Hidalgo Manuel, Cascinu Stefano, Kleeff Jörg, Labianca Roberto, Löhr J-Matthias, Neoptolemos John, Real Francisco X, Van Laethem Jean-Luc, Heinemann Volker
Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain.
Department of Medical Oncology, University of Ancona, Ancona, Italy.
Pancreatology. 2015 Jan-Feb;15(1):8-18. doi: 10.1016/j.pan.2014.10.001. Epub 2014 Oct 17.
Pancreatic ductal adenocarcinoma (PDAC), which accounts for more than 90% of all pancreatic tumours, is a devastating malignancy with an extremely poor prognosis, as shown by a 1-year survival rate of around 18% for all stages of the disease. The low survival rates associated with PDAC primarily reflect the fact that tumours progress rapidly with few specific symptoms and are thus at an advanced stage at diagnosis in most patients. As a result, there is an urgent need to develop accurate markers of pre-invasive pancreatic neoplasms in order to facilitate prediction of cancer risk and to help diagnose the disease at an earlier stage. However, screening for early diagnosis of prostate cancer remains challenging and identifying a highly accurate, low-cost screening test for early PDAC for use in clinical practice remains an important unmet need. More effective therapies are also crucial in PDAC, since progress in identifying novel therapies has been hampered by the genetic complexity of the disease and treatment remains a major challenge. Presently, the greatest step towards improved treatment efficacy has been made in the field of palliative chemotherapy by introducing FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan and oxaliplatin) and gemcitabine/nab-paclitaxel. Strategies designed to raise the profile of PDAC in research and clinical practice are a further requirement in order to ensure the best treatment for patients. This article proposes a number of approaches that may help to accelerate progress in treating patients with PDAC, which, in turn, may be expected to improve the quality of life and survival for those suffering from this devastating disease.
胰腺导管腺癌（PDAC）占所有胰腺肿瘤的90%以上，是一种极具毁灭性的恶性肿瘤，预后极差，该病所有阶段的1年生存率约为18%即表明了这一点。与PDAC相关的低生存率主要反映出肿瘤进展迅速且特异性症状很少，因此大多数患者在诊断时已处于晚期。因此，迫切需要开发准确的胰腺肿瘤前体标志物，以便于预测癌症风险并有助于在疾病早期进行诊断。然而，前列腺癌的早期诊断筛查仍然具有挑战性，并且确定一种用于临床实践的用于早期PDAC的高度准确、低成本的筛查测试仍然是一项尚未满足的重要需求。更有效的治疗方法在PDAC中也至关重要，因为该疾病的遗传复杂性阻碍了新型治疗方法的研发进展，治疗仍然是一项重大挑战。目前，在姑息化疗领域通过引入FOLFIRINOX（亚叶酸、5-氟尿嘧啶、伊立替康和奥沙利铂）和吉西他滨/纳米白蛋白结合型紫杉醇，在提高治疗效果方面迈出了最大的一步。为提高PDAC在研究和临床实践中的关注度而设计的策略是另一项需求，以便确保为患者提供最佳治疗。本文提出了一些可能有助于加速PDAC患者治疗进展的方法，这反过来可能会改善患有这种毁灭性疾病的患者的生活质量和生存率。
