Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK.
Lancet. 2020 Jun 27;395(10242):2008-2020. doi: 10.1016/S0140-6736(20)30974-0.
Pancreatic cancer is a highly fatal disease with a 5-year survival rate of approximately 10% in the USA, and it is becoming an increasingly common cause of cancer mortality. Risk factors for developing pancreatic cancer include family history, obesity, type 2 diabetes, and tobacco use. Patients typically present with advanced disease due to lack of or vague symptoms when the cancer is still localised. High quality computed tomography with intravenous contrast using a dual phase pancreatic protocol is typically the best method to detect a pancreatic tumour and to determine surgical resectability. Endoscopic ultrasound is an increasingly used complementary staging modality which also allows for diagnostic confirmation when combined with fine needle aspiration. Patients with pancreatic cancer are often divided into one of four categories based on extent of disease: resectable, borderline resectable, locally advanced, and metastatic; patient condition is also an important consideration. Surgical resection represents the only chance for cure, and advancements in adjuvant chemotherapy have improved long-term outcomes in these patients. Systemic chemotherapy combinations including FOLFIRINOX (5-fluorouracil, folinic acid [leucovorin], irinotecan, and oxaliplatin) and gemcitabine plus nab-paclitaxel remain the mainstay of treatment for patients with advanced disease. Data on the benefit of PARP inhibition as maintenance therapy in patients with germline BRCA1 or BRACA2 mutations might prove to be a harbinger of advancement in targeted therapy. Additional research efforts are focusing on modulating the pancreatic tumour microenvironment to enhance the efficacy of the immunotherapeutic strategies.
胰腺癌在美国的 5 年生存率约为 10%，是一种高度致命的疾病，且其发病率正不断上升。胰腺癌的危险因素包括家族史、肥胖、2 型糖尿病和吸烟。由于癌症在局部时缺乏或症状模糊，患者通常在疾病晚期才出现症状。高质量的 CT 静脉造影，使用双期胰腺方案，通常是检测胰腺肿瘤和确定手术可切除性的最佳方法。内镜超声是一种越来越常用的补充分期方式，当与细针抽吸结合使用时，也可以进行诊断确认。根据疾病的严重程度，胰腺癌患者通常分为以下四类：可切除、交界可切除、局部进展和转移；患者的身体状况也是一个重要的考虑因素。手术切除是唯一的治愈机会，辅助化疗的进展改善了这些患者的长期预后。包括 FOLFIRINOX（5-氟尿嘧啶、亚叶酸钙[甲酰四氢叶酸]、伊立替康和奥沙利铂）和吉西他滨加 nab-紫杉醇在内的全身化疗联合方案仍然是治疗晚期疾病患者的主要方法。关于 PARP 抑制剂作为有胚系 BRCA1 或 BRACA2 突变的患者维持治疗的益处的数据可能预示着靶向治疗的进步。更多的研究工作集中在调节胰腺肿瘤微环境上，以提高免疫治疗策略的疗效。
