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Cancers
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Diagnostics and Therapeutics Advances in Pancreatic Cancer
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Diagnostics and Therapeutics Advances in Pancreatic Cancer

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

Deadline for manuscript submissions: 30 April 2024 | Viewed by 9900

Special Issue Editors

Dr. Andrea Belli

E-Mail Website
Guest Editor
Division of HPB Surgical Oncology, Istituto Nazionale Tumori - Fondazione Pascale—IRCCS, 80131 Napoli, Italy
Interests: pancreatic cancer; pancreatic surgery; robotic pancreatic resection; laparoscopic pancreatic resection; electrochemotherapy of pancreatic cancer; multimodal treatments; liver resection; laparoscopic liver resection; robotic liver resection; cholangiocarcinoma hepatocellular carcinoma; liver metastasis; chemotherapy (neoadjuvant, induction); chemoradiotherapy
Dr. Vincenza Granata

E-Mail Website
Guest Editor
Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Campania, Italy
Interests: oncology; screening; diagnosis; monitoring; precision medicine; radiomics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pancreatic cancers, and especially pancreatic ductal adenocarcinoma (PDAC), are one of the leading causes of cancer-related mortality worldwide. PDAC is characterized by its aggressive nature and dismal prognosis, with an overall 5-year survival rate of lower than 10%. Surgical resection still remains the most effective treatment but, unfortunately, is precluded from the vast majority of patients because of the metastatic or locally advanced disease status at diagnosis. Even in resected patients, long-term results are disappointing, since cancer will recur in about 80% of cases. Therefore, accurate staging at diagnosis and even more accurate restaging after neoadjuvant therapies in the case of borderline resectable patients are of crucial importance to achieve efficient prognostic stratification and offer optimal treatment to each patient. In fact, due to the high rates of systemic and/or local recurrence, various sequences of chemotherapy and radiotherapy—whether adjuvant or neoadjuvant—are administered to pancreatic cancer patients evaluated for curative intent surgery, and several therapeutic options, including radiotherapy, chemotherapy, immunotherapy, and local ablative techniques, are used for locally advanced and/or metastatic patients. We are pleased to invite you to share your experiences as part of our update on recent advancements in the diagnosis and treatment of pancreatic cancer, for which the focus will be on radiologic and endoscopic techniques as well as on therapeutic treatment options.

This Special Issue aims to provide a comprehensive overview of recent advances in terms of both innovations in the diagnosis of pancreatic cancer (including the role of radiomics, MRI, ecoendoscopy, etc.) and the most advanced surgical techniques (including laparoscopic and robotic approaches) and innovative medical and multimodal strategies used in treatment. Study protocols and the results of clinical studies and translational research are also welcome.

We look forward to receiving your contributions. 

Dr. Andrea Belli
Dr. Vincenza Granata
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic cancer
  • pancreatic adenocarcinoma
  • IPMN
  • neoadjuvant chemotherapy
  • minimally invasive pancreatic resection
  • robotic pancreatic resection
  • radiomics
  • DWI
  • pancreatic electroporation

Published Papers (6 papers)

