The profiling of plasma cell-free DNA(cfDNA)is becoming a valuable tool rapidly for tumor diagnosis,monitoring and prognosis.Diverse plasma cfDNA technologies have been in routine or emerging use,including analyses of...The profiling of plasma cell-free DNA(cfDNA)is becoming a valuable tool rapidly for tumor diagnosis,monitoring and prognosis.Diverse plasma cfDNA technologies have been in routine or emerging use,including analyses of mutations,copy number alterations,gene fusions and DNA methylation.Recently,new technologies in cfDNA analysis have been developed in laboratories,and potentially reflect the status of epigenetic modification,the immune microenvironment and the microbiome in tumor tissues.In this review,the authors discuss the principles,methods and effects of the current cfDNA assays and provide an overview of studies that may inform clinical applications in the near future.展开更多
Objective This study aimed to identify SPRR2A as a hub gene in endometrial cancer(EC)and explore its potential as a diagnostic and prognostic biomarker.Methods Bioinformatics analysis was performed on highthroughput s...Objective This study aimed to identify SPRR2A as a hub gene in endometrial cancer(EC)and explore its potential as a diagnostic and prognostic biomarker.Methods Bioinformatics analysis was performed on highthroughput sequencing datasets of EC cases from The Cancer Genome Atlas.Reverse-transcription-quantitative PCR validated the differential expression of SPRR2A in EC cell lines and tissues.Results Compared with normal cells and adjacent tissues,EC cells and tissues showed significantly upregulated SPRR2A expression(p<0.05).High SPRR2A expression was associated with poor prognosis in EC patients(HR=1.52,95%CI 1.00 to 2.30,p=0.048).Furthermore,the expression levels of SPRR2A varied across histological grades,being significantly lower in G1 tumours than in G2 and G3 tumours.However,no significant differences in SPRR2A expression regarding age,clinical stage,tumour invasion or histological type were found.Conclusion SPRR2A is overexpressed in EC and serves as an independent predictor of poor prognosis.It may be a potential biomarker for EC diagnosis and prognosis.Further research is needed to explore its molecular mechanisms and clinical applications.展开更多
Background:Glecirasib,an inhibitor of Kirsten rat sarcoma viral oncogene homolog glycine-to-cysteine substitution at codon 12(KRAS G12C),has exhibited clinical activity in non-small-cell lung cancer(NSCLC)and colorect...Background:Glecirasib,an inhibitor of Kirsten rat sarcoma viral oncogene homolog glycine-to-cysteine substitution at codon 12(KRAS G12C),has exhibited clinical activity in non-small-cell lung cancer(NSCLC)and colorectal cancer(CRC).Here,we investigated the efficacy and safety of glecirasib in patients with pancreatic ductal adenocarcinoma(PDAC)and other solid tumors(excluding NSCLC and CRC)that rarely harbor the KRAS G12C mutation but for which effective treatment options remain limited.Methods:We conducted and analyzed two open-label,phase I/II trials in adult patients with KRAS G12C mutant solid tumors,in which glecirasib was administered orally.The two trials had similar eligibility criteria and endpoints but differed in the regions of patient recruitment.We performed a pooled analysis of all patients,excluding NSCLC and CRC,from both trials.The primary end-point in the pooled population was objective response rate(ORR).Efficacy and safety were assessed in patients who received at least one dose of glecirasib.Results:As of June 30,2024,the pooled analysis included 54 patients who were treated with glecirasib:32 PDACs,8 biliary tract cancers(BTCs),4 small intestinal cancers,3 gastric cancers,2 appendiceal cancers,and 5 other tumors.At baseline,24 received≥two prior lines of systemic therapy.Of the 53 efficacyevaluable patients,the confirmed ORR was 50.9%(95%confidence interval[CI],36.8%-64.9%),with an ORR of 46.9%(95%CI,29.1%-65.3%)in PDAC patients.Among other solid tumors,ORR was 71.4%(5/7)in BTC,100%(4/4)in small intestinal cancer,and 66.7%(2/3)in gastric cancer.Median progression-free survival and median overall survival were 6.9 and 10.8 months,respectively,in the overall population,and 5.5 and 10.8 months,respectively,in patients with PDAC.Treatment-related adverse events(TRAEs)of any grade occurred in 94.4%patients,with grade≥3 TRAEs in 27.8%.No fatal TRAEs or TRAEs leading to treatment discontinuation occurred.Conclusions:Glecirasib showed promising efficacy and was well tolerated in patients with PDAC and other advanced solid tumors(beyond NSCLC and CRC),warranting further expedited clinical development in this patient population.Trial registration:ClinicalTrials.gov identifier:NCT05009329 and NCT05002270.展开更多
