Chandrasegaram Manju D, Chen John W, Price Timothy J, Zalcberg John, Sjoquist Katrin, Merrett Neil D
From the *NHMRC Clinical Trials Centre; †Department of Surgery, The Prince Charles Hospital, Brisbane; ‡Department of Surgery, Flinders Medical Centre; §Queen Elizabeth Hospital, Adelaide; ∥University of Adelaide, South Australia; ¶School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne; #Cancer Care Centre, Department of Medical Oncology, St George Hospital; **Department of Surgery, Bankstown Hospital; and ††Division of Surgery, University of Western Sydney, Sydney, Australia.
Pancreas. 2016 Jan;45(1):32-9. doi: 10.1097/MPA.0000000000000385.
Periampullary cancers (PACs) include the following 4 traditional anatomic subtypes: pancreatic, ampullary, biliary, or duodenal cancers. This review was performed to highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in these cancer subtypes.
Recent advances have highlighted differences in the genomic and molecular features within each PAC subtype. Ampullary cancers can now be further defined accurately into their intestinal and pancreatobiliary subtypes using histomolecular profiling. K-ras mutation, which occurs in most pancreatic cancers, is found to occur less frequently in ampullary (42%-52%), biliary (22%-23%), and duodenal cancers (32%-35%), suggesting crucial differences in targetable mutations in these cancer subtypes.Ampullary cancers of intestinal subtype and duodenal cancers seem to share similarities with colorectal cancer, given that they respond to similar chemotherapeutic regimens. This has potential implications for clinical trials and treatment selection, where PACs are often considered together.
Future trials should be designed in view of our increased understanding of the different anatomic and histomolecularly profiled subtypes of PAC cancers, which respects their individual molecular characteristics, phenotype, and response to treatment.
壶腹周围癌（PACs）包括以下4种传统解剖学亚型：胰腺癌、壶腹癌、胆管癌或十二指肠癌。本综述旨在突出每种PAC亚型在基因组和分子层面认识的最新进展，以及这些癌症亚型在化疗和分子试验方面的进展。
最近的进展突出了每种PAC亚型在基因组和分子特征上的差异。现在可以通过组织分子谱分析将壶腹癌准确地进一步细分为肠型和胰胆管型。K-ras突变在大多数胰腺癌中出现，但在壶腹癌（42%-52%）、胆管癌（22%-23%）和十二指肠癌（32%-35%）中出现的频率较低，这表明这些癌症亚型在可靶向突变方面存在关键差异。肠型壶腹癌和十二指肠癌似乎与结直肠癌有相似之处，因为它们对相似的化疗方案有反应。这对临床试验和治疗选择具有潜在意义，因为PACs通常被一起考虑。
鉴于我们对PAC癌症不同解剖学和组织分子谱亚型的认识有所增加，未来的试验设计应考虑到这些亚型各自的分子特征、表型和对治疗的反应。
