BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where inva...BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where invasive ductal carcinoma(IDC)and ductal carcinoma in situ were found both inside and outside a breast hamartoma.This is the second case reported in the literature.CASE SUMMARY A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound,with suspicious areas indicative of malignant transformation.Biopsy of the suspicious area confirmed IDC with intraductal carcinoma.Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside.A breast-conserving surgery was performed,and postoperative pathology confirmed mammary hamartoma,concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma.Subsequently,appropriate adjuvant therapy was initiated.Currently,the patient is in good condition.Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma,which is difficult to detect preoperatively,especially when there is a focus of intraductal carcinoma,requiring accurate assessment of the tumor extent by modern imaging techniques.Early detection of the coexistence of cancer is clinically important as it can alter patient management.CONCLUSION This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.展开更多
BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is an aggressive lethal malignancy with limited options for treatment and a 5-year survival rate of 11%in the United States.As for other types of tumors,such as colorec...BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is an aggressive lethal malignancy with limited options for treatment and a 5-year survival rate of 11%in the United States.As for other types of tumors,such as colorectal cancer,aberrant de novo lipid synthesis and reprogrammed lipid metabolism have been suggested to be associated with PDAC development and progression.AIM To identify the possible involvement of lipid metabolism in PDAC by analyzing in tumoral and non-tumoral tissues the expression level of the most relevant genes involved in the long-chain fatty acid(FA)import into cell.METHODS A gene expression analysis of FASN,CD36,SLC27A1,SLC27A2,SLC27A3,SLC27A4,SLC27A5,ACSL1,and ACSL3 was performed by qRT-PCR in 24 tumoral PDAC tissues and 11 samples from non-tumoral pancreatic tissues obtained via fine needle aspiration or via surgical resection.The genes were considered significantly dysregulated between the groups when the p value was<0.05 and the fold change(FC)was≤0.5 and≥2.RESULTS We found that three FA transporters and two long-chain acyl-CoA synthetases genes were significantly upregulated in the PDAC tissue compared to the non-tumoral tissue:SLC27A2(FC=5.66;P=0.033),SLC27A3(FC=2.68;P=0.040),SLC27A4(FC=3.13;P=0.033),ACSL1(FC=4.10;P<0.001),and ACSL3(FC=2.67;P=0.012).We further investigated any possible association between the levels of the analyzed mRNAs and the specific characteristics of the tumors,including the anatomic location,the lymph node involvement,and the presence of metastasis.A significant difference in the expression of SLC27A3(FC=3.28;P=0.040)was found comparing patients with and without lymph nodes involvement with an overexpression of this transcript in 17 patients presenting tumoral cells in the lymph nodes.CONCLUSION Despite the low number of patients analyzed,these preliminary results seem to be promising.Addressing lipid metabolism through a broad strategy could be a beneficial way to treat this malignancy.Future in vitro and in vivo studies on these genes may offer important insights into the mechanisms linking PDAC with the long-chain FA import pathway.展开更多
BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive cancer with poor prognosis.When it metastasizes to the liver,treatment options become particularly limited and challenging.Current treatment opti...BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive cancer with poor prognosis.When it metastasizes to the liver,treatment options become particularly limited and challenging.Current treatment options for liver metastatic PDAC are limited,and chemotherapy alone often proves insufficient.Immunotherapy,particularly programmed cell death 1(PD-1)inhibitors like sintilimab,shows potential efficacy for various cancers but has limited reports on PDAC.This study compares the efficacy and safety of sintilimab plus S-1 and gemcitabine vs S-1 and gemcitabine alone in liver metastatic PDAC.AIM To explore the feasibility and effectiveness of combined PD-1 inhibitor sintilimab and S-1 and gemcitabine(combination group)vs S-1 and gemcitabine used alone(chemotherapy group)for treating liver metastatic pancreatic adenocarcinoma.METHODS Eligible patients were those with only liver metastatic PDAC,an Eastern Cooperative Oncology Group performance status of 0-1,adequate organ and marrow functions,and no prior anticancer therapy.Participants in the combination group received intravenous sintilimab 200 mg every 3 weeks,oral S-140 mg/m²twice daily on days 1-14 of a 21-day cycle,and intravenous gemcitabine 1000 mg/m²on days 1 and 8 of the same cycle for up to eight cycles or until disease progression,death,or unacceptable toxicity.Participants in the chemotherapy group received oral S-140 mg/m²twice daily on days 1-14 of a 21-day cycle and intravenous gemcitabine 1000 mg/m²on days 1 and 8 of the same cycle for up to eight cycles.Between June 2020 and December 2021,66 participants were enrolled,with 32 receiving the combination treatment and 34 receiving chemotherapy alone.RESULTS The group receiving the combined therapy exhibited a markedly prolonged median overall survival(18.8 months compared to 10.3 months,P<0.05)and progression-free survival(9.6 months vs 5.4 months,P<0.05).compared to the chemotherapy group.The incidence of severe adverse events did not differ significantly between the two groups(P>0.05).CONCLUSION The combination of PD-1 inhibitor sintilimab with S-1 and gemcitabine demonstrated effectiveness and safety for treating liver metastatic PDAC,meriting further investigation.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of...Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of major genetic factors that drive the progression and pathogenesis of PDAC.Notably,the research and application of molecular targeted therapies and immunotherapies have rapidly increased and facilitated great progress in the treatment of many malignant tumors,additional targeted therapies and immunotherapy based on next-generation sequencing results provide new opportunities for the diagnosis and treatment of pancreatic tumors.Immune checkpoint inhibitors are also now being incorporated as PDAC therapies,and combinations of molecularly targeted therapies with immunotherapies are emerging as strategies for boosting the immune response.The investigation of biomarkers of a response or primary resistance to immunotherapies is also an emerging research area.Herein,we further discuss the recent technological advances that continue to expand our understanding of PDAC complexity.We discuss the advancements expected in the near future,including biomarker-driven treatments and immunotherapies.We presume that the clinical translation of these research efforts will improve the survival outcomes of this challenging disease,which are currently dismal.展开更多
