Harne Prateek Suresh, Harne Vaishali, Wray Curtis, Thosani Nirav
Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA 15212, USA.
Division of Pediatric Gastroenterology, The University of Texas.
Therap Adv Gastroenterol. 2024 Dec 10;17:17562848241297434. doi: 10.1177/17562848241297434. eCollection 2024.
Pancreatic cancer serves as the third leading cause of cancer-associated morbidity and mortality in the United States, with a 5-year survival rate of only 12% with an expected increase in incidence and mortality in the coming years. Pancreatic ductal adenocarcinomas constitute most pancreatic malignancies. Certain genetic syndromes, including Lynch syndrome, hereditary breast and ovarian cancer syndrome, hereditary pancreatitis, familial adenomatous polyposis, Peutz-Jeghers syndrome, familial pancreatic cancer mutation, and ataxia telangiectasia, confer a significantly higher risk. Screening for pancreatic malignancies currently targets patients with germline mutations or those with significant family history. Screening the general population is not currently viable owing to overall low incidence and lack of specific tests. Endoscopic ultrasound (EUS) and its applied advances are increasingly being used for surveillance, diagnosis, and management of pancreatic malignancies and have now become an indispensable tool in their management. For patients with risk factors, EUS in combination with magnetic resonance imaging/magnetic resonance cholangiopancreatography is used for screening. The role of endoscopic modalities has been expanding with the increased utilization of endoscopic retrograde cholangiopancreatography, EUS-directed therapies include EUS-guided fine-needle aspiration and EUS-fine-needle biopsy (FNB). EUS combined with FNB has the highest specificity and sensitivity for detecting pancreatic cancer amongst available modalities. Studies also recognize that artificial intelligence assisted EUS in the early detection of pancreatic cancer. At the same time, surgical resection has been historically considered the only curative treatment for pancreatic cancer, over 80% of patients present with unresectable disease. We also discuss EUS-guided therapies of physicochemicals (radiofrequency ablation, brachytherapy, and intratumor chemotherapy), biological agents (gene therapies and oncolytic viruses), and immunotherapy. We aim to perform a detailed review of the current burden, risk factors, role of screening, diagnosis, and endoscopic advances in the treatment modalities available for pancreatic cancer.
胰腺癌是美国癌症相关发病和死亡的第三大主要原因，5年生存率仅为12%，预计未来几年发病率和死亡率还会上升。胰腺导管腺癌构成了大多数胰腺恶性肿瘤。某些遗传综合征，包括林奇综合征、遗传性乳腺癌和卵巢癌综合征、遗传性胰腺炎、家族性腺瘤性息肉病、黑斑息肉综合征、家族性胰腺癌突变和共济失调毛细血管扩张症，会显著增加患病风险。目前，胰腺癌筛查的对象是有生殖系突变的患者或有明显家族病史的患者。由于总体发病率较低且缺乏特异性检测方法，目前对普通人群进行筛查并不可行。内镜超声（EUS）及其应用进展越来越多地用于胰腺癌的监测、诊断和管理，现已成为其管理中不可或缺的工具。对于有风险因素的患者，EUS联合磁共振成像/磁共振胰胆管造影用于筛查。随着内镜逆行胰胆管造影术使用的增加，内镜检查方式的作用不断扩大，EUS引导的治疗包括EUS引导下细针穿刺抽吸和EUS细针活检（FNB）。在现有检查方式中，EUS联合FNB对检测胰腺癌具有最高的特异性和敏感性。研究还认识到人工智能辅助EUS在胰腺癌早期检测中的作用。与此同时，手术切除一直以来都被认为是胰腺癌唯一的治愈性治疗方法，但超过80%的患者就诊时已出现无法切除的疾病。我们还讨论了EUS引导下物理化学药物（射频消融、近距离放疗和瘤内化疗）、生物制剂（基因治疗和溶瘤病毒）和免疫治疗。我们旨在对胰腺癌目前的负担、风险因素、筛查作用、诊断以及治疗方式中的内镜进展进行详细综述。
