A sensitive,rapid and simple liquid chromatography-tandem mass spectrometric（LC-MS/MS） method was developed and validated for the determination of letrozole（LTZ） in nude mouse plasma in the current study,which was...A sensitive,rapid and simple liquid chromatography-tandem mass spectrometric（LC-MS/MS） method was developed and validated for the determination of letrozole（LTZ） in nude mouse plasma in the current study,which was successfully applied to a pharmacokinetic study.Using anastrozole as internal standard（IS）,plasma samples went through a one-step protein precipitation with acetonitrile before determination.The analyte and IS were analyzed on a reversed-phase ZORBAX-SB-C18 column（4.6 mm×250 mm,5 μm） with an isocratic mobile phase consisting of acetonitrile and water containing 0.1% formic acid（v/v） at a flow rate of 1.0 mL/min.The analyte and IS were detected by a triple-quadrupole tandem mass spectrometer,and electrospray and multiple reaction monitoring（MRM） were employed to select LTZ at m/z 286.4/217.1 and IS at m/z 294.1/225.3 simultaneously in the positive ion mode.The calibration curve showed good linearity ranging from 0.8–2000.0 ng/mL（r〉0.99）.The intra-day and inter-day precisions of LTZ were 4.0%–8.4%,with an accuracy of 98.6%–104.9%.Using this method,we successfully characterized the pharmacokinetics（PK） of LTZ by a one-compartment model with first-order absorption in female BALB/c nude mice.展开更多
Sunitinib(SUN)is a multi-targeted receptor tyrosine kinase inhibitor(TKI)that may lead to drug resistance and metastasis because of increased cancer stem-like cells(CSCs)due to the induction of hypoxia.Our group has p...Sunitinib(SUN)is a multi-targeted receptor tyrosine kinase inhibitor(TKI)that may lead to drug resistance and metastasis because of increased cancer stem-like cells(CSCs)due to the induction of hypoxia.Our group has proved that dopamine(DA)can specifically reduce CSC frequency and enhance the response of SUN in drug-resistant breast cancerand non-small cell lung cancer(NSCLC).In this study,DA and SUN combination therapy was investigated in the treatment of pancreatic cancer,a malignant tumor with high mortality rate and very limited therapies.The cytotoxicity assay,clone formation assay and wound healing assay in two pancreatic cancer cell line PANC-1 and SW1990 showed that DA could significantly increase the effect of SUN on cell survival,clone formation ability and migration ability.Besides,SW1990 cell-derived xenograft model and a pancreatic cancer patient-derived xenograft(PDX)model were constructed,further proving that DA could increase the in vivo anti-tumor efficacy of SUN,and could be reversed by SCH23390,a D1 dopamine receptor(D1DR)antagonist.Moreover,the CSC frequency of the combination groups was lower than the control groups or SUN monotherapy groups.In addition,the body weight,H&E staining and blood routine test results showed that the combination therapy was safe.In summary,DA and SUN combination therapy could be a promising strategy for the treatment of pancreatic cancer.展开更多
Background:Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related death in China.The rapid progress in systemic therapies has led to the approval of many therapeutic methods that have quickly chang...Background:Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related death in China.The rapid progress in systemic therapies has led to the approval of many therapeutic methods that have quickly changed clinical guidelines and practices.Because of the high heterogeneity of HCC,there are still some gaps between the guidelines and real-world clinical practice.The present study surveyed experts in China to investigate the current treatment concepts and clinical practice regarding HCC.Methods:A questionnaire survey on the treatment concepts and clinical practice of HCC was administered to 310 experts with senior professional titles in 2020 and 312 experts in 2021.The results were analyzed and compared.Results:For treating patients with resectable HCC,28%of hepatobiliary surgeons indicated neoadjuvant therapy,and 7%chose systemic therapy±locoregional therapy as 1 L therapy in 2021 compared with 20%and 1%in 2020.More experts chose adjuvant treatment within 1 month in 2021 compared with 2020,and 6 months and 12 months were the leading choices for the duration of adjuvant treatment.In 2021,79%of surgeons and 19%of interventionalists were willing to conduct downstaging/conversion therapy for patients with potentially resectable HCC,and 78%chose tyrosine kinase inhibitors(TKI)+immunotherapy(IO)+locoregional therapy for cases in which R0 resection could not be achieved.For completely unresectable HCC,more experts preferred TKI+IO-based therapy as 1 L therapy in 2021 compared with 2020(78%vs.55%).The proportion of experts who indicated TKI+IO-based therapy as 2 L therapy increased from 32%in 2020 to 40%in 2021.Conclusion:The survey results indicated that in 2021,compared with 2020,more experts opted to administer IO+TKI for the treatment of liver cancer,and more experts and patients were willing to participate in clinical research.展开更多
Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected pa...Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.展开更多
Desmoid-type fibromatosis (DF) is a rare monoclonal fibroblastic proliferation that is characterized by locally infiltrative but rarely metastatic lesions. Tyrosine kinase and γ-secretase inhibitors are primarily use...Desmoid-type fibromatosis (DF) is a rare monoclonal fibroblastic proliferation that is characterized by locally infiltrative but rarely metastatic lesions. Tyrosine kinase and γ-secretase inhibitors are primarily used in the targeted therapy of DF. The use of these drugs, however, is mainly based on the recommendations of retrospective studies with small sample sizes. Previous studies that focused on the mechanism, efficacy, and safety of targeted therapy for DF were reviewed to provide references for clinical applications and research. The efficacy and safety of targeted therapy were compared with those of other systemic therapy options. Targeted therapy does not provide considerable advantages in efficacy and safety over other medical treatments and is usually applied after the failure of antihormonal therapies, nonsteroidal anti-inflammatory drugs, and chemotherapy. Further studies are required to explore the mechanism, indications, and appropriate drug dosage of the targeted therapy of DF.展开更多
Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role...Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.展开更多
The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreat...The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.展开更多
Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter ...Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter cross-sectional study performed in China.Data from patients with pNENs undergoing surgery at 33 high-volume medical centers,where the number of pancreatectomies exceeds 20 cases per year,were collected and analyzed between March 1,2016 and February 28,2017.Results:In total,392 patients with pNENs were enrolled.The male to female ratio was 1.4.The majority of patients were aged between 40 and 70 years.65.6%of the patients had non-functional tumors.Among those with functional tumors,the percentages of insulinomas,gastrinomas,glucagonomas,and vasoactive intestinal peptide-secreting tumors were 94.8%,1.5%,2.2%,and 1.5%,respectively.Multidisciplinary team(MDT)discussion was conducted for 39.0%of the patients.Minimally invasive surgery was performed on 31.1%of the 392 patients.The incidence of grade B/C pancreatic fistula formation was 4.4%.A total of 89.0%of the surgeries achieved R0 resection,and 41.6%of the tumors were well differentiated.Lymph node metastasis was present in 8.9%of the patients.The percentages of patients with grades G1,G2,and G3 disease were 49.2%,45.7%,and 5.1%,respectively.Conclusion:This multicenter cross-sectional study systematically presents the current status of the diagnosis and treatment of patients with pNENs undergoing surgery in China.MDT consultation for pNENs has not been widely implemented in China.Although the incidence of surgical complications is relatively low,minimally invasive procedures should be further promoted.This study shows us how to improve the outcomes of these patients.展开更多
Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods...Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.展开更多
Pancreatic cancer is one of the leading causes of cancer-related mortality in both developed and developing coun-tries.The incidence of pancreatic cancer in China accounts for about a quater of the global incidence,an...Pancreatic cancer is one of the leading causes of cancer-related mortality in both developed and developing coun-tries.The incidence of pancreatic cancer in China accounts for about a quater of the global incidence,and the epidemiological characteristics and therapeutic strategies differ due to social,economic,cultural,environmental,and public health factors.Non-domestic guidelines do not reflect the clinicopathologic characteristics and treat-ment patterns of Chinese patients.Thus,in 2018,the Chinese Society of Clinical Oncology(CSCO)organized a panel of senior experts from all sub-specialties within the field of pancreatic oncology to compile the Chinese guidelines for the diagnosis and treatment of pancreatic cancer.The guidelines were made based on both the Western and Eastern clinical evidence and updated every one or two years.The experts made consensus judg-ments and classified evidence-based recommendations into various grades according to the regional differences,the accessibility of diagnostic and treatment resources,and health economic indexes in China.Here we present the latest version of the guidelines,which covers the diagnosis,treatment,and follow-up of pancreatic cancer.The guidelines might standardize the diagnosis and treatment of pancreatic cancer in China and will encourage oncologists to design and conduct more clinical trials about pancreatic cancer.展开更多