This editorial discusses Alpsoy et al’s significant study of prognosis of pancreatic ductal adenocarcinoma(PDAC),which lacks histopathological markers.This study evaluated the synergistic prognolymphocytes.Peritumora...This editorial discusses Alpsoy et al’s significant study of prognosis of pancreatic ductal adenocarcinoma(PDAC),which lacks histopathological markers.This study evaluated the synergistic prognolymphocytes.Peritumoral budding is significantly correlated with tumor volume,while intratumoral budding is closely related to lymph node metastasis.Peritumoral budding and intratumoral budding are confirmed as independent adverse prognostic factors,and their high levels of expression are associated with immature stromal phenotypes,suggesting the key role of epithelial-mesenchymal transition.These breakthrough findings provide a new multidimensional biomarker system for the prognostic assessment of PDAC,and promote the clinical transformation process of incorporating tumor budding indicators into the pathological reporting process.However,the complexity and spatiotemporal heterogeneity of the tumor microenvironment require us to go beyond traditional morphological analysis and move towards multiomics integration and dynamic monitoring.Through standardized pathological assessment,innovative treatment strategies and interdisciplinary collaboration,it is expected to transform tumor microenvironment-related markers into clinically applicable indicators,ultimately improving the treatment predicament of PDAC.This editorial intended to summarize relevant studies and share some of our views,in order to offer perspectives for future research.展开更多
BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,w...BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,whether it performs well in other countries remains unknown.AIM To externally validate the CT-based preoperative risk score for PDAC in a country outside South Korea.METHODS Consecutive patients with PDAC who underwent upfront surgery from January 2016 to December 2019 at our institute in a country outside South Korea were retrospectively included.The study utilized the CT-based risk scoring system,which incorporates tumor size,portal venous phase density,tumor necrosis,peripancreatic infiltration,and suspicious metastatic lymph nodes.Patients were categorized into prognosis groups based on their risk score,as good(risk score<2),moderate(risk score 2-4),and poor(risk score≥5).RESULTS A total of 283 patients were evaluated,comprising 170 males and 113 females,with an average age of 63.52±8.71 years.Follow-up was conducted until May 2023,and 76%of patients experienced tumor recurrence with median recurrence-free survival(RFS)of 29.1±1.9 months.According to the evaluation results of Reader 1,the recurrence rates were 39.0%in the good prognosis group,82.1%in the moderate group,and 84.5%in the poor group.In comparison,Reader 2 reported recurrence rates of 50.0%,79.5%,and 88.9%,respectively,across the same prognostic categories.The study validated the effectiveness of the risk scoring system,demonstrating better RFS in the good prognosis group.CONCLUSION This research validated that the CT-based preoperative risk scoring system can effectively predict RFS in patients with PDAC,suggesting that it may be valuable in diverse populations.展开更多
This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based r...This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.展开更多
This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnos...This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.展开更多
BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery....BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.展开更多
BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many...BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is characterized by high aggressiveness,poor prognosis,and unsatisfactory survival rates.The incidence of PDAC is increasing annually,and thus,the number of deaths due to PDAC is ...Pancreatic ductal adenocarcinoma(PDAC)is characterized by high aggressiveness,poor prognosis,and unsatisfactory survival rates.The incidence of PDAC is increasing annually,and thus,the number of deaths due to PDAC is increasing worldwide.Modern imaging modalities,including multidetector computed tomography,magnetic resonance imaging-cholangiopancreatography,endoscopic retrograde cholangiopancreatography,positron emission tomography-computed tomography,endoscopic ultrasound and tumor markers,have made significant contributions to the diagnosis of pancreatic cancer.However,early diagnosis remains challenging despite progress in liquid biopsy(tumor DNA,tumor parts or cells),miRNAs,genomic analysis,MTA(metastasis-associated)proteins or circulating cancer-derived exosomes.Early diagnosis and radical surgical excision offer a unique chance of long-term survival in patients with an otherwise poor prognosis.However,surgery alone is insufficient,and multimodal treatment is needed.Novel treatment modalities,i.e.,immunotherapy,vaccines,targeted gene therapy,extracellular vesicles(particularly exosomes),new chemotherapy,novel radiotherapy and angiogenesis-restricting biological agents,were applied with promising outcomes.It seems that the biological mechanisms underlying the disease determine the effectiveness of any therapeutic effort.Thus,further research at the molecular level must focus on novel treatments to prevent the growth,invasion,and spread of cancer cells.展开更多