Pancreatic cancer cachexia is a complex,multifactorial syndrome characterized by progressive wasting of skeletal muscle and adipose tissue,contributing to poor prognosis and high mortality in pancreatic cancer patient...Pancreatic cancer cachexia is a complex,multifactorial syndrome characterized by progressive wasting of skeletal muscle and adipose tissue,contributing to poor prognosis and high mortality in pancreatic cancer patients.While muscle and fat loss are the hallmark features,pancreatic cancer cachexia is increasingly recognized as a systemic disorder involving extensive metabolic and inflammatory disruptions across multiple organs.Tumor-derived cachexia-inducing factors play a central role in driving systemic inflammation,metabolic dysregulation,and neuroendocrine abnormalities,leading to anorexia,gut dysbiosis,cardiac dysfunction,and pancreatic exocrine and endocrine insufficiency.These multi-organ disturbances form a vicious cycle that accelerates disease progression and complicates clinical management.In this review,we provide a comprehensive overview of pancreatic cancer cachexia,including its definitions,classification,and heterogeneous clinical presentations.We further examine recent findings on the molecular mediators of cachexia and their role in inter-organ communication networks.Additionally,we highlight advances in experimental models that enable the dissection of pancreatic cancer cachexia pathophysiology,and discuss emerging mechanism-based therapeutic strategies aimed at disrupting the cachexia cycle.A deeper understanding of the systemic nature of pancreatic cancer cachexia and the crosstalk among affected organs may inform the development of multi-targeted interventions and hold promise for improving patient outcomes.展开更多
Objective:Pancreatic ductal adenocarcinoma(PDAC)presents a significant clinical challenge due to its poor prognosis and limited treatment modalities.The tumor microenvironment(TME),particularly tumor-associated macrop...Objective:Pancreatic ductal adenocarcinoma(PDAC)presents a significant clinical challenge due to its poor prognosis and limited treatment modalities.The tumor microenvironment(TME),particularly tumor-associated macrophages(TAMs),is known to critically influence PDAC progression.This study aims to identify a specific subtype of TAM promoting tumor progression.Methods:We utilized single-cell sequencing data to identify macrophages highly correlated with patient prognosis.Subsequently,through weighted gene co-expression network analysis(WGCNA),we pinpointed the upregulated expression of secreted phosphoprotein 1(SPP1).Following this,we analyzed the potential mechanisms by which SPP1+macrophages contribute to tumor progression through cellular communication and transcriptomic sequencing.Results:Through single-cell RNA sequencing(scRNA-seq),our study identified a specific subset of TAMs with high expression of SPP1,which is strongly correlated with reduced survival in PDAC patients.Conclusions:These TAMs with elevated SPP1 expression may function as a potential prognostic biomarker for identifying patients with aggressive disease.展开更多
Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is charac...Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is characterized by inadequate pancreatic enzymes,resulting in maldigestion and abdominal symptoms.EPI is a common postoperative complication of pancreatic surgery,yet often overlooked by surgeons.There is no clear answer to when EPI occurs after pancreatic surgery nor the duration of PERT after partial pancreatectomy.Methods:Benign or borderline pancreatic tumor patients undergoing surgeries were recruited between December 2020 and November 2021 from 10 medical centers in China.The EPI Questionnaire(EPI-Q)was performed at discharge,and 3-,6-,9-,and 12-month follow-ups to evaluate the occurrence of EPI.Statistical analyses were performed to identify the occurrence of EPI and explore PERT’s efficacy.Results:Of the 146 patients,105(71.9%)were female,and the median age was 49(range 16–78 years).Symptoms of EPI patients were most pronounced within 3 months post-surgery(15.7%),while most patients recovered after 1 year(96.9%).There was a negative correlation between symptom score and time since surgery.Lack of PERT in the 3-month post-surgery was associated with higher symptom scores in pancreatoduodenectomy(PD)patients,while not in distal pancreatectomy(DP)patients.Conclusions:Generally,the high-occurrence period for postoperative EPI is within 3 months after resection in patients with benign or borderline pancreatic tumors,and most will gradually recuperate with time.PERT can improve symptoms in PD patients,while reduced PERT duration may be considered for DP patients.展开更多
