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Incidence, mortality and survival rates of pancreatic cancer among residents in Pudong New Area of Shanghai from 2002 to 2010

Bei YAN ; Qiao SUN ; Liming YANG ; Chen YANG ; Xiaopan LI ; Zheng WU ; Yutang GAO

Chinese Journal of Pancreatology.2013;13(5):298-302. doi:10.3760/cma.j.issn.1674-1935.2013.05.003

Objective To analyze the incidence,mortality and survival rates of pancreatic cancer in Pudong New Area of Shanghai from 2002 to 2010.Methods The residents in Pudong New Area of Shanghai were recruited in this study during the period 2002 ～ 2010,the incidence,mortality were calculated according to different age groups and genders.The standardized morbidity and mortality of pancreatic cancer were calculated by world standard population.Logarithmic linear regression was used to calculate the annual percentage change (APC) of incidence and mortality.The 1 ～ 5 year survival of pancreatic cancer patients was analyzed by Kaplan-Meier method and COX regression analysis,and the survival of patients with different TNM staging,with or without operation was determined.Results Among 3089 newly occurred pancreatic cancer cases during 2002 ～ 2010,1707 and 1382 cases were males and females,respectively,with an average age of (69 ± 12) and (73 ± 12) years old,the crude incidence for both genders was 13.32/100 000,and it was 14.71/100 000 for males,which was higher than that in females (11.93/100 000).The ratio of male and female for incidence of age standardize was 1.57:1.There were 2963 death in total,including 1627 males and 1336 females,with a crude mortality rate of 12.78/100 000.The crude mortality rate for males was 14.02/100 000,which was higher than that in females (11.53/100 000).The ratio of male and female ASR for mortality was 1.55:1.Both incidence and mortality significantly increased for males aged over 35 and females aged over 40.The peak of morbidity and mortality appeared in male over 80 years old,and in female over 85 years old.The 1 ～ 5 year survival rates of pancreatic cancer patients were 16.59％,7.31％,5.23％,4.33％ and 3.87％,respectively.The differences in 1 ～5 year survival rates between surgical and non-surgical management groups were statistically significant (P ＜ 0.05).The median survival time of TNM 0 ～ Ⅱ,Ⅲ and Ⅳ staging was (250.00 ± 33.37),(224.00 ± 15.82),(86.00 ± 4.52) d.There was a statistically significant difference among the survival of TNM-Ⅳ and TNM 0 ～ Ⅰ,TNM Ⅲ (P ＜ 0.001).Conclusions The incidence and mortality of pancreatic cancer in males are higher than those in females in Pudong New Area of Shanghai.The survival is associated with TNM staging at diagnosis and whether surgical operation is performed.

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The value of serum galectin 3 detected by nanomagnetic beads sorting time resolved fluoroimmunoassay tandem analysis in the diagnosis of pancreatic cancer

Nan SHAO ; Xiaoyan LI ; Mingbing XIAO ; Feng JIANG ; Wenkai NI ; Cuihua LU ; Runzhou NI

Chinese Journal of Pancreatology.2013;13(5):303-306. doi:10.3760/cma.j.issn.1674-1935.2013.05.004

Objective To study the value of serum galectin-3 detected by nanomagnetic beads sorting time resolved fluoroimmunoassay (TRFIA) tandem analysis in the diagnosis of pancreatic cancer.Methods The serum of 88 cases of pancreatic cancer,50 cases of acute pancreatitis,10 cases of pancreatic cysts,and 20 cases of healthy volunteers as control were collected.First,galectin-3 antibody coupled nanomagnetic-beads was used to sort the semm,then TRFIA was applied to detect the level of galectin 3,and the result was compared with that of routine TRFIA.ROC curve was constructed to determine the cutoff value and sensitivity for pancreatic cancer diagnosis.Results The method of nanomagnetic beads sorting TRFIA detected the level of galectin 3 between O.78 and 100 ng/ml in a linear manner,the intra-CV was ≤6.38％,and inter-CV was ≤7.22％,and average recovery rate was 105.3％.The serum level of galectin-3 in control group by nanomagnetic beads sorting TRFIA was 0.38 (0.02 ～ 3.06) ng/ml,which was significantly higher than that detected by routine TRFIA [0.18 (0.00 ～ 2.64) ng/ml,P =0.000).The serum levels of galectin-3 by nanomagnetic beads sorting TRFIA in pancreatic cancer,acute pancreatitis,pancreatic cysts and healthy volunteers were 4.85(0.00 ～42.67),0.69(0.00～ 13.62),0.70(0.00 ～ 14.54),0.38(0.02 ～ 3.06) ng/ml,and the level of galectin-3 in pancreatic cancer was significantly higher than that in acute pancreatitis,pancreatic cysts and healthy volunteers group (P ＜0.01),while the difference among the other three group was not significantly different.The AUC of galectin-3 for pancreatic cancer was 0.851 ± 0.040,95％ CI:0.772 ～ 0.929.While using 1.07 ng/ml as the cut-off value,the positive rates for the diagnosis of pancreatic cancer,acute pancreatitis,pancreatic cysts and healthy volunteers were 84.1％ (74/88),34.0％ (17/50),20.0％ (2/10),10.0％ (2/20),and the sensitivity for diagnosis of pancreatic cancer was significantly higher than those in other 3 groups (P ＜ 0.01).Conclusions Nanomagnetic beads sorting TRFIA tandem analysis method can enrich serum galectin-3,and increase the sensitivity of detection for pancreatic cancer and enhance the diagnostic value of galectin-3 for pancreatic cancer.