BACKGROUND Predicting early recurrence(ER),(≤12 months)after pancreatic ductal adenocar-cinoma(PDAC)resection remains challenging.Preoperative biomarkers such as carbohydrate antigen 19-9(CA19-9)and computed tomograp...BACKGROUND Predicting early recurrence(ER),(≤12 months)after pancreatic ductal adenocar-cinoma(PDAC)resection remains challenging.Preoperative biomarkers such as carbohydrate antigen 19-9(CA19-9)and computed tomography(CT)lack optimal specificity and reproducibility.Extracellular volume(ECV),measured on equi-librium-phase CT to quantify stromal fibrosis,correlates with PDAC progression but its utility for ER prediction is unknown.This study evaluates preoperative CT-ECV as a novel biomarker to predict ER following curative-intent PDAC resection.This retrospective study included 93 PDAC patients undergoing R0 resection and preoperative pancreatic CT from January 2020 to November 2023.Clinical and CT features were analyzed.ECV was calculated using unenhanced and equilibrium-phase CT.Univariable and multivariable Cox regression identified ER predictors,followed by receiver operating characteristic analysis.Recurrence-free survival(RFS)was assessed by the Kaplan-Meier method.RESULTS Multivariable analysis identified elevated CT-ECV[hazard ratio(HR)=1.05;95%confidence interval(CI):1.02-1.09;P=0.003],high preoperative CA19-9(HR=1.00;95%CI:1.00-1.00;P=0.002),and poor tumor grade(HR=2.51;95%CI:1.20-5.22;P=0.014)as independent ER predictors.CT-ECV demonstrated comparable predictive accuracy to tumor grade[areas under the curve(AUC):0.736 vs 0.650;P=0.202].Combining CT-ECV and CA19-9 achieved a higher AUC than tumor grade alone(0.759 vs 0.650;P<0.05).Kaplan-Meier analysis revealed sig-nificantly shorter RFS in patients with low CT-ECV(≤35.37%),elevated CA19-9(>55 U/mL),or poorly differen-tiated tumors compared to those with high CT-ECV(>35.37%),low CA19-9(≤55 U/mL),or moderately/well-differentiated tumors.CONCLUSION CT-derived ECV is a promising non-invasive biomarker for preoperative ER prediction in PDAC.Combined with CA19-9,it outperforms tumor grade in stratifying recurrence risk,offering a clinically actionable tool for opti-mizing postoperative management.展开更多
Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of...Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.展开更多
Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical duc...Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.展开更多
Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To bet...Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To better understand the biology of pancreatic cancer,it is fundamental to know its precursors and to study the mechanisms of carcinogenesis.Each of these precursors displays peculiar histological features,as well as specific molecular alterations.Starting from such pre-invasive lesions,this review aims at summarizing the most important aspects of carcinogenesis of pancreatic cancer,with a specific focus on the recent advances and the future perspectives of the research on this lethal tumor type.展开更多
To investigate the expressions of presenilin-2 (PS2) and glutathione Stransferase π (GSTπ) and their roles in prognosis and therapy of breast infiltrating ductalcarcinoma. Methods: The paraffin-embedded specimens of...To investigate the expressions of presenilin-2 (PS2) and glutathione Stransferase π (GSTπ) and their roles in prognosis and therapy of breast infiltrating ductalcarcinoma. Methods: The paraffin-embedded specimens of 210 patients with breast infiltrating ductalcarcinoma were examined by using LSAB immunohistochemistry for the expression of PS2 and GSTπ.Results: The expression rate of PS2 and GSTπ was 49.5% (104/210) and 48.1% (101/210) respectively.The 5-year and 10-year postoperative survival rates in 4 groups, from high to low, were group 1 (PS2positive expression/GSTπ negative expression), group 2 (PS2 positive expression/GSTπ positiveexpression), group 3 (PS2 negative expression/GSTπ negative expression) and group 4 (PS2 negativeexpression/GSTπ positive expression) in turn. Conclusion: The prognosis of the group 1 was thebest, followed by the group 2, group 3 and group 4 in turn. These results suggested that thereasonable use of endocrinotherapy and chemotherapy for patients with breast infiltrating ductalcarcinoma is necessary.展开更多
Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recomm...Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts,including the intraductal papillary mucinous neoplasm(IPMN)-a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN.Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography(currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMNderived and-concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.展开更多
BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow...BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow,ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability,which need to be treated in perfect order.CASE SUMMARY We present a male infant with a gestational age of 39 wk,and his fetal echocardiography showed pulmonary atresia.At 28 d of age,transcatheter pulmonary valvuloplasty with balloon dilatation was performed.Two hours after the operation,the patient's pulse oxygen saturation continued to decrease.The patient was then transferred to receive cardiac catheterization.During catheterization,the invasive blood pressure and pulse oxygen saturation suddenly decreased,and repeated aortography revealed partial occlusion of the ductus arteriosus.It no longer changed when pulse oxygen saturation rose to 51%after approximately 20 min of maintenance therapy.Therefore,a ductal stent was used for implantation.Hemodynamics and hypoxemia were improved.CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization.Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.展开更多
Aim: To study the apoptotic rate (AR) and the androgen and estrogen milieu in the proximal and distal ductal sys-tems of prostate, in order to help exploring the effects of these factors on prostatic growth and the pa...Aim: To study the apoptotic rate (AR) and the androgen and estrogen milieu in the proximal and distal ductal sys-tems of prostate, in order to help exploring the effects of these factors on prostatic growth and the pathogenesis of be-nign prostatic hypertrophy (BPH). Methods: The proximal and distal ends of the ductal system were incised from20 normal prostate as well as the hypertrophic prostate tissue from 20 patients with BPH. The AR was determined bythe DNA end-labeling method and dihydrotestosterone (DHT) and estrodiol (E_2), by radioimmunoassay. Results:There was no significant difference in DHT and E_2 density between the proximal and distal ends of the ductal systems innormal prostate. E_2 appeared to be higher in BPH than in normal prostatic tissues, but the difference was statistically in-significant. In normal prostatic tissue, the AR was significantly higher in the distal than in the proximal ends of theductal system (P<0.05), while the AR of the proximal ends was significantly higher (P <0.01) than that in theBPH tissue. No significant correlation was noted between the DHT and E_2 density and the AR both in the normalprostate and BPH tissues. Conclusion: The paper is the first time describing a difference in AR in different regionsof the ductal system of normal prostate, while the hormonal milieu is similar, indicating a functional inhomogeneity ofthese regions. A low AR in the proximal duct, where BPH originates, and an even lower AR in the BPH tissue, sug-gesting the participation of apoptosis in the BPH pathogenesis.展开更多