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Research

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11 pages, 542 KiB  
Article
Utilising Pancreatic Exocrine Insufficiency in the Detection of Resectable Pancreatic Ductal Adenocarcinoma
by Declan McDonnell, Paul R. Afolabi, Sam Wilding, Gareth O. Griffiths, Jonathan R. Swann, Christopher D. Byrne and Zaed Z. Hamady
Cancers 2023, 15(24), 5756; https://doi.org/10.3390/cancers15245756 - 08 Dec 2023
Viewed by 842
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed late, leading to a high mortality rate. Early detection facilitates better treatment options. The aim of this UK-based case–control study was to determine whether two validated tests for pancreatic exocrine insufficiency (PEI), namely, the 13C-mixed [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is usually diagnosed late, leading to a high mortality rate. Early detection facilitates better treatment options. The aim of this UK-based case–control study was to determine whether two validated tests for pancreatic exocrine insufficiency (PEI), namely, the 13C-mixed triglyceride breath test (13C-MTGBT) and a faecal elastase (FE-1) test, can discriminate between patients with resectable PDAC versus healthy volunteers (HVs) along with a comparison group with chronic pancreatitis (CP). Discrimination between disease states and HVs was tested with receiver operator characteristic (ROC) curves. In total, 59 participants (23 PDAC (16 men), 24 HVs (13 men) and 12 CP (10 men)) were recruited, with a similar age in each population, and a combined median (IQR) age of 66 (57–71). The areas under the ROC curve for discriminating between PDAC and HVs were 0.83 (95% CI: 0.70–0.96) for the 13C-MTGBT, and 0.85 (95% CI: 0.75–0.95) for the FE-1 test. These were similar to CP vs. HV. In conclusion, PEI occurs in resectable PDAC to a similar extent as in CP; further large-scale, prospective studies using these tests in the primary care setting on high-risk groups are warranted. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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12 pages, 586 KiB  
Article
Peak Risk of Recurrence Occurs during the First Two Years after a Pancreatectomy in Patients Receiving Neoadjuvant FOLFIRINOX
by Marie-Sophie Alfano, Jonathan Garnier, Anaïs Palen, Jacques Ewald, Gilles Piana, Flora Poizat, Emmanuel Mitry, Jean-Robert Delpero and Olivier Turrini
Cancers 2023, 15(21), 5151; https://doi.org/10.3390/cancers15215151 - 26 Oct 2023
Viewed by 998
Abstract
No codified/systematic surveillance program exists for borderline/locally advanced pancreatic ductal carcinoma treated with neoadjuvant FOLFIRINOX and a secondary resection. This study aimed to determine the trend of recurrence in patients who were managed using such a treatment strategy. From 2010, 101 patients received [...] Read more.
No codified/systematic surveillance program exists for borderline/locally advanced pancreatic ductal carcinoma treated with neoadjuvant FOLFIRINOX and a secondary resection. This study aimed to determine the trend of recurrence in patients who were managed using such a treatment strategy. From 2010, 101 patients received FOLFIRINOX and underwent a pancreatectomy, in a minimum follow-up of 5 years. Seventy-one patients (70%, R group) were diagnosed with recurrence after a median follow-up of 11 months postsurgery. In the multivariable analysis, patients in the R-group had a higher rate of weight loss (p = 0.018), higher carbohydrate antigen (CA 19-9) serum levels at diagnosis (p = 0.012), T3/T4 stage (p = 0.017), and positive lymph nodes (p < 0.01) compared to patients who did not experience recurrence. The risk of recurrence in patients with T1/T2 N0 R0 was the lowest (19%), and all recurrences occurred during the first two postoperative years. The peak risk of recurrence for the entire population was observed during the first two postoperative years. The probability of survival decreased until the second year and rebounded to 100% permanently, after the ninth postoperative year. Close monitoring is needed at reduced intervals during the first 2 years following a pancreatectomy and should be extended to later than 5 years for those with unfavorable pathological results. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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13 pages, 1331 KiB  
Article
Survival Prediction after Curative Resection of Pancreatic Ductal Adenocarcinoma by Imaging-Based Intratumoral Necrosis
by Hokun Kim, Dong Hwan Kim, In Hye Song, Bohyun Kim, Soon Nam Oh, Joon-Il Choi and Sung Eun Rha
Cancers 2022, 14(22), 5671; https://doi.org/10.3390/cancers14225671 - 18 Nov 2022
Cited by 5 | Viewed by 1355
Abstract
We aimed to determine the histopathological characteristics and prognosis of curatively resected pancreatic ductal adenocarcinoma (PDAC) showing intratumoral necrosis on preoperative CT or MRI. This study consecutively included 102 patients who underwent upfront surgery with margin-negative resection from 2012 to 2020. All patients [...] Read more.
We aimed to determine the histopathological characteristics and prognosis of curatively resected pancreatic ductal adenocarcinoma (PDAC) showing intratumoral necrosis on preoperative CT or MRI. This study consecutively included 102 patients who underwent upfront surgery with margin-negative resection from 2012 to 2020. All patients underwent both pancreatic CT and MRI within 1 month before surgery. Two radiologists independently assessed CT/MRI findings, including the presence of CT- and MRI-detected necrosis. Histopathological characteristics of PDACs according to CT or MRI detection of necrosis were evaluated. Disease-free survival (DFS) and overall survival (OS) were assessed by the Kaplan–Meier method and the Cox proportional hazards model. Among the 102 PDAC patients, 14 patients (13.7%) had CT-detected necrosis, and 16 patients (15.7%) had MRI-detected necrosis, of which 9 showed both CT- and MRI-detected necrosis. PDACs with CT- or MRI-detected necrosis demonstrated a significantly higher degree of histopathological necrosis than those without (p < 0.001). Multivariable analysis revealed that tumor size (hazard ratio [HR], 1.19; p = 0.040), tumor location (HR, 0.46; p = 0.009), and MRI-detected necrosis (HR, 2.64; p = 0.002) had independent associations with DFS. Only MRI-detected necrosis was significantly associated with OS (HR, 2.59; p = 0.004). Therefore, MRI-detected necrosis might be a potential imaging predictor of poor survival after curative resection of PDAC. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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Review