This study was designed to investigate the gut microbiota of patients with non-alcoholic fatty liver disease. The inclusive and exclusive criteria for NAFLD patients and healthy subjects were formulated, and detailed ...This study was designed to investigate the gut microbiota of patients with non-alcoholic fatty liver disease. The inclusive and exclusive criteria for NAFLD patients and healthy subjects were formulated, and detailed clinical data were collected. The genomic DNA of stool samples were extracted for 16 S r DNA sequencing, and the amplified V4-region was sequenced on the Illumina Miseq platform. Metastats analysis was performed to identify the differential taxa between the groups. Redundancy analysis was used to evaluate the association between gut microbial structure and clinical variables. Thirty NAFLD patients and37 healthy controls were involved. The 16 S r DNA sequencing showed that there was a dramatic variability of the fecal microbiota among all the individuals. Metastats analysis identified eight families and 12 genera with significant differences between the two groups. When some clinical parameters, such as waist-to-hip ratio(WHR) and homeostasis model assessment of insulin resistance(HOMA-IR), were enrolled in Redundancy analysis, the distribution of the two group of samples was obviously changed. The compositional shifts in fecal bacterial communities of NAFLD patients from the healthy controls were mainly at family or genus levels. According to our Redundancy analysis, insulin resistance and obesity might be closely related to both NAFLD phenotype and intestinal microecology.展开更多
Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancr...Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancreatic cancer in China, called China Pancreas Data Center (CPDC). With continued effort, the CPDC has developed over time. Herein, we report the general results of the CPDC from January 2016 to January 2020 to present the real-world situation of surgical treatment of pancreatic cancer in China.Methods: The data of the CPDC from January 2016 to January 2020 were retrieved and analyzed in this real-world study, including the data on patient demographics, comorbidities, diagnostic modalities, neoadjuvant treatment, surgical procedures, postoperative complications and treatment, pathological examinations, postoperative adjuvant treatment, survival, and risk factors.Results: A total of 13,595 cases from 70 centers in 28 provinces were retrieved for analysis. This study reported the largest cohort of patients who underwent surgical treatment for pancreatic cancer in China to date. More cases were derived from the Eastern regions, among which Shanghai, Beijing, and Zhejiang ranked in the top three. The peak age of the patients ranged from 60 to 69 years. The ratio of males to females was 1.5:1. Overall, 64.3% of the tumors were located in the head and neck of the pancreas, and 35.7% in the body and tail of the pancreas. Of the patients, 23.0% underwent positron-emission tomography-computed tomography, 21.6% underwent endoscopic ultrasound, and 4.8% underwent preoperative biopsy. Two percent of the patients underwent neoadjuvant treatment, while 68.9% underwent R0 surgical resection (margin free of tumor cells). Of the latter, 78.6% of the operations were open procedures, 12.6% were laparoscopic procedures, 2.9% were robotic procedures, and 3.7% were converted to open procedures. The in-hospital mortality rate after surgery was 0.4%. The incidence of grade 2 and grade 3 postoperative pancreatic fistulas was 25.5% and 2.5%, respectively. The incidence of complications based on the Clavien-Dindo classification was 17.9% of grade II, 4.3% of grade IIIa, 1% of grade IIIb, and 0.6% of grade IV. Of the patients, 28.9% underwent postoperative adjuvant chemotherapy. The 1-year, 2-year, and 3-year overall survival of these patients were 77%, 51%, and 38%, respectively. In the 8542 patients who underwent R0 resection, the 1-year, 2-year, and 3-year overall survival and disease-free survival were 77% , 54%, and 43%, and 68%, 49%, and 41%, respectively. The factors related to the prognosis of these patients were also identified after uni-and multi-variate analyses.Conclusion: The surgical quality, safety, and long-term survival of the patients in CPDC are similar to those of international high-volume pancreatic centers. However, neoadjuvant and postoperative adjuvant chemotherapy should be improved.展开更多
Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit t...Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.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 World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNE...The World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNETs)and poorly differentiated pancreatic neuroendocrine carcinomas(pNECs),according to the mitotic count,Ki-67 index,and cell differentiation.As a new category,G3 pNETs remain a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice.Therefore,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.展开更多
Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer,the Chinese Pancreatic Surgery Association,Chinese Medical Association and Pancreatic Dise...Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer,the Chinese Pancreatic Surgery Association,Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer(2020 edition).Based on the Grading of Recommendations Assessment,Development,and Evaluation system,the guidelines have conducted a discussion on the indication,regimen selection,therapeutic effect evaluation,pathological diagnosis,surgery strategy,etc.The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer.The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer.Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients.However,more high-quality clinical researches are in urgent need to improve the level of evidence,optimize the clinical practice,and improve the survival of patients.展开更多
1 Introduction The facility location and capacity acquisition problem(LCAP)is essential to real-world applications,e.g.,the cloudlet placement for mobile edge computing[1]and automotive service firms locating[2],which...1 Introduction The facility location and capacity acquisition problem(LCAP)is essential to real-world applications,e.g.,the cloudlet placement for mobile edge computing[1]and automotive service firms locating[2],which mainly involves the issues of where to build facilities,how much capacity to acquire,and which parts of the market region each facility should serve.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
Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to inves...Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.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 neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancrea...Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.展开更多
基金supported by the Beijing Natural Science Foundation(No.Z190022)the National Natural Science Foundation of China(No.81972680,81773292 and 82072748)。
文摘The profiling of plasma cell-free DNA(cfDNA)is becoming a valuable tool rapidly for tumor diagnosis,monitoring and prognosis.Diverse plasma cfDNA technologies have been in routine or emerging use,including analyses of mutations,copy number alterations,gene fusions and DNA methylation.Recently,new technologies in cfDNA analysis have been developed in laboratories,and potentially reflect the status of epigenetic modification,the immune microenvironment and the microbiome in tumor tissues.In this review,the authors discuss the principles,methods and effects of the current cfDNA assays and provide an overview of studies that may inform clinical applications in the near future.
基金funded by Beijing Xisike Clinical Oncology Research Foundation,grant number Y-2019AZQN-1049.
文摘Objective This study aimed to identify SPRR2A as a hub gene in endometrial cancer(EC)and explore its potential as a diagnostic and prognostic biomarker.Methods Bioinformatics analysis was performed on highthroughput sequencing datasets of EC cases from The Cancer Genome Atlas.Reverse-transcription-quantitative PCR validated the differential expression of SPRR2A in EC cell lines and tissues.Results Compared with normal cells and adjacent tissues,EC cells and tissues showed significantly upregulated SPRR2A expression(p<0.05).High SPRR2A expression was associated with poor prognosis in EC patients(HR=1.52,95%CI 1.00 to 2.30,p=0.048).Furthermore,the expression levels of SPRR2A varied across histological grades,being significantly lower in G1 tumours than in G2 and G3 tumours.However,no significant differences in SPRR2A expression regarding age,clinical stage,tumour invasion or histological type were found.Conclusion SPRR2A is overexpressed in EC and serves as an independent predictor of poor prognosis.It may be a potential biomarker for EC diagnosis and prognosis.Further research is needed to explore its molecular mechanisms and clinical applications.