AIM:To investigate the expression of toll-like receptor(TLR) 4,nuclear factor-κB(NF-κB) p65 and hypoxiainducible transcription factor 1α(HIF-1α) in pancreatic ductal adenocarcinoma and their clinical significance....AIM:To investigate the expression of toll-like receptor(TLR) 4,nuclear factor-κB(NF-κB) p65 and hypoxiainducible transcription factor 1α(HIF-1α) in pancreatic ductal adenocarcinoma and their clinical significance.METHODS:The mRNA of TLR4 and HIF-1α were investigated by real-time polymerase chain reaction in 30 cases of pancreatic ductal adenocarcinoma and its adjacent tissues,and expression of TLR4,NF-κB p65 and HIF-1α protein were detected by immunohistochemistry in 65 cases of pancreatic ductal adenocarcinoma tissues and 38 cases of corresponding adjacent tissues.The relationship between TLR4 or HIF-1α and pathologic features,as well as the association between TLR4 and HIF-1α,were also analyzed.Kaplan-Meier method was used to assess the impact of expression of TLR4 and HIF-1α on survival of patients with pancreatic cancer.RESULTS:The relative quantif ication of TLR4 and HIF-1α mRNA in tumor tissues was 0.81±0.10 and 0.87±0.11,respectively,signif icantly higher than that in adjacent tissues(0.81±0.10 vs 0.70±0.16,P=0.002;0.87±0.11 vs 0.68±0.13,P=0.000).The protein expression of TLR4,NF-κB p65 and HIF-1α in tumor tissues was 69.20%,66.15% and 70.80%,respectively,being signif icantly higher than that in adjacent normal tissues(69.20% vs 39.50%,P=0.003;66.15% vs 31.58%,P=0.001;70.80% vs 36.80%,P=0.001).There was no signif icant correlation between TLR4 or HIF-1α expression and the age,gender,tumor location,the degree of tumor differentiation in the patients(P>0.05).However,there was signif icant correlation between the expression of TLR4 or HIF-1α and tumor size,lymph node metastasis,venous invasion and clinical staging(P<0.05).The expression of TLR4 and HIF-1α had a signif icant impact on survival of patients with pancreatic adenocarcinoma.CONCLUSION:TLR4,NF-κB p65 and HIF-1α are overexpressed in pancreatic adenocarcinoma,TLR4 may be partly involved in up-regulating HIF-1α,and both synergestically promote development of pancreatic adenocarcinoma.展开更多
基金Supported by Jilin City Science and Technology Innovation Development Plan Project,China,No.20230406201Jilin Province Traditional Chinese Medicine Technology Project,China,No.2024159.
文摘BACKGROUND Breast hamartomas are rare benign breast tumors,with an incidence rate of 0.8%-4.8%.Further,the coexistence of hamartomas and carcinoma is also uncommon.Our case report presents a unique instance where invasive ductal carcinoma(IDC)and ductal carcinoma in situ were found both inside and outside a breast hamartoma.This is the second case reported in the literature.CASE SUMMARY A 51-year-old woman presented with a 6.0 cm breast tumor on mammography and ultrasound,with suspicious areas indicative of malignant transformation.Biopsy of the suspicious area confirmed IDC with intraductal carcinoma.Breast magnetic resonance imaging showed typical hamartoma changes with irregular areas of abnormal enhancement both inside and outside.A breast-conserving surgery was performed,and postoperative pathology confirmed mammary hamartoma,concurrent with IDC and intraductal carcinoma occurring both inside and outside the hamartoma.Subsequently,appropriate adjuvant therapy was initiated.Currently,the patient is in good condition.Breast cancer may be located both inside and outside the ipsilateral mammary hamartoma,which is difficult to detect preoperatively,especially when there is a focus of intraductal carcinoma,requiring accurate assessment of the tumor extent by modern imaging techniques.Early detection of the coexistence of cancer is clinically important as it can alter patient management.CONCLUSION This case emphasizes the importance of modern imaging techniques in accurately evaluating mammary hamartomas associated with malignancies prior to surgery.
基金Supported by Romanian Ministry of Research,Innovation and Digitization,No.PN23.16.02.04 and No.31PFE/30.12.2021.
文摘BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is an aggressive lethal malignancy with limited options for treatment and a 5-year survival rate of 11%in the United States.As for other types of tumors,such as colorectal cancer,aberrant de novo lipid synthesis and reprogrammed lipid metabolism have been suggested to be associated with PDAC development and progression.AIM To identify the possible involvement of lipid metabolism in PDAC by analyzing in tumoral and non-tumoral tissues the expression level of the most relevant genes involved in the long-chain fatty acid(FA)import into cell.METHODS A gene expression analysis of FASN,CD36,SLC27A1,SLC27A2,SLC27A3,SLC27A4,SLC27A5,ACSL1,and ACSL3 was performed by qRT-PCR in 24 tumoral PDAC tissues and 11 samples from non-tumoral pancreatic tissues obtained via fine needle aspiration or via surgical resection.The genes were considered significantly dysregulated between the groups when the p value was<0.05 and the fold change(FC)was≤0.5 and≥2.RESULTS We found that three FA transporters and two long-chain acyl-CoA synthetases genes were significantly upregulated in the PDAC tissue compared to the non-tumoral tissue:SLC27A2(FC=5.66;P=0.033),SLC27A3(FC=2.68;P=0.040),SLC27A4(FC=3.13;P=0.033),ACSL1(FC=4.10;P<0.001),and ACSL3(FC=2.67;P=0.012).We further investigated any possible association between the levels of the analyzed mRNAs and the specific characteristics of the tumors,including the anatomic location,the lymph node involvement,and the presence of metastasis.A significant difference in the expression of SLC27A3(FC=3.28;P=0.040)was found comparing patients with and without lymph nodes involvement with an overexpression of this transcript in 17 patients presenting tumoral cells in the lymph nodes.CONCLUSION Despite the low number of patients analyzed,these preliminary results seem to be promising.Addressing lipid metabolism through a broad strategy could be a beneficial way to treat this malignancy.Future in vitro and in vivo studies on these genes may offer important insights into the mechanisms linking PDAC with the long-chain FA import pathway.