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Gemcitabine vs.5-FU with radiotherapy for locally advanced pancreatic carcinomas

Ying XUE ; Guangjin CHAI ; Yunfeng MU ; Feng XIAO ; Yao FAN ; Mei SHI

Chinese Journal of Pancreatology.2013;13(5):311-314. doi:10.3760/cma.j.issn.1674-1935.2013.05.007

Objective To evaluate the efficacy,adverse events of gemcitabine vs.5-FU with radiotherapy for locally advanced pancreatic carcinomas.Methods Between January 2007 and January 2011,a total of 56 patients with locally advanced pancreatic carcinomas was included and clinical data were retrospectively analyzed.All patients received 3-DCRT radiotherapy with individual dose of 1.8 ～ 2 Gy,5 times per week,and total dose of 45 ～ 50.4 Gy for 25 ～ 28 fractions,and received concurrent chemotherapy (5-FU or gemcitabine).The patients (n =30) in gemcitabine group were treated with gemcitabine (500 rng/m2 at the 1st,8th,15th,22nd day,at 10 mg · (m2)-1 · min-1,through micro-pump) during radiotherapy; 3 weeks after radiotherapy the patients received gemcitabine infusion at a dose of 800 mg · (m2)-1 · d-1,one time per week,for 3 or 4 cycles.The patients (n =26) in 5-FU group were treated with 5-FU (500 mg/m2 at the 1 ～ 5th day per week,IV),the cycle was repeated every 2 weeks during radiotherapy; 3 weeks later the patients received 5-FU infusion at a dose of 800 mg · (m2)-1 · d-1,the 1st ～5th day per week,the cycle was repeated every 2 weeks ; with a total of 3 or 4 cycles.The efficacy and adverse events were observed,and the patients were followed until June 2013,and the median survival,1 year and 2 year survival was calculated.Results Of the 56 patients,the overall response (CR + PR) rate was 73.2％,and it was 65.3％ in radiotherapy with 5-FU group,80.0％ in radiotherapy with gemcitabine group (P ＜ 0.05).The overall one and two year survival rate was 48.2％ and 14.3％,while median survival was 15.2 months,and the corresponding values were 42.3％,11.5％,13.3 months in radiotherapy with 5-FU group,and 53.3％,16.7％,16.6 months in radiotherapy with gemcitabine group,and the survival difference between the two groups was not statistically significant (P =0.071).At the end of treatment,the pain-relief rate (VAS score ＜4) of the 56 patients was 83.3％,it was 75.0％ in 5-FU group and 90.0％ in gemcitabine group.In radiotherapy with gemcitabine group,the incidence of 3～ 4 grade myelosuppression was significantly higher than that in radiotherapy with 5-FU group,and the difference between the two groups was statistically significant (20.0％ vs 7.6％,P ＜ 0.05).Conclusions For the locally advanced pancreatic carcinomas,radiotherapy with gemcitabine can improve pain-relief and prolong survival compared with radiotherapy with 5-FU,but the incidence of adverse event of myelosuppression is higher.