Introduction Primary liver cancer is a significant health issue in China,where it ranks fourth in morbidity and second in mortality among all malignant tumors.[1-4]The 5-year overall survival rate of Chinese patients ...Introduction Primary liver cancer is a significant health issue in China,where it ranks fourth in morbidity and second in mortality among all malignant tumors.[1-4]The 5-year overall survival rate of Chinese patients with liver cancer from 2012 to 2015 was only 12.2%for males and 13.1%for females.[5]Hepatocellular carcinoma(HCC)accounts for 75-85%of primary liver cancers.[6]Furthermore,most liver cancers are unresectable at diagnosis.To combat this,conversion therapy is used,which involves systematic treatments like anti-angiogenic drugs or molecular targeted therapy combined with immunotherapies,as well as locoregional treatments such as transcatheter arterial chemoembolization(TACE),hepatic artery infusion chemotherapy(HAIC),ablation therapy,and radiation therapy.The goal is to eliminate unresectable status and increase the chances of surgery.The reported 5-year survival rate after salvage surgery following tumor downstaging varied from 24.9-57%.展开更多
基金National Natural Science Foundation of China(Grant No.81673500)Innovation Team of Ministry of Education(Grant No.BMU2017TD003)
文摘A sensitive,rapid and simple liquid chromatography-tandem mass spectrometric（LC-MS/MS） method was developed and validated for the determination of letrozole（LTZ） in nude mouse plasma in the current study,which was successfully applied to a pharmacokinetic study.Using anastrozole as internal standard（IS）,plasma samples went through a one-step protein precipitation with acetonitrile before determination.The analyte and IS were analyzed on a reversed-phase ZORBAX-SB-C18 column（4.6 mm×250 mm,5 μm） with an isocratic mobile phase consisting of acetonitrile and water containing 0.1% formic acid（v/v） at a flow rate of 1.0 mL/min.The analyte and IS were detected by a triple-quadrupole tandem mass spectrometer,and electrospray and multiple reaction monitoring（MRM） were employed to select LTZ at m/z 286.4/217.1 and IS at m/z 294.1/225.3 simultaneously in the positive ion mode.The calibration curve showed good linearity ranging from 0.8–2000.0 ng/mL（r〉0.99）.The intra-day and inter-day precisions of LTZ were 4.0%–8.4%,with an accuracy of 98.6%–104.9%.Using this method,we successfully characterized the pharmacokinetics（PK） of LTZ by a one-compartment model with first-order absorption in female BALB/c nude mice.
基金National Natural Science Foundation of China(Grant No.81473277)Innovation Team of Ministry of Education(Grant No.BMU2017TD003)。
文摘Sunitinib(SUN)is a multi-targeted receptor tyrosine kinase inhibitor(TKI)that may lead to drug resistance and metastasis because of increased cancer stem-like cells(CSCs)due to the induction of hypoxia.Our group has proved that dopamine(DA)can specifically reduce CSC frequency and enhance the response of SUN in drug-resistant breast cancerand non-small cell lung cancer(NSCLC).In this study,DA and SUN combination therapy was investigated in the treatment of pancreatic cancer,a malignant tumor with high mortality rate and very limited therapies.The cytotoxicity assay,clone formation assay and wound healing assay in two pancreatic cancer cell line PANC-1 and SW1990 showed that DA could significantly increase the effect of SUN on cell survival,clone formation ability and migration ability.Besides,SW1990 cell-derived xenograft model and a pancreatic cancer patient-derived xenograft(PDX)model were constructed,further proving that DA could increase the in vivo anti-tumor efficacy of SUN,and could be reversed by SCH23390,a D1 dopamine receptor(D1DR)antagonist.Moreover,the CSC frequency of the combination groups was lower than the control groups or SUN monotherapy groups.In addition,the body weight,H&E staining and blood routine test results showed that the combination therapy was safe.In summary,DA and SUN combination therapy could be a promising strategy for the treatment of pancreatic cancer.
