Buanes Trond A
Trond A Buanes, Department of Hepato-Pancreatico-Biliary Surgery, Oslo University Hospital, N-0424 Oslo, Norway.
World J Gastroenterol. 2016 Dec 28;22(48):10502-10511. doi: 10.3748/wjg.v22.i48.10502.
Chemotherapy with improved effect in patients with metastatic pancreatic cancer has recently been established, launching a new era for patients with this very aggressive disease. FOLFIRINOX and gemcitabine plus nab-paclitaxel are different regimens, both capable of stabilizing the disease, thus increasing the number of patients who can reach second line and even third line of treatment. Concurrently, new windows of opportunity open for nutritional support and other therapeutic interventions, improving quality of life. Also pancreatic surgery has changed significantly during the latest years. Extended operations, including vascular/multivisceral resections are frequently performed in specialized centers, pushing borders of resectability. Potentially curative treatment including neoadjuvant and adjuvant chemotherapy is offered new patient groups. Translational research is the basis for the essential understanding of the ongoing development. Even thou biomarkers for clinical management of patients with periampullary tumors have almost been lacking, biomarker driven trials are now in progress. New insight is constantly made available for clinicians; one recent example is selection of patients for gemcitabine treatment based on the expression level of the human equilibrium nucleoside transporter 1. An example of new diagnostic tools is identification of early pancreatic cancer patients by a three-biomarker panel in urine: The proteins lymphatic vessel endothelial hyaluronan receptor 1, regenerating gene 1 alpha and translation elongation factor 1 alpha. Requirement of treatment guideline revisions is intensifying, as combined chemotherapy regimens result in unexpected advantages. The European Study Group for Pancreatic Cancer 4 trial outcome is an illustration: Addition of capecitabine in the adjuvant setting improved overall survival more than expected from the effect in advanced disease. Rapid implementation of new treatment options is mandatory when progress finally extends to patients with this serious disease.
最近已确立了对转移性胰腺癌患者疗效更佳的化疗方案，开启了这种极具侵袭性疾病患者治疗的新时代。FOLFIRINOX方案和吉西他滨联合纳米白蛋白结合型紫杉醇是不同的治疗方案，二者均能使病情稳定，从而增加了能够接受二线甚至三线治疗的患者数量。与此同时，营养支持和其他治疗干预措施也迎来了新的机遇，改善了生活质量。近年来，胰腺手术也发生了显著变化。在专业中心，包括血管/多脏器切除在内的扩大手术经常开展，拓展了可切除性的边界。新的患者群体可以接受包括新辅助和辅助化疗在内的潜在治愈性治疗。转化研究是深入理解当前进展的基础。尽管壶腹周围肿瘤患者临床管理的生物标志物几乎一直缺失，但目前基于生物标志物的试验正在进行。临床医生不断获得新的见解；最近的一个例子是根据人平衡核苷转运体1的表达水平选择接受吉西他滨治疗的患者。新型诊断工具的一个例子是通过尿液中的三种生物标志物组合来识别早期胰腺癌患者：淋巴管内皮透明质酸受体1、再生基因1α和翻译延伸因子1α。由于联合化疗方案带来了意想不到的优势，修订治疗指南的需求日益迫切。欧洲胰腺癌研究组4试验结果就是一个例证：在辅助治疗中添加卡培他滨改善了总生存期，超出了其在晚期疾病中的预期效果。当进展最终惠及这种严重疾病的患者时，必须迅速实施新的治疗方案。
