To investigate whether chemotherapy could prolong the postoperative survival time in patients with early stages pancreatic ductal adenocarcinoma (PDAC). A total of 5280 stage ⅠA -ⅡB PDAC patients diagnosed from 2010 to 2015 were selected from surveillance，epidemiology，and end results (SEER) database. Propensity score matching (PSM) analysis was adopted to reduce the baseline differences between the groups. Univariate survival analysis was conducted with the Kaplan-Meier method. Multivariate survival analysis was performed with the Cox proportional hazards model. Univariate and multivariate survival analyses showed that age, differentiation, stage, chemotherapy were independent risk factors for the survival of PDAC patients. After PSM, it is found that adjuvant chemotherapy could prolong the median overall survival time (mOS) for stage ⅠB, ⅡA and ⅡB patients. However, for stage ⅠA patients, there were no significant differences in 3-year survival rate and mOS between patients with chemotherapy (=283) and without chemotherapy (=229) (57.4% vs 55.6%, vs all >0.05). Further analyses show that among 101 patients with well differentiated PDAC and 294 patients with moderately differentiated PDAC, there were no significant differences in survival rate and mOS between patients with and without chemotherapy (all >0.05). Among 117 patients with low-differentiated + undifferentiated PDAC, 3-year survival rate and mOS in patients with chemotherapy were significantly better than those without chemotherapy (48.5% vs 34.1%, vs all <0.05). Chemotherapy regimen used currently is not beneficial for patients with moderately and well differentiated stage ⅠA PDAC, but it is an independent prognostic factor for low-differentiated + undifferentiated PDAC patients.
Adenocarcinoma/pathology* ; Carcinoma, Pancreatic Ductal/surgery* ; Chemotherapy, Adjuvant ; Humans ; Neoplasm Staging ; Pancreatic Neoplasms/drug therapy* ; Prognosis ; Propensity Score

Pancreatoblastoma is a rare primary pancreatic neoplasm of children that may arise in any portion of the pancreas. We report a case of a 3-yr-old boy who presented to with abdominal pain our hospital and a progressive bulge in his right abdomen. Biochemical evaluation and serum levels of tumoral markers were within reference limits. On the computed tomography, two tumors were found. One located in the head of the pancreas; however, a laparotomy revealed that the head of pancreas was compressed but normal. The other was in the left abdomen near the spleen and the tail of the pancreas. The diagnosis of two synchronous pancreatoblastoma originating from the omentum was confirmed by pathology. Therefore, a pancreatoblastoma should be considered when a large well-defined, lobulated, and heterogeneous mass is identified in the pancreas of children. In addition, an ectopic pancreatoblastoma should be considered when identified within or near the ectopic pancreatic tissue.
Antineoplastic Agents/therapeutic use ; Child, Preschool ; Drug Therapy, Combination ; Humans ; Laparotomy ; Male ; Pancreatic Neoplasms/drug therapy/*pathology/surgery ; Peritoneal Neoplasms/drug therapy/pathology/surgery ; Tomography, X-Ray Computed

As pancreatic cancer (PC) is highly malignant, its patients tend to develop metastasis at an early stage and show a poor response to conventional chemotherapies. First-line chemotherapies for PC, according to current guidelines, include fluoropyrimidine- and gemcitabine-based regimens. Accumulating research on drug resistance has shown that biochemical metabolic aberrations in PC, especially those involving glycolysis and glutamine metabolism, are highly associated with chemoresistance. Additionally, lipid metabolism is a major factor in chemoresistance. However, emerging compounds that target these key metabolic pathways have the potential to overcome chemoresistance. This review summarizes how PC develops chemoresistance through aberrations in biochemical metabolism and discusses novel critical targets and pathways within cancer metabolism for new drug research.
Humans ; Gemcitabine ; Deoxycytidine/therapeutic use* ; Drug Resistance, Neoplasm ; Metabolic Reprogramming ; Carcinoma, Pancreatic Ductal/drug therapy* ; Pancreatic Neoplasms/pathology* ; Cell Line, Tumor