文摘BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a highly aggressive cancer with poor prognosis.When it metastasizes to the liver,treatment options become particularly limited and challenging.Current treatment options for liver metastatic PDAC are limited,and chemotherapy alone often proves insufficient.Immunotherapy,particularly programmed cell death 1(PD-1)inhibitors like sintilimab,shows potential efficacy for various cancers but has limited reports on PDAC.This study compares the efficacy and safety of sintilimab plus S-1 and gemcitabine vs S-1 and gemcitabine alone in liver metastatic PDAC.AIM To explore the feasibility and effectiveness of combined PD-1 inhibitor sintilimab and S-1 and gemcitabine(combination group)vs S-1 and gemcitabine used alone(chemotherapy group)for treating liver metastatic pancreatic adenocarcinoma.METHODS Eligible patients were those with only liver metastatic PDAC,an Eastern Cooperative Oncology Group performance status of 0-1,adequate organ and marrow functions,and no prior anticancer therapy.Participants in the combination group received intravenous sintilimab 200 mg every 3 weeks,oral S-140 mg/m²twice daily on days 1-14 of a 21-day cycle,and intravenous gemcitabine 1000 mg/m²on days 1 and 8 of the same cycle for up to eight cycles or until disease progression,death,or unacceptable toxicity.Participants in the chemotherapy group received oral S-140 mg/m²twice daily on days 1-14 of a 21-day cycle and intravenous gemcitabine 1000 mg/m²on days 1 and 8 of the same cycle for up to eight cycles.Between June 2020 and December 2021,66 participants were enrolled,with 32 receiving the combination treatment and 34 receiving chemotherapy alone.RESULTS The group receiving the combined therapy exhibited a markedly prolonged median overall survival(18.8 months compared to 10.3 months,P<0.05)and progression-free survival(9.6 months vs 5.4 months,P<0.05).compared to the chemotherapy group.The incidence of severe adverse events did not differ significantly between the two groups(P>0.05).CONCLUSION The combination of PD-1 inhibitor sintilimab with S-1 and gemcitabine demonstrated effectiveness and safety for treating liver metastatic PDAC,meriting further investigation.
文摘Pancreatic ductal adenocarcinoma(PDAC)is a global health challenge and remains one of the most lethal malignancies;there are only a few therapeutic options.However,significant efforts have led to the identification of major genetic factors that drive the progression and pathogenesis of PDAC.Notably,the research and application of molecular targeted therapies and immunotherapies have rapidly increased and facilitated great progress in the treatment of many malignant tumors,additional targeted therapies and immunotherapy based on next-generation sequencing results provide new opportunities for the diagnosis and treatment of pancreatic tumors.Immune checkpoint inhibitors are also now being incorporated as PDAC therapies,and combinations of molecularly targeted therapies with immunotherapies are emerging as strategies for boosting the immune response.The investigation of biomarkers of a response or primary resistance to immunotherapies is also an emerging research area.Herein,we further discuss the recent technological advances that continue to expand our understanding of PDAC complexity.We discuss the advancements expected in the near future,including biomarker-driven treatments and immunotherapies.We presume that the clinical translation of these research efforts will improve the survival outcomes of this challenging disease,which are currently dismal.
基金Supported by National Natural Science Foundation of China,No.82404058Shanghai Municipal Commission of Health and Family Planning,No.2024ZZ2049Beijing Xisike Clinical Oncology Research Foundation,No.Y-HS202401-0011.
文摘This editorial discusses Alpsoy et al’s significant study of prognosis of pancreatic ductal adenocarcinoma(PDAC),which lacks histopathological markers.This study evaluated the synergistic prognolymphocytes.Peritumoral budding is significantly correlated with tumor volume,while intratumoral budding is closely related to lymph node metastasis.Peritumoral budding and intratumoral budding are confirmed as independent adverse prognostic factors,and their high levels of expression are associated with immature stromal phenotypes,suggesting the key role of epithelial-mesenchymal transition.These breakthrough findings provide a new multidimensional biomarker system for the prognostic assessment of PDAC,and promote the clinical transformation process of incorporating tumor budding indicators into the pathological reporting process.However,the complexity and spatiotemporal heterogeneity of the tumor microenvironment require us to go beyond traditional morphological analysis and move towards multiomics integration and dynamic monitoring.Through standardized pathological assessment,innovative treatment strategies and interdisciplinary collaboration,it is expected to transform tumor microenvironment-related markers into clinically applicable indicators,ultimately improving the treatment predicament of PDAC.This editorial intended to summarize relevant studies and share some of our views,in order to offer perspectives for future research.
文摘BACKGROUND The computed tomography(CT)-based preoperative risk score was developed to predict recurrence after upfront surgery in patients with resectable pancreatic ductal adenocarcinoma(PDAC)in South Korea.However,whether it performs well in other countries remains unknown.AIM To externally validate the CT-based preoperative risk score for PDAC in a country outside South Korea.METHODS Consecutive patients with PDAC who underwent upfront surgery from January 2016 to December 2019 at our institute in a country outside South Korea were retrospectively included.The study utilized the CT-based risk scoring system,which incorporates tumor size,portal venous phase density,tumor necrosis,peripancreatic infiltration,and suspicious metastatic lymph nodes.Patients were categorized into prognosis groups based on their risk score,as good(risk score<2),moderate(risk score 2-4),and poor(risk score≥5).RESULTS A total of 283 patients were evaluated,comprising 170 males and 113 females,with an average age of 63.52±8.71 years.Follow-up was conducted until May 2023,and 76%of patients experienced tumor recurrence with median recurrence-free survival(RFS)of 29.1±1.9 months.According to the evaluation results of Reader 1,the recurrence rates were 39.0%in the good prognosis group,82.1%in the moderate group,and 84.5%in the poor group.In comparison,Reader 2 reported recurrence rates of 50.0%,79.5%,and 88.9%,respectively,across the same prognostic categories.The study validated the effectiveness of the risk scoring system,demonstrating better RFS in the good prognosis group.CONCLUSION This research validated that the CT-based preoperative risk scoring system can effectively predict RFS in patients with PDAC,suggesting that it may be valuable in diverse populations.