文摘Background:Hepatocellular carcinoma(HCC)is the second leading cause of cancer-related death in China.The rapid progress in systemic therapies has led to the approval of many therapeutic methods that have quickly changed clinical guidelines and practices.Because of the high heterogeneity of HCC,there are still some gaps between the guidelines and real-world clinical practice.The present study surveyed experts in China to investigate the current treatment concepts and clinical practice regarding HCC.Methods:A questionnaire survey on the treatment concepts and clinical practice of HCC was administered to 310 experts with senior professional titles in 2020 and 312 experts in 2021.The results were analyzed and compared.Results:For treating patients with resectable HCC,28%of hepatobiliary surgeons indicated neoadjuvant therapy,and 7%chose systemic therapy±locoregional therapy as 1 L therapy in 2021 compared with 20%and 1%in 2020.More experts chose adjuvant treatment within 1 month in 2021 compared with 2020,and 6 months and 12 months were the leading choices for the duration of adjuvant treatment.In 2021,79%of surgeons and 19%of interventionalists were willing to conduct downstaging/conversion therapy for patients with potentially resectable HCC,and 78%chose tyrosine kinase inhibitors(TKI)+immunotherapy(IO)+locoregional therapy for cases in which R0 resection could not be achieved.For completely unresectable HCC,more experts preferred TKI+IO-based therapy as 1 L therapy in 2021 compared with 2020(78%vs.55%).The proportion of experts who indicated TKI+IO-based therapy as 2 L therapy increased from 32%in 2020 to 40%in 2021.Conclusion:The survey results indicated that in 2021,compared with 2020,more experts opted to administer IO+TKI for the treatment of liver cancer,and more experts and patients were willing to participate in clinical research.
文摘Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.
基金We would like to thank all faculty members who assisted us in this study. This work was supported by the Beijing Municipal Administration of Hospitals Clinical Medicine Development Special Funding Support (No. XMLX201708)the Capital Health Research and Development Special Funds (No. 2016-2-2151)+1 种基金Beijing Municipal Administration of Hospitafs Ascent Plan (No. DFL20181104)the National Natural Science Foundation of China (No. 31770836).
文摘Desmoid-type fibromatosis (DF) is a rare monoclonal fibroblastic proliferation that is characterized by locally infiltrative but rarely metastatic lesions. Tyrosine kinase and γ-secretase inhibitors are primarily used in the targeted therapy of DF. The use of these drugs, however, is mainly based on the recommendations of retrospective studies with small sample sizes. Previous studies that focused on the mechanism, efficacy, and safety of targeted therapy for DF were reviewed to provide references for clinical applications and research. The efficacy and safety of targeted therapy were compared with those of other systemic therapy options. Targeted therapy does not provide considerable advantages in efficacy and safety over other medical treatments and is usually applied after the failure of antihormonal therapies, nonsteroidal anti-inflammatory drugs, and chemotherapy. Further studies are required to explore the mechanism, indications, and appropriate drug dosage of the targeted therapy of DF.
文摘Acute pancreatitis(AP)is a common acute abdominal condition of the digestive system.In recent years,treatment concepts,methods,and strategies for the diagnosis of AP have advanced,and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients.On the basis of previous guidelines and expert consensus,this guideline adopts an evidence-based,problem-based expression;synthesizes important clinical research data at home and abroad in the most recent 5 years;and forms 29 recommendations through multidisciplinary expert discussion,including diagnosis,treatment,and follow-up.It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
文摘The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.