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Surgical treatment of chronic pancreatitis and choice of procedure

Liang JI ; Bei SUN ; Hongchi JIANG ; Jie LIU ; Linfeng WU

Chinese Journal of Pancreatology.2014;14(1):30-33. doi:10.3760/cma.j.issn.1674-1935.2014.01.009

Objective To analyze the results of surgical treatment on chronic pancreatitis(CP),and investigate how to choose the appropriate surgical procedure.Methods The clinical data of 54 patients with chronic pancreatitis who underwent surgery at the First Affiliated Hospital of Harbin Medical University from January 2007 to December 2011 were retrospectively analyzed.Results All the 54 patients underwent surgery,including 8 decompression and drainage procedure (Partington procedure) ; 13 resections (7 cases of pancreaticoduodenectomy,1 case of distal pancreatectomy,4 cases of distal pancreatectomy combined with splenectomy and 1 case of pancreaticoduodenectomy combined with distal pancreatectomy,respectively); 12hybrids (7 cases of Beger procedure and 5 cases of Frey procedure,respectively) and 21 other procedures (15 cases of pancreatic pseudocyst jejunostomy,4 cases of exploratory laparotomy combined with pancreatic tissue biopsy,2 cases of gastrojejunostomy combined with choledochojejunostomy,respectively).There were 4 cases of post-operative pathologic evidence of cancer.Twelve patients had postoperative complications and were cured with non-operative management.Forty-four patients (81.5％) were followed for 2 to 67 months,36 out of 42(85.7％) patients who suffered from abdominal pain had a persistent remission,there were one case of new on-set diabetes and no steatorrhea was reported.Conclusions For CP patients with surgical indications,the choice of procedure should be individualized for the purpose of preserving the endocrine and exocrine functions of pancreas,and taking effectiveness as well as safety into consideration.

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National Natural Science Foundation of China (NSFC) and the progress of basic research of pancreatitis in China

Jian ZHANG ; Weihua GONG ; Xiaowei LIU ; Ruijuan SUN

Chinese Journal of Pancreatology.2014;14(1):3-7. doi:10.3760/cma.j.issn.1674-1935.2014.01.002

Objective To evaluate the funding and output of pancreatitis related projects supported by National Natural Science Foundation of China (NSFC),and provide suggestions for the funding strategy in the field of pancreatitis research.Methods Database of funded projects and completion reports of NSFC between 1990 and 2012 were retrieved.The number of grants,amount of grants,types,contents,and paper output of funded projects were respectively analyzed.Results From 2000 to 2012,114 projects involving pancreatitis were funded by NSFC,including 71 general programs (62.3％),8 regional programs,34 youth programs (29.8％),1 key program.The total fund during 2011-2012 reached 25.44 million RMB for pancreatitis research,which was 2.76 times higher than that of 2000-2010.According to PubMed search,93 SCI papers funded by NSFC were published during 2011-2012,which was 2.07 times more than that of 2000-2010.The researches mostly focused on molecular mechanism and therapeutic effect of acute pancreatitis,chronic pancreatitis and severe acute pancreatitis,which accounted for 61.4％ of all projects.Conclusions The number of grants,amount of grants,and NSFC funded SCI paper output of pancreatitis research have grown steadily,and it indicates that long-term funding of NSFC has played a positive role in promoting the development of clinical and basic research in the field of pancreatitis.

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Trends in incidence and clinical feature of hypertriglyceridemic acute pancreatitis: clinical review of 20 years

Yaoxing HUANG ; Lin JIA ; Yuqiang NIE ; Shuman JIANG ; Ya OU

Chinese Journal of Pancreatology.2014;14(1):16-20. doi:10.3760/cma.j.issn.1674-1935.2014.01.005

Objective To retrospectively investigate the clinical features and incidence trends of hypertriglyceridemic acute pancreatitis (HLAP) in Guangzhou First People's Hospital for 20 years.Methods The medical records of 1 362 patients,who were admitted to Guangzhou First People's Hospital with acute pancreatitis during January 1991 to December 2010,were reviewed and 99 patients met the HLAP criterion.These patients were divided into four groups according to years (1991 ～ 1995,1996 ～2000,2001 ～2005,and 2006 ～2010).The incidence and clinical features were compared among the 4 groups.Results Among the 99 patients,there were 61 males and 38 females,the mean age was (44 ± 12) years old,and young male was predominant in HLAP.HLAP accounted for 7.3％ of all AP patients,and the incidence was increased 1.5 times during the 20 years period (5.4％,5.7％,6.7％,and 8.3％ respectively).The serum amylase level was (513.3 ±462.7) mmol/L,TG level was (12.7 ± 7.0) mmol/L,Ranson score was (1.2 ± 1.1),CTSI score was 2.2 ± 1.1,incidence of SIRS was 36.4％,and the incidence of MODS was 18.2％,and the incidence of pancreatic pseudocyst was 5.1％,but the incidence and mortality of SAP was not changed with time.The incidence and mortality of SAP of HLAP were significantly higher than those of acute biliary pancreatitis (20.2％ vs 8.5％,6.1％ vs 2.8％).The rate of blood purification increased from 0 to 10.7％,and the hospital stay was decreased from 26 d to 14 d,and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Incidence of HLAP is increased gradually,with a trend towards more severe disease,but the prognosis is improved.

