Recent Advances in Diagnosis and Treatment of Pancreatic Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Molecular Cancer Biology".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 9453

Special Issue Editor


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Guest Editor
Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
Interests: pancreatic and periampullary cancer; pancreas transplant; pancreaticoduodenectomy; minimally invasive surgery; robotic surgery; prognosis; biomarker

Special Issue Information

Dear Colleagues, 

Pancreatic cancer is a malignancy with a dismal outcome, mainly due to its aggressive biology. Surgical resection remains the only hope of cure in patients with this type of cancer. Nevertheless, the diagnosis and treatment of this notorious disease have been challenging because the pancreas is located in the deeply seated retroperitoneal space and associated with a complex anatomy. Therefore, pancreatic cancer is often diagnosed late. Moreover, resection with pancreaticoduodenectomy requires a high level of technical skill, is time-consuming, and is traditionally performed via an open approach requiring a long abdominal incision which causes severe pain and even torture for patients. Recent technological advances have made significant progress in the diagnosis and treatment of the pancreatic cancer. In diagnosis, the advances include the wide application of endoscopic ultrasound, liquid biopsy with circulating biomarkers, and precise imaging modalities. Recently, the introduction of robotic surgical systems such as the da Vinci Robotic Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has overcome several limitations related to the laparoscopic approach and driven pancreatic surgeons on the path of minimally invasive surgery. Providing a high-quality 3-D and magnified vision of the robotic scope, articulated instruments with 540 degrees of motion, greater precision with suture targeting, and elimination of surgeon tremor, the robotic approach makes it possible to perform more delicate and complex procedures such as pancreaticoduodenectomy. With the introduction of breakthrough chemotherapy regimens, neoadjuvant therapy for pancreatic cancer has been advocated in some centers.

Dr. Yi-Ming Shyr
Guest Editor

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Keywords

  • pancreatic cancer
  • pancreaticoduodenectomy
  • minimally invasive surgery
  • robotic surgery
  • diagnosis
  • treatment
  • neoadjuvant therapy
  • adjuvant therapy

Published Papers (4 papers)

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Research

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12 pages, 2332 KiB  
Article
The Development of a Prediction Model Based on Random Survival Forest for the Postoperative Prognosis of Pancreatic Cancer: A SEER-Based Study
by Jiaxi Lin, Minyue Yin, Lu Liu, Jingwen Gao, Chenyan Yu, Xiaolin Liu, Chunfang Xu and Jinzhou Zhu
Cancers 2022, 14(19), 4667; https://doi.org/10.3390/cancers14194667 - 25 Sep 2022
Cited by 18 | Viewed by 2883
Abstract
Accurate prediction for the prognosis of patients with pancreatic cancer (PC) is a emerge task nowadays. We aimed to develop survival models for postoperative PC patients, based on a novel algorithm, random survival forest (RSF), traditional Cox regression and neural networks (Deepsurv), using [...] Read more.
Accurate prediction for the prognosis of patients with pancreatic cancer (PC) is a emerge task nowadays. We aimed to develop survival models for postoperative PC patients, based on a novel algorithm, random survival forest (RSF), traditional Cox regression and neural networks (Deepsurv), using the Surveillance, Epidemiology, and End Results Program (SEER) database. A total of 3988 patients were included in this study. Eight clinicopathological features were selected using least absolute shrinkage and selection operator (LASSO) regression analysis and were utilized to develop the RSF model. The model was evaluated based on three dimensions: discrimination, calibration, and clinical benefit. It found that the RSF model predicted the cancer-specific survival (CSS) of the postoperative PC patients with a c-index of 0.723, which was higher than the models built by Cox regression (0.670) and Deepsurv (0.700). The Brier scores at 1, 3, and 5 years (0.188, 0.177, and 0.131) of the RSF model demonstrated the model’s favorable calibration and the decision curve analysis illustrated the model’s value of clinical implement. Moreover, the roles of the key variables were visualized in the Shapley Additive Explanations plotting. Lastly, the prediction model demonstrates value in risk stratification and individual prognosis. In this study, a high-performance prediction model for PC postoperative prognosis was developed, based on RSF The model presented significant strengths in the risk stratification and individual prognosis prediction. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Pancreatic Cancer)
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Review