文摘Background:Glecirasib,an inhibitor of Kirsten rat sarcoma viral oncogene homolog glycine-to-cysteine substitution at codon 12(KRAS G12C),has exhibited clinical activity in non-small-cell lung cancer(NSCLC)and colorectal cancer(CRC).Here,we investigated the efficacy and safety of glecirasib in patients with pancreatic ductal adenocarcinoma(PDAC)and other solid tumors(excluding NSCLC and CRC)that rarely harbor the KRAS G12C mutation but for which effective treatment options remain limited.Methods:We conducted and analyzed two open-label,phase I/II trials in adult patients with KRAS G12C mutant solid tumors,in which glecirasib was administered orally.The two trials had similar eligibility criteria and endpoints but differed in the regions of patient recruitment.We performed a pooled analysis of all patients,excluding NSCLC and CRC,from both trials.The primary end-point in the pooled population was objective response rate(ORR).Efficacy and safety were assessed in patients who received at least one dose of glecirasib.Results:As of June 30,2024,the pooled analysis included 54 patients who were treated with glecirasib:32 PDACs,8 biliary tract cancers(BTCs),4 small intestinal cancers,3 gastric cancers,2 appendiceal cancers,and 5 other tumors.At baseline,24 received≥two prior lines of systemic therapy.Of the 53 efficacyevaluable patients,the confirmed ORR was 50.9%(95%confidence interval[CI],36.8%-64.9%),with an ORR of 46.9%(95%CI,29.1%-65.3%)in PDAC patients.Among other solid tumors,ORR was 71.4%(5/7)in BTC,100%(4/4)in small intestinal cancer,and 66.7%(2/3)in gastric cancer.Median progression-free survival and median overall survival were 6.9 and 10.8 months,respectively,in the overall population,and 5.5 and 10.8 months,respectively,in patients with PDAC.Treatment-related adverse events(TRAEs)of any grade occurred in 94.4%patients,with grade≥3 TRAEs in 27.8%.No fatal TRAEs or TRAEs leading to treatment discontinuation occurred.Conclusions:Glecirasib showed promising efficacy and was well tolerated in patients with PDAC and other advanced solid tumors(beyond NSCLC and CRC),warranting further expedited clinical development in this patient population.Trial registration:ClinicalTrials.gov identifier:NCT05009329 and NCT05002270.
基金supported by Noncommunicable Chronic Diseases-National Science and Technology Major Project(grant numbers 2024ZD0525502/2024ZD0525500)the National High Level Hospital Clinical Research Funding(grant number 2022-PUMCH-D-001)CAMS Innovation Fund for Medical Sciences(CIFMS)(grant numbers 2021-I2M-1-002,2023-I2M-2-002)to W.W.
文摘Pancreatic cancer cachexia is a complex,multifactorial syndrome characterized by progressive wasting of skeletal muscle and adipose tissue,contributing to poor prognosis and high mortality in pancreatic cancer patients.While muscle and fat loss are the hallmark features,pancreatic cancer cachexia is increasingly recognized as a systemic disorder involving extensive metabolic and inflammatory disruptions across multiple organs.Tumor-derived cachexia-inducing factors play a central role in driving systemic inflammation,metabolic dysregulation,and neuroendocrine abnormalities,leading to anorexia,gut dysbiosis,cardiac dysfunction,and pancreatic exocrine and endocrine insufficiency.These multi-organ disturbances form a vicious cycle that accelerates disease progression and complicates clinical management.In this review,we provide a comprehensive overview of pancreatic cancer cachexia,including its definitions,classification,and heterogeneous clinical presentations.We further examine recent findings on the molecular mediators of cachexia and their role in inter-organ communication networks.Additionally,we highlight advances in experimental models that enable the dissection of pancreatic cancer cachexia pathophysiology,and discuss emerging mechanism-based therapeutic strategies aimed at disrupting the cachexia cycle.A deeper understanding of the systemic nature of pancreatic cancer cachexia and the crosstalk among affected organs may inform the development of multi-targeted interventions and hold promise for improving patient outcomes.