PURPOSE: To evaluate the effectiveness of external radiation therapy and the prognostic factors, we retrospectively analyzed therapeutic results of malignant extrahepatic biliary obstruction (EHBO). METHODS AND MATERIALS: We analyzed the results of the external radiation therapy in 59 patients of inoperable malignant EHBO who had been treated with more than 10 Gy of external radiation therapy from April 1984 to December 1996. There were 21 stomach cancer (35.6%), 12 pancreas cancer (20.3%), 15 extrahepatic biliary cancer (18.6%) and 11 another cancer (18.6%). Their pathologies were confirmed in 31 patients (52.5%). They divided into 27 adenocarcinoma and 4 nonadenocarcinoma. Their chief complaints were jaundice in 47 patients (79.7%) and abdominal pain in 15 patients (49.2%). Twelve patients had slightly increased bilirubin level in liver function test without jaundice. We treated twenty four patients (40.6%) with percutaneous transhepatic biliary drainage (PTBD) and 32 patients (54%) with systemic chemotherapy (CT). We performed external radiation therapy (ERT) upto 10.8~55.8 Gy (median 37.8 Gy) with palliative aim. RESULTS: Overall median survival duration was 7.80+/-1.15 months. The response rates of jaundice were 81.8% in PTBD group and 66.7% in non-PTBD group without statistical significance. The improving rate of jaundice was not significantly different in decreased ratio of total bilirubin level. But abdominal pain was more decreased in CT group than non-CT group (P<0.05). The significant prognostic factors were high performance status (Karnofski Performance Status >70), total radiation dose more than 35 Gy and good response of pain after therapy. There were increased in bacterial cholagitis in PTBD group and gastrointestinal complications in CT group. CONCLUSION: External radiotheapy could improve jaundice and abdominal pain in malignant EHBO patients. Overall survival duration was prolonged in patients with higher performance status and patients who had been treated with more than 35 Gy of total radiation dose. In the future, we expect not only better palliative role but also the prolongation of survival of using the ERT combined with other treatment method. But to achieve certain conclusion, we need futher study consisted with many kinds of treatment methods including new technologies in RT.
Abdominal Pain ; Adenocarcinoma ; Bilirubin ; Drainage ; Drug Therapy ; Humans ; Jaundice ; Liver Function Tests ; Pancreatic Neoplasms ; Pathology ; Radiotherapy ; Retrospective Studies ; Stomach Neoplasms

OBJECTIVETo establish a 5-fluorouracil (5-FU)-resistant pancreatic adenocarcinoma (PAC) cell strain, and to investigate its biological characteristics.

METHODSThe PAC cell strain SW1990 was selected into a multidrug-resistant cell strain stepwise with 5-FU, one of the most common drugs used in PAC chemotherapy, for 12 months and subsequently named SW1990/FU. The cell strain was characterized in terms of morphology, biology, and cross-resistance to adriamycin(ADM), mitomycin-C (MMC), and gemcitabine. BHLB/c-m nude mice tumor growth and CEA and CA19-9 levels were analyzed. In addition, karyotyping and FACS analysis were performed in SW1990/FU and SW1990.

RESULTSThe SW1990/FU cell strain was 132.7 times more resistant to 5-FU than the parental SW1990 cells, and exhibited cross-resistance to other agents. Compared to the parental cells, SW1990/FU cells exhibited a smaller growth rate, delayed cell-doubling time, and specific changes in chromosomes 18. Tumor diameters in multidrug resistance and parental cells inoculated in in vivo experiments were (1.5 +/- 0.30) cm and (0.8 +/- 0.15) cm, respectively.

CONCLUSIONSMorphological adaptation and intracellular changes can be induced by drug challenge in PAC cells. SW1990/FU may be used as an experimental system for the search to overcome drug resistance and to elucidate possible mechanisms of acquired drug resistance in human pancreatic cancer.

Adenocarcinoma ; drug therapy ; pathology ; Animals ; Antimetabolites, Antineoplastic ; pharmacology ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Drug Resistance, Neoplasm ; genetics ; Fluorouracil ; pharmacology ; Humans ; Mice ; Mice, Nude ; Pancreatic Neoplasms ; drug therapy ; pathology

OBJECTIVETo study the role of slow-release 5-fluorouracil implantation in treatment of unresectable pancreatic cancer.

METHODS85 cases of untreated patients with locally advanced pancreatic cancer (LAPC) were randomized into two groups: Trial group: slow-release 5-fluorouracil implantation (50 patients) and control group (35 patients). Observing the objective tumor response, clinical benefit response, toxicity, complications and survival of patients of the two groups.

RESULTSIn the trial group the overall response rate (PR + NC) was 76.0%, and the clinical benefit response rate was 52.0%. No toxicity was observed. Pancreatic fistula occurred in 2 patients. The median survival time of the two groups was 9.0 months and 4.0 months, respectively. The survival rates of 6- and 12-month were 56.8% vs. 31.4% and 22.9% vs. 2.9% in the two groups, respectively (P = 0.012).

CONCLUSIONSlow-release 5-fluorouracil implantation is a simple, safe and effective method in treatment of LAPC.