文摘This editorial critically evaluated Liu et al's recent retrospective analysis of 283 Chinese patients with resectable pancreatic ductal adenocarcinoma(PDAC)that validated a preoperative computed tomography-based risk scoring system origi-nally developed in South Korea.The scoring system incorporated five parame-ters:(1)Tumor size;(2)Portal venous phase density;(3)Necrosis;(4)Peripan-creatic infiltration;and(5)Suspected metastatic lymph nodes.While demonstra-ting satisfactory recurrence prediction capability without requiring complex tech-nologies,thereby supporting clinical utility in Chinese populations,the study exhibited notable limitations.Most analyzed patients lacked neoadjuvant chemo-therapy exposure,resulting in underrepresentation of low-risk subgroups.Addi-tionally,the short follow-up duration potentially compromised long-term progno-stic assessment.Contemporary advances in radiomics coupled with machine learning have enhanced multimodal data integration for PDAC management.However,clinical implementation continues to confront challenges including variability in imaging parameters,incomplete understanding of molecular underpinnings,and confounding treatment effects.Future investigations should prioritize developing multidimensional predictive frameworks that synergize radiographic,molecular,and clinical data.Prospective multicenter validation and artificial intelligence-powered real-time risk stratification systems represent essential steps to overcome current barriers in precision medicine translation,ultimately advancing personalized therapeutic strategies for PDAC.
文摘This editorial comments on Yang et al’s article that reported a correlation between dynamic contrast-enhanced ultrasound(CEUS)quantitative parameters and Ki67/tumor differentiation.The validation of CEUS as a diagnostic modality in this study deserves merit.However,it raises interesting points of discussion:(1)Since pancreatic cancer is an overarching term that includes conventional pancreatic ductal adenocarcinoma(PDAC),other subtypes,and neuroendocrine neoplasms(NENs),the inclusion/exclusion criteria require better clarification;(2)Most PDACs are grade 1-2 which contrasts with Yang et al’s study where 46%were grade 3;(3)Ki67 is officially recognized for grading NENs,but not for PDAC;(4)Hotspots are selected for the Ki67 grading of NENs.However,for other tumors(e.g.,breast carcinoma),the average count or hotspots are used;(5)There is no agreement for defining high-grade Ki67 cut-off for non-NENs;reports range from 10%to 50%;and(6)Ki67 reflects cellular proliferation but is not always the most important indicator for biologic aggressiveness.That notwithstanding,since the ratification of Ki67 for prognosis in NENs was based on survival outcomes,the real gold standard should be survival,instead of using Ki67 as a surrogate gold standard.In conclusion,the validation of CEUS parameters for PDAC is a work in progress.CEUS is valuable in assessing PDAC but should be viewed as augmenting other modalities such as computed tomography,magnetic resonance imaging,positron emission tomography and endoscopic ultrasound.
基金Supported by the Council for Science,Technology,and Innovation(CSTI)Cross-Ministerial Strategic Innovation Promotion Program(SIP)“Innovative AI Hospital System”(National Institute of Biomedical Innovation,Health and Nutrition),No.SIPAIH18C03the Japan Society for the Promotion of Science(JSPS)KAKENHI,No.JP19K09179 and No.JP23K08158.
文摘BACKGROUND Some patients with resectable or borderline resectable pancreatic ductal adenocarcinoma(PDAC)may have distant metastases,undetected on preoperative imaging or early recurrence,within 6 months after surgery.Occult metastases(OMs)must be accurately predicted to optimize multidisciplinary treatment.AIM To investigate the efficacy of circulating tumor DNA(ctDNA)in predicting OM.METHODS Two Japanese institutions prospectively collected preoperative plasma samples from PDAC patients between July 2019 and September 2021 and evaluated ctDNA using a targeted next-generation sequencing panel covering 52 cancer-related genes.RESULTS Among 135 PDAC patients,38 had OM and 35 were positive for ctDNA.The ctDNA positivity rate was significantly higher in patients with OM than in patients without OM.ctDNA-positive patients had significantly shorter median recurrence-free survival than ctDNA-negative patients.Logistic multivariate regression revealed ctDNA positivity as an independent predictor of OM.CONCLUSION Preoperative ctDNA in resectable PDAC is an independent predictor of OM and indicates poor prognosis following pancreatectomy and may be a useful biomarker in determining multidisciplinary patient care.
文摘BACKGROUND Although previous findings indicated that pathological assessment of tumor budding(TB),desmoplastic reaction(DR),and tumor-infiltrating lymphocytes(TILs)may play a role in determining tumor behavior in many malignancies,the relationship between TB,DR,and TILs in patients with pancreatic ductal adenocarcinoma(PDAC)is still unknown.AIM To evaluate relationships of TB,DR,and TILs with histopathological parameters and determine their prognostic value in patients with PDAC.METHODS The study cohort comprised 100 patients diagnosed with PDAC.Peritumoral budding(PTB)and intratumoral budding(ITB)were assessed according to the International Tumor Budding Consensus Conference guidelines.DR was classified based on stromal maturation.TILs were evaluated semiquantitatively with a 5%cutoff.Additionally,cases were categorized into two groups according to lymphocyte density:No/Low lymphocytes and medium/high lymphocytes.RESULTS A significant correlation was observed between ITB and PTB(r=0.890).Higher PTB was associated with fewer TILs and immature stroma(P<0.001).PTB and TILs were significantly related to tumor dimension,lymphovascular invasion,lymph node metastasis(LNM),and stage(P<0.005).ITB was also associated with the presence of lymph node involvement.The results of the univariate analysis revealed a significant correlation between poor survival rates and the presence of lymphovascular invasion,LNM,PTB,ITB,and TILs according to scoring(P<0.001).The multivariate analysis revealed LNM,PTB,ITB,and TILs according to scoring as independent prognostic factors.CONCLUSION TB assessment stratified patients with PDAC.PTB-ITB correlation showed diagnostic relevance of ITB in biopsy specimens.The prognostic significance of DR and interplay with TIL subsets warrant further investigation.