基金grant provided by the National High Level Hospital Clinical Research Funding(2022-PUMCH-D-001 to WW)the National Natural Science Foundation of China(nos.82273452 and 92474301 to ML)the National Key Research and Development Program of China(nos.2023YFC2413200 and 2023YFC2413205 to ML).
文摘Objective:Pancreatic ductal adenocarcinoma(PDAC)presents a significant clinical challenge due to its poor prognosis and limited treatment modalities.The tumor microenvironment(TME),particularly tumor-associated macrophages(TAMs),is known to critically influence PDAC progression.This study aims to identify a specific subtype of TAM promoting tumor progression.Methods:We utilized single-cell sequencing data to identify macrophages highly correlated with patient prognosis.Subsequently,through weighted gene co-expression network analysis(WGCNA),we pinpointed the upregulated expression of secreted phosphoprotein 1(SPP1).Following this,we analyzed the potential mechanisms by which SPP1+macrophages contribute to tumor progression through cellular communication and transcriptomic sequencing.Results:Through single-cell RNA sequencing(scRNA-seq),our study identified a specific subset of TAMs with high expression of SPP1,which is strongly correlated with reduced survival in PDAC patients.Conclusions:These TAMs with elevated SPP1 expression may function as a potential prognostic biomarker for identifying patients with aggressive disease.
文摘Objectives:We assess the incidence of exocrine pancreatic insufficiency(EPI)at different time points after pancreatic surgery and explore pancreatic enzyme replacement therapy’s(PERT)efficacy.Background:EPI is characterized by inadequate pancreatic enzymes,resulting in maldigestion and abdominal symptoms.EPI is a common postoperative complication of pancreatic surgery,yet often overlooked by surgeons.There is no clear answer to when EPI occurs after pancreatic surgery nor the duration of PERT after partial pancreatectomy.Methods:Benign or borderline pancreatic tumor patients undergoing surgeries were recruited between December 2020 and November 2021 from 10 medical centers in China.The EPI Questionnaire(EPI-Q)was performed at discharge,and 3-,6-,9-,and 12-month follow-ups to evaluate the occurrence of EPI.Statistical analyses were performed to identify the occurrence of EPI and explore PERT’s efficacy.Results:Of the 146 patients,105(71.9%)were female,and the median age was 49(range 16–78 years).Symptoms of EPI patients were most pronounced within 3 months post-surgery(15.7%),while most patients recovered after 1 year(96.9%).There was a negative correlation between symptom score and time since surgery.Lack of PERT in the 3-month post-surgery was associated with higher symptom scores in pancreatoduodenectomy(PD)patients,while not in distal pancreatectomy(DP)patients.Conclusions:Generally,the high-occurrence period for postoperative EPI is within 3 months after resection in patients with benign or borderline pancreatic tumors,and most will gradually recuperate with time.PERT can improve symptoms in PD patients,while reduced PERT duration may be considered for DP patients.
文摘本文研究Hilbert空间H上投影算子组的联合谱.首先通过计算给出正则投影对的联合谱,进而给出一般的投影算子对的联合谱.本文还对两个投影算子的和与差的可逆性给出一些等价刻画.特别地,当P和Q为正则投影对时,本文通过计算算子组[I, P, Q]的联合谱来给出σ(P+Q)和σ(P-Q)的具体刻画.反过来,本文证明两类具有特定形式的复数集分别是Hilbert空间上正则投影对的和与差的谱.本文也给出一般的投影算子对的和与差的谱.最后,本文计算特定条件下的3个投影算子组[P, Q, R]的联合谱.
