Objective To investigate the predictive value of the plasma D-dimer levels on stage and response to chemotherapy of the pancreatic cancer (PC).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 212 PC patients who were admitted to the Fudan University Shanghai Cancer Center between December 2016 and May 2017 were collected.Plasma D-dimer levels of 212 patients were measured,and relationship between plasma D-dimer levels and clinicopathological features or response to chemotherapy were analyzed.Observation indicators:(1) relationship between clinicopathological features and positive rate of plasma D-dimer before treatment;(2) relationship between response to chemotherapy and plasma D-dimer levels;(3) follow-up and survival situations.Follow-up using telephone interview was performed to detect survival of patients up to January 2018.Comparisons of count data were analyzed using chi-square test.Measurement data with skewed distribution were described as M (range).Results (1) Relationship between clinicopathological features and positive rate of plasma D-dimer before treatment:positive rate of plasma D-dimer before treatment was respectively 18.37％ (9/49),43.64％ (24/55),53.85％ (28/52),80.36％ (45/56) in patients with stage Ⅰ-Ⅱ A,ⅡB,Ⅲ and Ⅳ of TNM staging and 43.59％(17/39),24.62％(16/65) in patients with low-differentiated tumor and high-and moderate-differentiated tumor,with statistically significantly differences (x2 =41.454,4.051,P＜0.05).(2) Relationship between response to chemotherapy and plasma D-dimer levels:of 212 PC patients,108 received pathological diagnosis by endoscopic ultrasonography or liver puncture,and then underwent 4-6 cycles chemotherapy with gemcitabine.Of 108 patients,response to chemotherapy of 59 patients was partial remission or stable disease,plasma D-dimer level before treatment was increased in 39 patients (28 with reduced plasma D-dimer level after treatment) and normal in 20 patients;response to chemotherapy of 49 patients was progressive disease,plasma D-dimer level before treatment was increased in 34 patients (8 with reduced plasma D-dimer level after treatment) and normal in 15 patients.There was no statistically significant difference in proportion of patients with increased plasma D-dimer level before treatment (x2=0.132,P＞0.05),and there was a statistically significant difference in proportion of patients with reduced plasma D-dimer level after treatment (x2 =16.929,P＜0.05).(3) Follow-up and survival situations:212 patients were followed up for 3.5-12.0 months,with a median time of 7.5 months.During the follow-up,7 patients died and 205 had survival.Conclusion The plasma D-dimer level is significantly associated with TNM staging of the PC,tumor differentiation and response to chemotherapy.

Pancreatic ductal adenocarcinoma (PDAC) is among the most devastating human malignancies. The poor clinical outcome in PDAC is partly attributed to a growth-permissive tumor microenvironment. In the PDAC microenvironment, the stroma is characterized by the development of extensive fibrosis, with stromal components outnumbering pancreatic cancer cells. Each of the components within the stroma has a distinct role in conferring chemoresistance to PDAC, and intrinsic chemoresistance has further worsened this pessimistic prognosis. The nucleoside analog gemcitabine (GEM) is usually the recommended first-line chemotherapeutic agent for PDAC patients and is given alone or in combination with other agents. The mechanisms of intrinsic resistance to GEM are an active area of ongoing research. This review highlights the important role the complex structure of stroma in PDAC plays in the intrinsic resistance to GEM and discusses whether antistroma therapy improves the efficacy of GEM. The addition of antistroma therapy combined with GEM is expected to be a novel therapeutic strategy with significant survival benefits for PDAC patients.

Pancreatic neuroendocrine tumor is a common pancreatic tumor with high heterogeneity and multiple management modalities. A standard and practical staging system for pancreatic neuroendocrine tumors will be beneficial to clinical management and research. At present, there are two staging systems (ENETS and AJCC). Both of them have shortcomings which limit their clinical application. In addition, the coexistence of two staging systems is confusing to clinicians. We proposed a modified ENETS staging system by keeping the ENETS TNM definition and adopting the AJCC staging definition. The modified staging system can successfully distinguish patients with different prognosis and is helpful in establishing clinical standard. This study has been published in Journal of Clinical Oncology (JCO) and was selected as 2017 Best of JCO: Gastrointestinal edition. This paper was aimed to interpret the modified staging system in clinical practice.