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Involvement of pancreatic beta cell in pancreatic regeneration following experimental acute pancreatitis

Guoyong HU ; Yan ZHAO ; Jie SHEN ; Lijuan YANG ; Jie XIONG ; Rong WAN ; Chuanyong GUO ; Xingpeng WANG

Chinese Journal of Pancreatology.2011;11(5):359-362. doi:10.3760/cma.j.issn.1674-1935.2011.05.018

Objective To investigate the role of pancreatic β cell on pancreatic regeneration following experimental acute pancreatitis.Methods Eighty-seven SD male rats were randomly divided into four groups:control group ( n =15 ),STZ group ( n =24),L-Arg group ( n =24 ),STZ + Arg group ( n =24).60 mg/kg of STZ was administrated by intraperitoneal injection to induce the diabetes model.2.5 g/kg body weight of LArg was administrated by intraperitoneal injection to induce the acute pancreatitis model.The rats were sacrificed 1,3,5,7 d later and the serum levels of amylase and glucose were measured.Relative pancreatic weight (pancreatic weight/body weight) were measured.Pancreatic tissue underwent routine pathologic examination,and the percentage of area of necrosis and tissue transformation was calculated.The expression of Reg4 and insulin was performed by immunofluorescence.Results Serum level of glucose significantly increased after STZ injection.After L-Arg injection,serum level of amylase significantly increased,and there was pancreatic tissue edema,necrosis,infiltration of inflammatory cells,which suggested the successful model induction.The percentage of area of necrosis in STZ + L-Arg group was (71.6 ± 6.0) ％ at the 3rd day,which were significantly higher than (42.3 ± 4.0 ) ％ in L-Arg group; the percentage of area of transformation was (45.6 ± 5.4) ％,which were significantly lower than (78.5 ± 6.4) ％ in L-Arg group.Expression of Reg4 in pancreatic islets of STZ + L-Arg group was significantly lower than those in L-Arg group.Conclusions STZ impairs pancreatic β cells,aggravates pancreatic damage following L-arginine induced pancreatitis and inhibits pancreatic regeneration.

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Gastric bypass and biliopancrtic diversion in the treatment type 2 diabetes

Jianzhong DI ; Xiaodong HAN ; Hongwei ZHANG ; Yibao DU ; Yu WANG ; Qi ZHENG ; Pin ZHANG

Chinese Journal of Pancreatology.2011;11(5):355-358. doi:10.3760/cma.j.issn.1674-1935.2011.05.017

Objective To compare the treatment effects of gastric bypass (GBP) and biliopancrtic diversion (BPD) in non-insulin dependent diabetes mellitus rats,and investigate the mechanism.Methods Forty GK rats with diabetes mellitus were randomly allocated into four groups:GBP group; BPD group; food restriction group ( FR group) and control group with 10 rats in each group.Rats in GBP group and BPD group received GBP and BPD procedures respectively.Rats in FR group were fed with basic feed of 15 g and free access to water.There was no food restriction in rats in control group.The operation time,mortality was recorded.The fasting body weight was measured every week.The plasma glucose,insulin-like growth factor-1 (IGF-1),and leptin concentrations,were measured before treatment and 1,2,3,4,8,16 week after treatment.Results The mean operation time was (25 ± 4) min in GBP group and (35 ± 6) min in BPD group; one rat died in GBP group and 3 rats died in BPD group,and the difference between the two groups was statistically significant (P ＜ 0.01 ).The levels of plasma glucose,IGF-1 and leptin were not statistically significant among these groups before treatment.There was no significant difference in plasma glucose and leptin concentrations in the control group.The levels of plasma glucose and leptin in rats in FR group began to decrease 2 weeks later,at the 4th week,the levels of plasma glucose and leptin was significantly lower than that before treatment,and it lasted for the 16 th week,but the level of IGF-1 were significantly different.The levels of plasma glucose and leptin in rats in GBP group and BPD group began to decrease and IGF-1 began to increase 2 weeks after operation,and it lasted for the 16th week,[plasma glucose:(6.8 ± 1.0),(6.3 ± 0.8 ) mmol/L vs.(13.9±2.6),(14.1 ±2.6)mmol/L; leptin:(16.1±3.3),(17.2±3.2)pg/ml vs.(29.4±3.9)pg/ml,(29.4±3.9); IGF-1:(166.1±8.3),(142.2±8.2)ng/L vs.(119.4±8.8),(109.8±7.9)ng/L,P＜0.01],but the levels of plasma glucose and leptin was not statistically different between the two groups.The level of IGF-1 in GBP group was significantly higher than that in BPD group (P ＜ 0.05).Conclusions Both GBP and BPD can effectively control plasma glucose concentration for rats with diabetes.The possible mechanism is related to decreased leptin and increased IGF-1.Group GBP had a better outcome in operation time,mortality and increasing IGF-1 than those in group BPD.