基金supported by National High Technology Research and Development Program of China (2015AA020701)
文摘This study was designed to investigate the gut microbiota of patients with non-alcoholic fatty liver disease. The inclusive and exclusive criteria for NAFLD patients and healthy subjects were formulated, and detailed clinical data were collected. The genomic DNA of stool samples were extracted for 16 S r DNA sequencing, and the amplified V4-region was sequenced on the Illumina Miseq platform. Metastats analysis was performed to identify the differential taxa between the groups. Redundancy analysis was used to evaluate the association between gut microbial structure and clinical variables. Thirty NAFLD patients and37 healthy controls were involved. The 16 S r DNA sequencing showed that there was a dramatic variability of the fecal microbiota among all the individuals. Metastats analysis identified eight families and 12 genera with significant differences between the two groups. When some clinical parameters, such as waist-to-hip ratio(WHR) and homeostasis model assessment of insulin resistance(HOMA-IR), were enrolled in Redundancy analysis, the distribution of the two group of samples was obviously changed. The compositional shifts in fecal bacterial communities of NAFLD patients from the healthy controls were mainly at family or genus levels. According to our Redundancy analysis, insulin resistance and obesity might be closely related to both NAFLD phenotype and intestinal microecology.
文摘Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancreatic cancer in China, called China Pancreas Data Center (CPDC). With continued effort, the CPDC has developed over time. Herein, we report the general results of the CPDC from January 2016 to January 2020 to present the real-world situation of surgical treatment of pancreatic cancer in China.Methods: The data of the CPDC from January 2016 to January 2020 were retrieved and analyzed in this real-world study, including the data on patient demographics, comorbidities, diagnostic modalities, neoadjuvant treatment, surgical procedures, postoperative complications and treatment, pathological examinations, postoperative adjuvant treatment, survival, and risk factors.Results: A total of 13,595 cases from 70 centers in 28 provinces were retrieved for analysis. This study reported the largest cohort of patients who underwent surgical treatment for pancreatic cancer in China to date. More cases were derived from the Eastern regions, among which Shanghai, Beijing, and Zhejiang ranked in the top three. The peak age of the patients ranged from 60 to 69 years. The ratio of males to females was 1.5:1. Overall, 64.3% of the tumors were located in the head and neck of the pancreas, and 35.7% in the body and tail of the pancreas. Of the patients, 23.0% underwent positron-emission tomography-computed tomography, 21.6% underwent endoscopic ultrasound, and 4.8% underwent preoperative biopsy. Two percent of the patients underwent neoadjuvant treatment, while 68.9% underwent R0 surgical resection (margin free of tumor cells). Of the latter, 78.6% of the operations were open procedures, 12.6% were laparoscopic procedures, 2.9% were robotic procedures, and 3.7% were converted to open procedures. The in-hospital mortality rate after surgery was 0.4%. The incidence of grade 2 and grade 3 postoperative pancreatic fistulas was 25.5% and 2.5%, respectively. The incidence of complications based on the Clavien-Dindo classification was 17.9% of grade II, 4.3% of grade IIIa, 1% of grade IIIb, and 0.6% of grade IV. Of the patients, 28.9% underwent postoperative adjuvant chemotherapy. The 1-year, 2-year, and 3-year overall survival of these patients were 77%, 51%, and 38%, respectively. In the 8542 patients who underwent R0 resection, the 1-year, 2-year, and 3-year overall survival and disease-free survival were 77% , 54%, and 43%, and 68%, 49%, and 41%, respectively. The factors related to the prognosis of these patients were also identified after uni-and multi-variate analyses.Conclusion: The surgical quality, safety, and long-term survival of the patients in CPDC are similar to those of international high-volume pancreatic centers. However, neoadjuvant and postoperative adjuvant chemotherapy should be improved.
基金supported by the National Natural Science Foundation of China(Grant number,82141127).
文摘Many management strategies are available for pancreatic neuroendocrine neoplasms with liver metastases.However,a lack of biological,molecular,and genomic information and an absence of data from rigorous trials limit the validity of these strategies.This review presents the viewpoints from an international conference consisting of several expert working groups.The working groups reviewed a series of questions of particular interest to clinicians taking care of patients with pancreatic neuroendocrine neoplasms with liver metastases by reviewing the existing management strategies and literature,evaluating the evidence on which management decisions were based,developing internationally acceptable recommendations for clinical practice,and making recommendations for clinical and research endeavors.The review for each question will be followed by recommendations from the panel.