文摘Pancreatic ductal adenocarcinoma(PDAC)is characterized by high aggressiveness,poor prognosis,and unsatisfactory survival rates.The incidence of PDAC is increasing annually,and thus,the number of deaths due to PDAC is increasing worldwide.Modern imaging modalities,including multidetector computed tomography,magnetic resonance imaging-cholangiopancreatography,endoscopic retrograde cholangiopancreatography,positron emission tomography-computed tomography,endoscopic ultrasound and tumor markers,have made significant contributions to the diagnosis of pancreatic cancer.However,early diagnosis remains challenging despite progress in liquid biopsy(tumor DNA,tumor parts or cells),miRNAs,genomic analysis,MTA(metastasis-associated)proteins or circulating cancer-derived exosomes.Early diagnosis and radical surgical excision offer a unique chance of long-term survival in patients with an otherwise poor prognosis.However,surgery alone is insufficient,and multimodal treatment is needed.Novel treatment modalities,i.e.,immunotherapy,vaccines,targeted gene therapy,extracellular vesicles(particularly exosomes),new chemotherapy,novel radiotherapy and angiogenesis-restricting biological agents,were applied with promising outcomes.It seems that the biological mechanisms underlying the disease determine the effectiveness of any therapeutic effort.Thus,further research at the molecular level must focus on novel treatments to prevent the growth,invasion,and spread of cancer cells.
基金Supported by the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2025MSXM043。
文摘BACKGROUND Predicting early recurrence(ER),(≤12 months)after pancreatic ductal adenocar-cinoma(PDAC)resection remains challenging.Preoperative biomarkers such as carbohydrate antigen 19-9(CA19-9)and computed tomography(CT)lack optimal specificity and reproducibility.Extracellular volume(ECV),measured on equi-librium-phase CT to quantify stromal fibrosis,correlates with PDAC progression but its utility for ER prediction is unknown.This study evaluates preoperative CT-ECV as a novel biomarker to predict ER following curative-intent PDAC resection.This retrospective study included 93 PDAC patients undergoing R0 resection and preoperative pancreatic CT from January 2020 to November 2023.Clinical and CT features were analyzed.ECV was calculated using unenhanced and equilibrium-phase CT.Univariable and multivariable Cox regression identified ER predictors,followed by receiver operating characteristic analysis.Recurrence-free survival(RFS)was assessed by the Kaplan-Meier method.RESULTS Multivariable analysis identified elevated CT-ECV[hazard ratio(HR)=1.05;95%confidence interval(CI):1.02-1.09;P=0.003],high preoperative CA19-9(HR=1.00;95%CI:1.00-1.00;P=0.002),and poor tumor grade(HR=2.51;95%CI:1.20-5.22;P=0.014)as independent ER predictors.CT-ECV demonstrated comparable predictive accuracy to tumor grade[areas under the curve(AUC):0.736 vs 0.650;P=0.202].Combining CT-ECV and CA19-9 achieved a higher AUC than tumor grade alone(0.759 vs 0.650;P<0.05).Kaplan-Meier analysis revealed sig-nificantly shorter RFS in patients with low CT-ECV(≤35.37%),elevated CA19-9(>55 U/mL),or poorly differen-tiated tumors compared to those with high CT-ECV(>35.37%),low CA19-9(≤55 U/mL),or moderately/well-differentiated tumors.CONCLUSION CT-derived ECV is a promising non-invasive biomarker for preoperative ER prediction in PDAC.Combined with CA19-9,it outperforms tumor grade in stratifying recurrence risk,offering a clinically actionable tool for opti-mizing postoperative management.
基金supported by grants from the Young Elite Sci-entists Sponsorship Program by CAST(2023QNRC001)the Young Elite Scientists Sponsorship Program by BAST(BYESS2024001)the National Key Research and Development Program of China(2022YFC2407402).
文摘Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.
文摘Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.
基金Supported by the Associazione Italiana Ricerca sul Cancro,No.12182Cassini Project
文摘Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To better understand the biology of pancreatic cancer,it is fundamental to know its precursors and to study the mechanisms of carcinogenesis.Each of these precursors displays peculiar histological features,as well as specific molecular alterations.Starting from such pre-invasive lesions,this review aims at summarizing the most important aspects of carcinogenesis of pancreatic cancer,with a specific focus on the recent advances and the future perspectives of the research on this lethal tumor type.
文摘To investigate the expressions of presenilin-2 (PS2) and glutathione Stransferase π (GSTπ) and their roles in prognosis and therapy of breast infiltrating ductalcarcinoma. Methods: The paraffin-embedded specimens of 210 patients with breast infiltrating ductalcarcinoma were examined by using LSAB immunohistochemistry for the expression of PS2 and GSTπ.Results: The expression rate of PS2 and GSTπ was 49.5% (104/210) and 48.1% (101/210) respectively.The 5-year and 10-year postoperative survival rates in 4 groups, from high to low, were group 1 (PS2positive expression/GSTπ negative expression), group 2 (PS2 positive expression/GSTπ positiveexpression), group 3 (PS2 negative expression/GSTπ negative expression) and group 4 (PS2 negativeexpression/GSTπ positive expression) in turn. Conclusion: The prognosis of the group 1 was thebest, followed by the group 2, group 3 and group 4 in turn. These results suggested that thereasonable use of endocrinotherapy and chemotherapy for patients with breast infiltrating ductalcarcinoma is necessary.