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15 pages, 3281 KiB  
Review
Therapy of Locally Advanced and Oligometastatic Pancreatic Adenocarcinoma
by Isabell Luisa Wahler, Alexander Damanakis, Nils Große Hokamp, Christiane Bruns and Thomas Schmidt
Cancers 2023, 15(24), 5881; https://doi.org/10.3390/cancers15245881 - 18 Dec 2023
Viewed by 1127
Abstract
Pancreatic adenocarcinoma is a lethal disease, and surgical resection remains the only curative treatment option. Unfortunately, upon primary diagnosis, only 15–20% of all patients with pancreatic ductal adenocarcinoma (PDAC) have localized disease that is eligible for operation. The remainder of patients either have [...] Read more.
Pancreatic adenocarcinoma is a lethal disease, and surgical resection remains the only curative treatment option. Unfortunately, upon primary diagnosis, only 15–20% of all patients with pancreatic ductal adenocarcinoma (PDAC) have localized disease that is eligible for operation. The remainder of patients either have borderline resectable or locally advanced disease or present with distant metastasis. In this review, we present a comprehensive overview regarding the current strategies and future directions in the multimodal therapy of locally advanced and oligometastasized pancreatic adenocarcinoma and discuss the benefit of surgery following neoadjuvant therapy in these patients. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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17 pages, 3642 KiB  
Review
Technical Implications for Surgical Resection in Locally Advanced Pancreatic Cancer
by Martín de Santibañes, Juan Pekolj, Rodrigo Sanchez Claria, Eduardo de Santibañes and Oscar Maria Mazza
Cancers 2023, 15(5), 1509; https://doi.org/10.3390/cancers15051509 - 28 Feb 2023
Cited by 3 | Viewed by 1632
Abstract
Pancreatic ductal adenocarcinoma remains a global health challenge and is predicted to soon become the second leading cause of cancer death in developed countries. Currently, surgical resection in combination with systemic chemotherapy offers the only chance of cure or long-term survival. However, only [...] Read more.
Pancreatic ductal adenocarcinoma remains a global health challenge and is predicted to soon become the second leading cause of cancer death in developed countries. Currently, surgical resection in combination with systemic chemotherapy offers the only chance of cure or long-term survival. However, only 20% of cases are diagnosed with anatomically resectable disease. Neoadjuvant treatment followed by highly complex surgical procedures has been studied over the last decade with promising short- and long-term results in patients with locally advanced pancreatic ductal adenocarcinoma (LAPC). In recent years, a wide variety of complex surgical techniques that involve extended pancreatectomies, including portomesenteric venous resection, arterial resection, or multi-organ resection, have emerged to optimize local control of the disease and improve postoperative outcomes. Although there are multiple surgical techniques described in the literature to improve outcomes in LAPC, the comprehensive view of these strategies remains underdeveloped. We aim to describe the preoperative surgical planning as well different surgical resections strategies in LAPC after neoadjuvant treatment in an integrated way for selected patients with no other potentially curative option other than surgery. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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25 pages, 7771 KiB  
Review
Risk Assessment and Pancreatic Cancer: Diagnostic Management and Artificial Intelligence
by Vincenza Granata, Roberta Fusco, Sergio Venanzio Setola, Roberta Galdiero, Nicola Maggialetti, Lucrezia Silvestro, Mario De Bellis, Elena Di Girolamo, Giulia Grazzini, Giuditta Chiti, Maria Chiara Brunese, Andrea Belli, Renato Patrone, Raffaele Palaia, Antonio Avallone, Antonella Petrillo and Francesco Izzo
Cancers 2023, 15(2), 351; https://doi.org/10.3390/cancers15020351 - 05 Jan 2023
Cited by 6 | Viewed by 3085
Abstract
Pancreatic cancer (PC) is one of the deadliest cancers, and it is responsible for a number of deaths almost equal to its incidence. The high mortality rate is correlated with several explanations; the main one is the late disease stage at which the [...] Read more.
Pancreatic cancer (PC) is one of the deadliest cancers, and it is responsible for a number of deaths almost equal to its incidence. The high mortality rate is correlated with several explanations; the main one is the late disease stage at which the majority of patients are diagnosed. Since surgical resection has been recognised as the only curative treatment, a PC diagnosis at the initial stage is believed the main tool to improve survival. Therefore, patient stratification according to familial and genetic risk and the creation of screening protocol by using minimally invasive diagnostic tools would be appropriate. Pancreatic cystic neoplasms (PCNs) are subsets of lesions which deserve special management to avoid overtreatment. The current PC screening programs are based on the annual employment of magnetic resonance imaging with cholangiopancreatography sequences (MR/MRCP) and/or endoscopic ultrasonography (EUS). For patients unfit for MRI, computed tomography (CT) could be proposed, although CT results in lower detection rates, compared to MRI, for small lesions. The actual major limit is the incapacity to detect and characterize the pancreatic intraepithelial neoplasia (PanIN) by EUS and MR/MRCP. The possibility of utilizing artificial intelligence models to evaluate higher-risk patients could favour the diagnosis of these entities, although more data are needed to support the real utility of these applications in the field of screening. For these motives, it would be appropriate to realize screening programs in research settings. Full article
(This article belongs to the Special Issue Diagnostics and Therapeutics Advances in Pancreatic Cancer)
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