Antimetabolites, Antineoplastic ; administration & dosage ; therapeutic use ; Drug Implants ; adverse effects ; Female ; Fluorouracil ; administration & dosage ; therapeutic use ; Follow-Up Studies ; Humans ; Male ; Microspheres ; Middle Aged ; Neoplasm Staging ; Pancreatic Fistula ; etiology ; Pancreatic Neoplasms ; drug therapy ; pathology ; Prospective Studies ; Remission Induction ; Survival Rate

Antineoplastic Agents, Immunological ; immunology ; pharmacology ; Cell Line, Tumor ; GPI-Linked Proteins ; antagonists & inhibitors ; immunology ; Humans ; Neoplasm Proteins ; analysis ; immunology ; Pancreatic Neoplasms ; drug therapy ; immunology ; pathology

Pancreatic adenocarcinoma is one of the fatalist malignancies. A large proportion of patients are diagnosed with unresectable stage pancreatic cancer at the time of presentation. Gemcitabine is a standard chemotherapeutic agent since 1997, but survival benefit is not satisfactory. Recent clinical study proved that several new combination chemotherapy regimens are superior to gemcitabine single chemotherapy and extended overall survival. However, its prognosis still remains grim. Current research is taking a multidirectional approach in the hope of developing more effective treatments. This article reviews the major clinical trial data that is the basis for the current chemotherapy regimens used as first- and second-line treatments for advanced pancreatic adenocarcinoma. This article also reviews the current ongoing clinical trials, which include the use of molecular targeting agents and immune therapies.
Adenocarcinoma/*drug therapy/pathology ; Antimetabolites, Antineoplastic/therapeutic use ; Antineoplastic Agents/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Deoxycytidine/analogs & derivatives/therapeutic use ; Humans ; Immunotherapy ; Pancreatic Neoplasms/*drug therapy/pathology ; Protein Kinase Inhibitors/therapeutic use

OBJECTIVETo explore the possible mechanism of apoptosis induced by photodynamic therapy (PDT) in human pancreatic cancer cells Capan-1 with 2-butylamino-2-demethoxy-hypocrellin B (BAHB) as photosensitizer.

METHODSThe localization of BAHB in Capan-1 cells was studied, apoptosis was determined by DNA gel electrophoresis after PDT. The mitochondria membrane potential (DYm) and cytochrome C release were observed by laser scan confocal microscopy and Western blotting.

RESULTSThe low concentration photosensitizer was mainly localized in mitochondria and also in lysosomes when the concentration is high. DNA ladder analysis showed characteristic of apoptosis. The mitochondria membrane potential (DYm) showed a loss of 30% around, after 6 hours by PDT under laser scan confocal microscopy, which is caused by a sudden increase in the permeability of mitochondria membrane accompanied with apoptosis. In Western blotting, cytochrome C release was observed from the mitochondria into the cytoplasm during BAHB-induced apoptosis.

CONCLUSIONThe research suggests that BAHB-induced apoptosis is related to photosensitization of mitochondria.

Apoptosis ; drug effects ; Dose-Response Relationship, Drug ; Humans ; Membrane Potentials ; drug effects ; Mitochondria ; drug effects ; physiology ; Pancreatic Neoplasms ; drug therapy ; pathology ; Perylene ; administration & dosage ; analogs & derivatives ; pharmacology ; Photochemotherapy ; Photosensitizing Agents ; administration & dosage ; pharmacology ; Quinones ; administration & dosage ; pharmacology ; Tumor Cells, Cultured

OBJECTIVETo evaluate the efficacy and safety of Chinese herbal medicine combined with systemic chemotherapy and/or regional arterial perfusion for pancreatic cancer with liver metastases (PCLM).

METHODSWe retrospectively selected 292 patients with PCLM who were treated by Chinese herbal medicine combined with systemic chemotherapy and/or regional arterial perfusion at Tianjin Medical University Cancer Hospital from January 2001 to December 2010. All patients were assigned to the Western medicine treatment group (157 cases) and the integrative medicine treatment group (135 cases). Patients in the Western medicine treatment group were treated with gemcitabine (GEM)-based chemotherapy, and partial of them received regional arterial perfusion. Those in the integrative medicine treatment group additionally took Chinese herbs of clearing heat and eliminating mass for at least 4 weeks. The median survival time (MST) , adverse reactions and the incidence of complications were observed.

RESULTSThere was no statistical significance in general data between the two groups (P > 0.05). There was statistical difference in MST between the two groups (4.8 months vs 5.5 months, P < 0.05). No death occurred during chemotherapy or regional arterial perfusion. All toxic or adverse reactions were tolerable.

CONCLUSIONChinese herbal medicine combined with systemic chemotherapy and/or regional arterial perfusion was effective and safe, and it could be optimally selected as palliative therapy for PCLM.

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Complementary Therapies ; methods ; Deoxycytidine ; analogs & derivatives ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Pancreatic Neoplasms ; drug therapy ; pathology ; Retrospective Studies