文摘Because delayed diagnosis is one of the causes of poor prognosis in pancreatic ductal adenocarcinoma(PDAC), early detection is a key for overall improvement of prognosis. Towards this end, periodic screening is recommended for individuals considered high-risk for PDAC. Advances in diagnostic imaging modalities have increased the frequency of incidental findings of pancreatic cysts,including the intraductal papillary mucinous neoplasm(IPMN)-a major risk factor of PDAC, having 1% annual prevalence of concomitance with IPMN.Proper retainment of patients with IPMN and regular follow-up by routine imaging examination will likely improve early detection and better prognosis of PDAC. Unfortunately, current guidelines only address management of PDAC derived from IPMN and overlook PDAC concomitant with IPMN. Screening of patients with IPMN, by endoscopic ultrasonography(currently the most reliable modality for detecting small PDAC), may facilitate early detection of both IPMNderived and-concomitant PDAC. Prospective studies to evaluate the usefulness of endoscopic ultrasonography in screening of IPMN-concomitant PDAC will also help in determining the optimal surveillance strategy for more widespread applications.
文摘BACKGROUND Ductal spasm is a rare but life-threatening complication of cardiac catheterization in neonates with pulmonary atresia and an intact ventricular septum.In patients with ductal-dependent pulmonary blood flow,ductal spasm may lead to refractory hypoxemia and severe hemodynamic instability,which need to be treated in perfect order.CASE SUMMARY We present a male infant with a gestational age of 39 wk,and his fetal echocardiography showed pulmonary atresia.At 28 d of age,transcatheter pulmonary valvuloplasty with balloon dilatation was performed.Two hours after the operation,the patient's pulse oxygen saturation continued to decrease.The patient was then transferred to receive cardiac catheterization.During catheterization,the invasive blood pressure and pulse oxygen saturation suddenly decreased,and repeated aortography revealed partial occlusion of the ductus arteriosus.It no longer changed when pulse oxygen saturation rose to 51%after approximately 20 min of maintenance therapy.Therefore,a ductal stent was used for implantation.Hemodynamics and hypoxemia were improved.CONCLUSION We should know that ductal spasm may occur during pulmonary atresia and intact ventricular septum cardiac catheterization.Understand the pathophysiology of ductal-dependent pulmonary blood flow and make comprehensive perioperative preparations essential to deal with hemodynamic disorders caused by ductal spasm.
文摘Aim: To study the apoptotic rate (AR) and the androgen and estrogen milieu in the proximal and distal ductal sys-tems of prostate, in order to help exploring the effects of these factors on prostatic growth and the pathogenesis of be-nign prostatic hypertrophy (BPH). Methods: The proximal and distal ends of the ductal system were incised from20 normal prostate as well as the hypertrophic prostate tissue from 20 patients with BPH. The AR was determined bythe DNA end-labeling method and dihydrotestosterone (DHT) and estrodiol (E_2), by radioimmunoassay. Results:There was no significant difference in DHT and E_2 density between the proximal and distal ends of the ductal systems innormal prostate. E_2 appeared to be higher in BPH than in normal prostatic tissues, but the difference was statistically in-significant. In normal prostatic tissue, the AR was significantly higher in the distal than in the proximal ends of theductal system (P<0.05), while the AR of the proximal ends was significantly higher (P <0.01) than that in theBPH tissue. No significant correlation was noted between the DHT and E_2 density and the AR both in the normalprostate and BPH tissues. Conclusion: The paper is the first time describing a difference in AR in different regionsof the ductal system of normal prostate, while the hormonal milieu is similar, indicating a functional inhomogeneity ofthese regions. A low AR in the proximal duct, where BPH originates, and an even lower AR in the BPH tissue, sug-gesting the participation of apoptosis in the BPH pathogenesis.
基金Supported by Grants from the National Natural Science Foundation of China, No 30972898
文摘AIM:To investigate the expression of toll-like receptor(TLR) 4,nuclear factor-κB(NF-κB) p65 and hypoxiainducible transcription factor 1α(HIF-1α) in pancreatic ductal adenocarcinoma and their clinical significance.METHODS:The mRNA of TLR4 and HIF-1α were investigated by real-time polymerase chain reaction in 30 cases of pancreatic ductal adenocarcinoma and its adjacent tissues,and expression of TLR4,NF-κB p65 and HIF-1α protein were detected by immunohistochemistry in 65 cases of pancreatic ductal adenocarcinoma tissues and 38 cases of corresponding adjacent tissues.The relationship between TLR4 or HIF-1α and pathologic features,as well as the association between TLR4 and HIF-1α,were also analyzed.Kaplan-Meier method was used to assess the impact of expression of TLR4 and HIF-1α on survival of patients with pancreatic cancer.RESULTS:The relative quantif ication of TLR4 and HIF-1α mRNA in tumor tissues was 0.81±0.10 and 0.87±0.11,respectively,signif icantly higher than that in adjacent tissues(0.81±0.10 vs 0.70±0.16,P=0.002;0.87±0.11 vs 0.68±0.13,P=0.000).The protein expression of TLR4,NF-κB p65 and HIF-1α in tumor tissues was 69.20%,66.15% and 70.80%,respectively,being signif icantly higher than that in adjacent normal tissues(69.20% vs 39.50%,P=0.003;66.15% vs 31.58%,P=0.001;70.80% vs 36.80%,P=0.001).There was no signif icant correlation between TLR4 or HIF-1α expression and the age,gender,tumor location,the degree of tumor differentiation in the patients(P>0.05).However,there was signif icant correlation between the expression of TLR4 or HIF-1α and tumor size,lymph node metastasis,venous invasion and clinical staging(P<0.05).The expression of TLR4 and HIF-1α had a signif icant impact on survival of patients with pancreatic adenocarcinoma.CONCLUSION:TLR4,NF-κB p65 and HIF-1α are overexpressed in pancreatic adenocarcinoma,TLR4 may be partly involved in up-regulating HIF-1α,and both synergestically promote development of pancreatic adenocarcinoma.
