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Medicina
Special Issues
Current Progress in the Multidisciplinary Treatment for Pancreatic Cancer
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Current Progress in the Multidisciplinary Treatment for Pancreatic Cancer

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 5613

Special Issue Editors

Dr. Uwe Pelzer

E-Mail Website
Guest Editor
Division of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität - Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
Interests: pancreatic cancer; clinical oncology; tumor immunology; tumor biology
Prof. Dr. Marcus Bahra

E-Mail Website
Co-Guest Editor
1. Division of Surgery, Medical Department, Charité Universitätsmedizin Berlin, Berlin, Germany
2. Free University Berlin, Berlin, Germany
3. Humboldt University of Berlin, Berlin, Germany
4. Berlin Institute of Health, Berlin, Germany
Interests: oncological surgery; pancreatic cancer; robotics; minimally invasive; Appleby resection

Special Issue Information

Dear Colleagues,

The pancreatic adenocarcinoma is still a multidisciplinary treatment challenge.

Within a decade, this disease will become the second most common cause of death among cancer patients. To treat the disease successfully, various specialist disciplines have to work closely together and develop therapy strategies. Preferably, patients should be discussed in a multidisciplinary cancer conference at time of first diagnosis and at every step in the progression of their course of disease.

Currently, we achieve a median survival time of around 28 to 54 months for patients after successful resection; in the inoperable situation we can expect median survival times of around 8–15 months. Survival times are closely linked to the performance status. A subset of patient disorders in the DNA repair mechanism can improve their prognosis by adding PARP inhibitors. Subgroups with specific characteristics still need to be identified, which can then benefit from individually tailored therapy. This applies to many areas, such as operative, perioperative, oligometastatic disease, radiation therapy, and molecular-based variants.

Over the past decade, many advances have been made for our patients. It is important to implement this as the clinical standard for all patients in order to achieve a consistent quality of care.

This Special Issue will give an overview of the current standard treatment procedures. It is also intended to explain and discuss specific aspects of current research in the individual areas of the participating disciplines.

PD Dr. Uwe Pelzer
Guest Editor

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. Medicina is an international peer-reviewed open access monthly 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 1800 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
  • prognosis
  • surgery
  • multidisciplinary approach
  • chemotherapy
  • radiation
  • cachexia
  • palliative care
  • pathology

Published Papers (3 papers)