基金Chinese Academy of Medical Sciences(CAMS)Initiative for Innovative Medicine(CAMS-I2M)2017-I2M-1-001 supported this study.
文摘Objective:The aim of this study is to investigate the current status of the diagnosis and treatment of patients with pancreatic neuroendocrine neoplasms(pNENs)undergoing surgery in China.Methods:This is a multicenter cross-sectional study performed in China.Data from patients with pNENs undergoing surgery at 33 high-volume medical centers,where the number of pancreatectomies exceeds 20 cases per year,were collected and analyzed between March 1,2016 and February 28,2017.Results:In total,392 patients with pNENs were enrolled.The male to female ratio was 1.4.The majority of patients were aged between 40 and 70 years.65.6%of the patients had non-functional tumors.Among those with functional tumors,the percentages of insulinomas,gastrinomas,glucagonomas,and vasoactive intestinal peptide-secreting tumors were 94.8%,1.5%,2.2%,and 1.5%,respectively.Multidisciplinary team(MDT)discussion was conducted for 39.0%of the patients.Minimally invasive surgery was performed on 31.1%of the 392 patients.The incidence of grade B/C pancreatic fistula formation was 4.4%.A total of 89.0%of the surgeries achieved R0 resection,and 41.6%of the tumors were well differentiated.Lymph node metastasis was present in 8.9%of the patients.The percentages of patients with grades G1,G2,and G3 disease were 49.2%,45.7%,and 5.1%,respectively.Conclusion:This multicenter cross-sectional study systematically presents the current status of the diagnosis and treatment of patients with pNENs undergoing surgery in China.MDT consultation for pNENs has not been widely implemented in China.Although the incidence of surgical complications is relatively low,minimally invasive procedures should be further promoted.This study shows us how to improve the outcomes of these patients.
文摘Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.
文摘Pancreatic cancer is one of the leading causes of cancer-related mortality in both developed and developing coun-tries.The incidence of pancreatic cancer in China accounts for about a quater of the global incidence,and the epidemiological characteristics and therapeutic strategies differ due to social,economic,cultural,environmental,and public health factors.Non-domestic guidelines do not reflect the clinicopathologic characteristics and treat-ment patterns of Chinese patients.Thus,in 2018,the Chinese Society of Clinical Oncology(CSCO)organized a panel of senior experts from all sub-specialties within the field of pancreatic oncology to compile the Chinese guidelines for the diagnosis and treatment of pancreatic cancer.The guidelines were made based on both the Western and Eastern clinical evidence and updated every one or two years.The experts made consensus judg-ments and classified evidence-based recommendations into various grades according to the regional differences,the accessibility of diagnostic and treatment resources,and health economic indexes in China.Here we present the latest version of the guidelines,which covers the diagnosis,treatment,and follow-up of pancreatic cancer.The guidelines might standardize the diagnosis and treatment of pancreatic cancer in China and will encourage oncologists to design and conduct more clinical trials about pancreatic cancer.
文摘Introduction Primary liver cancer is a significant health issue in China,where it ranks fourth in morbidity and second in mortality among all malignant tumors.[1-4]The 5-year overall survival rate of Chinese patients with liver cancer from 2012 to 2015 was only 12.2%for males and 13.1%for females.[5]Hepatocellular carcinoma(HCC)accounts for 75-85%of primary liver cancers.[6]Furthermore,most liver cancers are unresectable at diagnosis.To combat this,conversion therapy is used,which involves systematic treatments like anti-angiogenic drugs or molecular targeted therapy combined with immunotherapies,as well as locoregional treatments such as transcatheter arterial chemoembolization(TACE),hepatic artery infusion chemotherapy(HAIC),ablation therapy,and radiation therapy.The goal is to eliminate unresectable status and increase the chances of surgery.The reported 5-year survival rate after salvage surgery following tumor downstaging varied from 24.9-57%.