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15 pages, 1126 KiB  
Review
Pancreatic Cancer-Secreted Proteins: Targeting Their Functions in Tumor Microenvironment
by Anna Lisa Cammarota, Antonia Falco, Anna Basile, Carlo Molino, Massimiliano Chetta, Gianni D’Angelo, Liberato Marzullo, Margot De Marco, Maria Caterina Turco and Alessandra Rosati
Cancers 2023, 15(19), 4825; https://doi.org/10.3390/cancers15194825 - 01 Oct 2023
Viewed by 1205
Abstract
Pancreatic Ductal Adenocarcinoma (PDAC) is a ravaging disease with a poor prognosis, requiring a more detailed understanding of its biology to foster the development of effective therapies. The unsatisfactory results of treatments targeting cell proliferation and its related mechanisms suggest a shift in [...] Read more.
Pancreatic Ductal Adenocarcinoma (PDAC) is a ravaging disease with a poor prognosis, requiring a more detailed understanding of its biology to foster the development of effective therapies. The unsatisfactory results of treatments targeting cell proliferation and its related mechanisms suggest a shift in focus towards the inflammatory tumor microenvironment (TME). Here, we discuss the role of cancer-secreted proteins in the complex TME tumor-stroma crosstalk, shedding lights on druggable molecular targets for the development of innovative, safer and more efficient therapeutic strategies. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Pancreatic Cancer)
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17 pages, 1878 KiB  
Review
Role of Therapeutic Endoscopic Ultrasound in Management of Pancreatic Cancer: An Endoscopic Oncologist Perspective
by Dushyant Singh Dahiya, Saurabh Chandan, Hassam Ali, Bhanu Siva Mohan Pinnam, Manesh Kumar Gangwani, Hashem Al Bunni, Andrew Canakis, Harishankar Gopakumar, Ishaan Vohra, Jay Bapaye, Mohammad Al-Haddad and Neil R. Sharma
Cancers 2023, 15(12), 3235; https://doi.org/10.3390/cancers15123235 - 18 Jun 2023
Viewed by 2293
Abstract
Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a [...] Read more.
Pancreatic cancer is a highly lethal disease with an aggressive clinical course. Patients with pancreatic cancer are usually asymptomatic until significant progression of their disease. Additionally, there are no effective screening guidelines for pancreatic cancer in the general population. This leads to a delay in diagnosis and treatment, resulting in poor clinical outcomes and low survival rates. Endoscopic Ultrasound (EUS) is an indispensable tool for the diagnosis and staging of pancreatic cancer. In the modern era, with exponential advancements in technology and device innovation, EUS is also being increasingly used in a variety of therapeutic interventions. In the context of pancreatic cancer where therapies are limited due to the advanced stage of the disease at diagnosis, EUS-guided interventions offer new and innovative options. Moreover, due to their minimally invasive nature and ability to provide real-time images for tumor localization and therapy, they are associated with fewer complication rates compared to conventional open and laparoscopic approaches. In this article, we detail the most current and important therapeutic applications of EUS for pancreatic cancer, namely EUS-guided Fine Needle Injections, EUS-guided Radiotherapy, and EUS-guided Ablations. Furthermore, we also discuss the feasibility and safety profile of each intervention in patients with pancreatic cancer to provide gastrointestinal medical oncologists, radiation and surgical oncologists, and therapeutic endoscopists with valuable information to facilitate patient discussions and aid in the complex decision-making process. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Pancreatic Cancer)
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19 pages, 851 KiB  
Review
Challenges in Diagnosis and Treatment of Pancreatic Exocrine Insufficiency among Patients with Pancreatic Ductal Adenocarcinoma
by Xiaoyang Lan, Gabrielle Robin, Jessica Kasnik, Grace Wong and Omar Abdel-Rahman
Cancers 2023, 15(4), 1331; https://doi.org/10.3390/cancers15041331 - 20 Feb 2023
Cited by 8 | Viewed by 2365
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the most common malignancy of the pancreas and is associated with an extremely poor prognosis. Many PDAC patients suffer from profound nutritional complications such as nutrient deficiencies, weight loss, malnutrition, and cancer cachexia. These complications cause barriers to [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is the most common malignancy of the pancreas and is associated with an extremely poor prognosis. Many PDAC patients suffer from profound nutritional complications such as nutrient deficiencies, weight loss, malnutrition, and cancer cachexia. These complications cause barriers to effective anticancer treatments, gravely influence their quality of life, and decrease their overall survival. Pancreatic exocrine insufficiency (PEI) is defined as impaired digestion due to inadequate secretion of pancreatic enzymes and is a common cause of malnutrition in PDAC. This review first summarizes the existing literature around malnutrition in PDAC, with a particular focus on PEI and its management with pancreatic enzyme replacement therapy (PERT). Second, we summarize existing guidelines and recommendations for the management of PEI among patients with PDAC. Lastly, we highlight potential gaps of knowledge of PEI among healthcare providers resulting in underdiagnosis and treatment, which may have implications for the quality of life and overall survival of PDAC patients. Full article
(This article belongs to the Special Issue Recent Advances in Diagnosis and Treatment of Pancreatic Cancer)
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