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Research

11 pages, 5213 KiB  
Article
Notch Signaling Pathway in Pancreatobiliary Tumors
by Francesca Borlak, Anja Reutzel-Selke, Anja Schirmeier, Julia Gogolok, Ellen von Hoerschelmann, Igor M. Sauer, Johann Pratschke, Marcus Bahra and Rosa B. Schmuck
Medicina 2021, 57(2), 105; https://doi.org/10.3390/medicina57020105 - 24 Jan 2021
Cited by 1 | Viewed by 2062
Abstract
Background and Objectives: The Notch signaling pathway plays an important role both in the development of the ductal systems of the pancreas and the bile ducts as well as in cancer development and progression. The aim of this study was to examine the [...] Read more.
Background and Objectives: The Notch signaling pathway plays an important role both in the development of the ductal systems of the pancreas and the bile ducts as well as in cancer development and progression. The aim of this study was to examine the expression of central proteins of the Notch signaling pathway in pancreatobiliary tumors and its influence on patient survival. Materials and Methods: We compared the receptors (Notch1, Notch4), activating splicing factors (ADAM17), and target genes (HES1) of the Notch pathway and progenitor cell markers with relevance for the Notch signaling pathway (CD44, MSI1) between pancreatic adenocarcinomas (PDAC, n = 14), intrahepatic cholangiocarcinoma (iCC, n = 24), and extrahepatic cholangiocarcinoma (eCC, n = 22) cholangiocarcinomas via immunohistochemistry and ImageJ software-assisted analysis. An Immunohistochemistry (IHC)-score was determined by the percentage and intensity of stained (positive) cells (scale 0–7) and normal and malignant tissue was compared. In the IHC results, patients’ (gender, age) and tumor (TNM Classification of Malignant Tumors, Union Internationale contre le Cancer (UICC) stages, grading, and lymphangitic carcinomatosa) characteristics were correlated to patient survival. Results: For eCC, the expression of CD44 (p = 0.043, IHC-score 3.94 vs. 3.54) and for iCC, the expression of CD44 (p = 0.026, IHC-score 4.04 vs. 3.48) and Notch1 (p < 0.001, IHC-score 2.87 vs. 1.78) was significantly higher in the tumor compared to non-malignant tissue. For PDAC, the expression of ADAM17 (p = 0.008, IHC-score 3.43 vs. 1.73), CD44 (p = 0.012, IHC-score 3.64 vs. 2.27), Notch1 (p = 0.012, IHC-score 2.21 vs. 0.64), and Notch4 (p = 0.008, IHC-score 2.86 vs. 0.91) was significantly higher in the tumor tissue. However, none of the analyzed Notch-signaling related components showed an association to patient survival. Conclusion: A significant overexpression of almost all studied components of the Notch signaling pathway can be found in the tumor tissue, however, without a significant influence on patient survival. Therefore, further studies are warranted to draw conclusions on Notch pathway’s relevance for patient survival. Full article
(This article belongs to the Special Issue Current Progress in the Multidisciplinary Treatment for Pancreatic Cancer)
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14 pages, 484 KiB  
Article
Induction Chemotherapy for Primarily Unresectable Locally Advanced Pancreatic Adenocarcinoma—Who Will Benefit from a Secondary Resection?
by Nathalie Rosumeck, Lea Timmermann, Fritz Klein, Marcus Bahra, Sebastian Stintzig, Thomas Malinka and Uwe Pelzer
Medicina 2021, 57(1), 77; https://doi.org/10.3390/medicina57010077 - 18 Jan 2021
Cited by 1 | Viewed by 1630
Abstract
Background and Objectives: An increasing number of patients (pts) with locally advanced pancreatic cancer (LAPC) are treated with an intensive neoadjuvant therapy to obtain a secondary curative resection. Only a certain number of patients benefit from this intention. The aim of this investigation [...] Read more.
Background and Objectives: An increasing number of patients (pts) with locally advanced pancreatic cancer (LAPC) are treated with an intensive neoadjuvant therapy to obtain a secondary curative resection. Only a certain number of patients benefit from this intention. The aim of this investigation was to identify prognostic factors which may predict a benefit for secondary resection. Materials and Methods: Survival time and clinicopathological data of pts with pancreatic cancer were prospective and consecutively collected in our Comprehensive Cancer Center Database. For this investigation, we screened for pts with primarily unresectable pancreatic cancer who underwent a secondary resection after receiving induction therapy in the time between March 2017 and May 2019. Results: 40 pts had a sufficient database to carry out a reliable analysis. The carbohydrate-antigen 19-9 (CA 19-9) level of the pts treated with induction therapy decreased by 44.7% from 4358.3 U/mL to 138.5 U/mL (p = 0.001). The local cancer extension was significantly reduced (p < 0.001), and the Eastern Cooperative Oncology Group (ECOG) performance status was lowered (p = 0.03). The median overall survival (mOS) was 20 months (95% CI: 17.2–22.9). Pts who showed a normal CA 19-9 level (<37 U/mL) at diagnosis and after neoadjuvant therapy or had a Body Mass Index (BMI) below 25 kg/m2 after chemotherapy had a significant prolonged overall survival (29 vs. 19 months, p = 0.02; 26 vs. 18 months, p = 0.04; 15 vs. 24 months, p = 0.01). Pts who still presented elevated CA 19-9 levels >400 U/mL after induction therapy did not profit from a secondary resection (24 vs. 7 months, p < 0.001). Nodal negativity as well as the performance of an adjuvant therapy lead to better mOS (25 vs. 15 months, p = 0.003; 10 vs. 25 months, p < 0.001). Conclusion: The pts in our investigation had different benefits from the multimodal treatment. We identified the CA 19-9 level at time of diagnosis and after neoadjuvant therapy as well as the preoperative BMI as predictive factors for overall survival. Furthermore, diagnostics of presurgical nodal status should gain more importance as nodal negativity is associated with better outcome. Full article
(This article belongs to the Special Issue Current Progress in the Multidisciplinary Treatment for Pancreatic Cancer)
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11 pages, 1067 KiB  
Article
Procoagulant Disorders in Patients with Newly Diagnosed Pancreatic Adenocarcinoma
by Renata Talar-Wojnarowska, Małgorzata Woźniak, Anna Borkowska, Katarzyna Cypryk, Marek Olakowski and Ewa Małecka-Panas
Medicina 2020, 56(12), 677; https://doi.org/10.3390/medicina56120677 - 09 Dec 2020
Cited by 4 | Viewed by 1425
Abstract
Background and objectives: Cancer coagulopathy is thought to be partially due to the up-regulation of tissue factor (TF), thrombin-antithrombin complex (TAT) and soluble P-selectin (sP-selectin). The purpose of this study was to evaluate the clinical significance of TF, TAT and sP-selectin in [...] Read more.
Background and objectives: Cancer coagulopathy is thought to be partially due to the up-regulation of tissue factor (TF), thrombin-antithrombin complex (TAT) and soluble P-selectin (sP-selectin). The purpose of this study was to evaluate the clinical significance of TF, TAT and sP-selectin in patients with pancreatic cancer. Materials and methods: The study included 93 subjects: 73 newly diagnosed patients with pancreatic adenocarcinoma (42 with stage I-III and 31 with metastatic cancer (stage IV)) and a control group of 20 healthy subjects. Analyzed patients were hospitalized in the Department of Digestive Tract Diseases, Medical University of Lodz or in the Department of Digestive Tract Surgery, Silesian University, Katowice, Poland. All laboratory parameters were measured using ELISA procedures. Results: TF plasma levels were detectable in all patients and were significantly higher in metastatic cancer compared to stage I-III patients and the control group (p < 0.05). In patients with pancreatic adenocarcinoma, the median levels of TAT were also elevated compared to the control group. Moreover, patients with metastases had significantly higher TAT concentration compared to the I-III cancer group. On the other hand, only the metastatic patients group showed significantly higher plasma sP-selectin levels compared to the controls (p = 0.009), whereas there was no difference between localized and metastatic cancer patients. Conclusions: The coagulation disorders are present in the majority of patients with pancreatic adenocarcinoma already at the diagnosis stage and reflect cancer progression and spread. Full article
(This article belongs to the Special Issue Current Progress in the Multidisciplinary Treatment for Pancreatic Cancer)
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