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Serum proteomic analysis of acute pancreatitis in rats

Kaihuan YU ; Jun REN ; Yuntao HUANG ; Chen CHEN ; Yong SONG

Chinese Journal of Pancreatology.2011;11(5):329-331. doi:10.3760/cma.j.issn.1674-1935.2011.05.008

Objective To investigate the difference of the protein expression in serum of rats with acute edematous pancreatitis (AEP) and acute necrotizing pancreatitis (ANP),and to investigate serum marker for acute pancreatitis severity.Methods The model of AEP and ANP was induced by retrograde injection of 4％ or 5％ sodium taurocholate into the biliopancreatic duct.Weak cation exchange (WCX2) and surface enhanced laser desorption/ionization time of flight mass spectrometry ( SELDI TOF MS) was used to investigate the difference of the protein expression in serum of rats with AEP and ANP.Results Thirty-eight spectral peak clusters which had significantly different signal intensities between AEP and ANP sera at mass charge ratio between 1000-50 000(P ＜0.05) were detected.The peak clusters at 9500 and 9700 in the sera of AEP were higher than that in ANP rata.Conclusions Serum analysis with SELDI-TOF MS can detect the difference of the protein expression in rats with AEP and ANP.The decreased expression of the protein of molecular weight of 9500 and 9700 may be a signal of AEP transition into ANP.

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Efficacy of rectally administered indomethacin for the prevention of post ERCP pancreatitis

Jianqing QIAN ; Jianjun DAI ; Weijun WANG ; Xiaodan XU

Chinese Journal of Pancreatology.2011;11(5):326-328. doi:10.3760/cma.j.issn.1674-1935.2011.05.007

Objectives To evaluate the efficacy of rectally administered indomethacin for the prevention of post-ERCP pancreatitis(PEP).Methods All eligible patients without high risk factors such as heart,lung,liver and kidney,coagulation dysfunction,without malignant disease and contraindication for NSAIDs,and pre-operative imaging study and lab test suggesting no pancreatitis,aged from 18 ～ 75 who underwent ERCP and EST were enrolled.In a randomized prospective trial,patients were randomized to receive a suppository containing indomethacin,100 mg,or an identical placebo 30 minutes after ERCP.PEP was diagnosed when there was pancreatitis related clinical symptoms,and serum amylase was higher than 3 times of the normal values,and when the patient needed more than 1 day hospitalization.Patients with PEP were evaluated with APACHE Ⅱ score 72 hours after ERCP.Results During 2004 ～ 2010,a total of 348 patients were enrolled,of which 182 received indomethacin and 166 received placebo.Six patients developed pancreatitis in the indomethacin group and 14 in the placebo group (3.3％ vs.8.4％,P ＜0.05),and the difference between the two group was statistically significant ( P ＜ 0.05 ).In those patients with PEP,the APACHE Ⅱ scores in indomethacin group (4.3 ± 1.3 ) were lower than that in the placebo group (7.4 ±1.7),and the difference between the two groups was statistically significant ( P ＜ 0.05 ).The incidence of hyperamylasemia in both groups was not statistically significant (9.3％ vs.10.8％,P ＞ 0.05 ).Conclusions This trial shows that rectally administered indomethacin after ERCP and EST can effectively reduce the incidence and severity of PEP.

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