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.
基金supported by the National Natural Science Foundation of China(Grant No.82141104)National Natural Science Foundation of China(Grant No.82141102)Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(Grant No.2021-I2M-1-002).
文摘The World Health Organization(WHO)2017 classifications for neuroendocrine neoplasms(NENs)subdivided grade 3 pancreatic neuroendocrine neoplasms(pNENs)into G3 well-differentiated pancreatic neuroendocrine tumors(G3 pNETs)and poorly differentiated pancreatic neuroendocrine carcinomas(pNECs),according to the mitotic count,Ki-67 index,and cell differentiation.As a new category,G3 pNETs remain a challenging group of tumors to manage by lacking large randomized trials and consensus to support its clinical practice.Therefore,the Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association gathered experts in this field to formulate this consensus for the diagnosis and treatment of G3 pNETs.
文摘Aiming to keep pace with the renewal of international guidelines and refine the domestic treatment system of pancreatic cancer,the Chinese Pancreatic Surgery Association,Chinese Medical Association and Pancreatic Disease Committee of China Research Hospital Association launched this Chinese guidelines for neoadjuvant therapy of pancreatic cancer(2020 edition).Based on the Grading of Recommendations Assessment,Development,and Evaluation system,the guidelines have conducted a discussion on the indication,regimen selection,therapeutic effect evaluation,pathological diagnosis,surgery strategy,etc.The guidelines have quantified the evidence level of the current clinical researches and provided recommendations for the clinical practice in neoadjuvant therapy of pancreatic cancer.The guidelines have highlighted the role of multiple disciplinary team and represented the conversion of treatment concepts in pancreatic cancer.Neoadjuvant therapy has prolonged the survival of part of pancreatic cancer patients.However,more high-quality clinical researches are in urgent need to improve the level of evidence,optimize the clinical practice,and improve the survival of patients.
基金supported by the National Natural Science Foundation of China (Grant No.61972128).
文摘1 Introduction The facility location and capacity acquisition problem(LCAP)is essential to real-world applications,e.g.,the cloudlet placement for mobile edge computing[1]and automotive service firms locating[2],which mainly involves the issues of where to build facilities,how much capacity to acquire,and which parts of the market region each facility should serve.
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.
文摘Background:Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method:A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for Digestive Tract Reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results:A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)pancreatojejunostomy was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.PD/pylorus-preserving PD accounted for 79%/11%of gastrojejunostomy(GJ)cases,the distance between GJ and hepaticojejunostomy<30,30-50,and>50 cm were 11%,75%,and 14%,respectively.Antecolic/retrocolic GJ accounted for 71%/23%of cases.Twenty-two percent of GJ cases employed Braun anastomosis,while 55%and 19%of GJ cases used linear cutting staplers/tube-type staplers,respectively;60%/14%were reinforced/not reinforced via manual suturing after stapler anastomosis.Manual anastomosis in GJ surgery employed absorbable/non-absorbable sutures(91%/9%).Significant differences in reconstruction techniques were detected between different volumes of PD procedures(<100/year and>100/year),regions with different economic development levels,and between north and south China.Conclusion:Digestive tract reconstruction following PD exists heterogeneity in Chinese university hospitals.Corresponding prospective clinical studies are needed to determine the consensus on pancreatic surgery that meets the clinical reality in China.
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.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(CIFMS)2017-I2M-1-001.
文摘Pancreatic neuroendocrine neoplasms(pNENs)are highly heterogeneous,and the management of pNENs patients can be intractable.To address this challenge,an expert committee was established on behalf of the Chinese Pancreatic Surgery Association,which consisted of surgical oncologists,gastroenterologists,medical oncologists,endocrinologists,radiologists,pathologists,and nuclear medicine specialists.By reviewing the important issues regarding the diagnosis and treatment of pNENs,the committee concluded evidence-based statements and recommendations in this article,in order to further improve the management of pNENs patients in China.
