin derivatives (HpD), hypocrellin A (HA) and 2butylamino2demethoxyhypocrellin A (2BA2DMHA).MethodsThe animal model of human pancreatic cancer was developed by injecting human pancreatic cancer cells SW1990 into the back of the nude mice. After photosensitizers HpD, HA and 2BA2DMHA was given by the intratumoral injection, the 632.8 nm HeNe laser was used to irradiate the tumor. The curative effect was recorded and factorⅧ was used in the immunohistochemical staining to study the vessel change. ResultsPDT can destroy the pancreatic neoplasm, the tumor growth rate was significantly reduced after PDT. The immunohistochemical staining showed PDT could make injury to vessel endothelial cell.ConclusionPDT can induce injuries of pancreatic cancer; vascular injury is an important way to exert function.

Bibliometric and visualization analysis of current status and hotspots of pancreatic cancer imaging research

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.