Cortiana Viviana, Vallabhaneni Harshitha, Gambill Jade, Nadar Soumiya, Itodo Kennedy, Park Chandler H, Leyfman Yan
Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy.
Apollo Institute of Medical Sciences and Research, Hyderabad 517001, India.
Cancers (Basel). 2024 Aug 15;16(16):2848. doi: 10.3390/cancers16162848.
Pancreatic cancer is a significant challenge in oncology due to its aggressive nature and complex management, leading to high mortality rates and a dismally low 5-year survival rate. Approximately 85% of cases manifest as adenocarcinoma, while endocrine tumors constitute less than 5%. Borderline resectable and locally advanced pancreatic cancers are particularly difficult to treat due to vascular involvement, which complicates complete resections and increases morbidity. Various therapeutic modalities aim to overcome these challenges and improve patient outcomes. Traditionally, upfront surgery was the standard for resectable tumors, with multimodal chemotherapy being central to treatment. Understanding surgical anatomy is pivotal in enhancing surgical outcomes and patient survival. Resectability challenges are several when seeking to achieve R0 resections, particularly for borderline resectable tumors. Various classification systems-the MD Anderson criteria, the NCCN criteria, the AHPA/SSAT/SSO consensus statement, and the Alliance definition-assess tumor involvement with major blood vessels, with the first of these systems being broadly accepted. Vascular staging integration is also important, with the Ishikawa staging system using preoperative imaging to assess venous involvement. Furthermore, neoadjuvant therapy enhances treatment effectiveness by addressing micro-metastatic disease early, increasing R0 resection chances, and downstaging tumors for optimal surgery. Insights from the Fox Chase Cancer Center's neoadjuvant treatment approach highlight the importance of a multidisciplinary strategy when advancing therapy and improving patient prognosis. This commentary, inspired by Dr. Sanjay S. Reddy's Keynote Conference during MedNews week, highlights current advancements and ongoing challenges in the treatment of pancreatic cancer, emphasizing the need for a comprehensive, multidisciplinary approach to improve outcomes.
胰腺癌因其侵袭性本质和复杂的治疗管理，成为肿瘤学领域的一项重大挑战，导致死亡率高且5年生存率极低。约85%的病例表现为腺癌，而内分泌肿瘤占比不到5%。由于血管受累，可切除边缘和局部晚期胰腺癌尤其难以治疗，这使得完整切除变得复杂并增加了发病率。各种治疗方式旨在克服这些挑战并改善患者预后。传统上，对于可切除肿瘤， upfront手术是标准治疗方法，多模式化疗是治疗的核心。了解手术解剖结构对于提高手术效果和患者生存率至关重要。在寻求实现R0切除时，尤其是对于可切除边缘肿瘤，存在诸多可切除性挑战。各种分类系统——MD安德森标准、NCCN标准、AHPA/SSAT/SSO共识声明以及联盟定义——评估肿瘤与主要血管的受累情况，其中第一个系统被广泛接受。血管分期整合也很重要，石川分期系统利用术前成像评估静脉受累情况。此外，新辅助治疗通过早期处理微转移疾病、增加R0切除机会以及使肿瘤降期以进行最佳手术，提高了治疗效果。福克斯蔡斯癌症中心新辅助治疗方法的见解突出了在推进治疗和改善患者预后时多学科策略的重要性。这篇受桑杰·S·雷迪博士在医学新闻周主题演讲启发的评论，强调了胰腺癌治疗中的当前进展和持续挑战，强调需要采用全面的多学科方法来改善治疗结果。