Background and purpose:Lower expression of E-cadherin is associated with metastasis of cancer cells, however, the correlation between E-cadherin and glucose metabolism has seldom been reported. This article studied the correlation between E-cadherin and glycolysis effect in PANC-1 cells.Methods:Through treatment of transforming growth factor β (TGF-β) in PANC-1 cells to decrease E-cadherin expression, knock-down the gene of E-cadherin interaction protein β-catenin, and overexpressing of E-cadherin, the effects of E-cadherin on the glucose uptake and lactate production ability and on the expression of key glycolytic genes were assessed.Results:E-cadherin negatively regulated the glycolytic effect of PANC-1 cells by inhibiting glucose uptake and lactate production (P<0.05). Moreover, E-cadherin interacting partner β-catenin signiifcantly promoted glucose metabolism transformation in PANC-1 cells (P<0.05). Moreover, key glycolysis regulator sirtuin 3 (SIRT3) could lower E-cadherin expression.Conclusion:Lower expression of E-cadherin induced the transformation of glucose metabolism transformation in PANC-1 cells and manipulation of E-cadherin expression level could change the glycolysis effect. Moreover, through maneuver glycolysis process could inhibit high metastatic potential of pancreatic cancer cells.

Lymphatic metastasis is an important prognostic factor for pancreatic cancer.However,lymphatic metastatic status (N0 or N1) can not reflect the degree of lymphatic metastasis.Lymph node ratio,which is defined as the number of positive lymph nodes divided by total examined lymph nodes,can reflect the degree of lymph metastatic metastasis and give consideration to examined lymph nodes.Lymph node ratio is superior to lymph metastatic status in staging,guiding treatment,and predicting prognosis.However,currently,lymph node ratio cannot replace lymph metastatic status for the undetermined minimum number of examined lymph nodes and cut-off value.Further evidence is needed to prove its clinical value.

Lymph metastasis has great impact on the prognosis of pancreatic cancer patients, which can relfect the biological and invasive potential of pancreatic cancer. However, currently, there is no standard in the clinical management of the lymph metastasis in pancreatic cancer. In this report, we will discuss and summarize the followings:lymph metastatic rate and its impact on prognosis, the rule of lymph metastasis, sentinel lymph node, intra-operative lymph nodes mapping, TNM staging, regional lymph nodes resection, number of lymph nodes examined, lymph node ratio, guiding adjuvant treatments, lymphatic targeted therapy.

OBJECTIVETo investigate the association between urinary levels of isothiocyanates (ITCs) and the risk of pancreatic cancer in urban Shanghai.

METHODSA case-control study has been conducted in urban Shanghai. The cases (from December 2006 to December 2008) were identified through an newly established "instant case reporting" system. The high performance liquid chromatography (HPLC) method was applied to determine the urinary levels of isothiocyanates in 390 cases and 414 controls. A food-frequency questionnaire was administered to estimate cruciferous vegetables consumption and dietary ITC exposure.Non-conditional logistic regression model was used to analyze the relationship between dietary and urinary levels of isothiocyanates and the risk of pancreatic cancer.

RESULTSThe cruciferous vegetables intake and ITC consumption, urinary ITC levels (median (P25, P75)) were 95.0 (66.9, 135.8) g/d, 11.0 (7.1, 16.0) µmol/d, 0.95 (0.12, 2.92) µmol/g Cr respectively in cases, all lower than those in controls, separately 107.4 (80.1, 154.1) g/d, 12.3 (8.0, 18.0) µmol/d, 1.78 (0.53, 5.28) µmol/g Cr. The differences were statistically significant (t = 3.75, 3.03, 4.40, all P values <0.01). Urinary levels of ITCs in controls were correlated with cruciferous vegetables consumption and dietary ITC exposure (r = 0.189, 0.201, all P values <0.01). There was inverse association between urinary ITCs and the risk of pancreatic cancer after adjusting for possible confounding factors such as age, sex, history of diabetes and pancreatitis. Compared with the first tertile (<0.825 µmol/g Cr), the odds ratio (95%CI) for the second (0.825-3.342 µmol/g Cr) and third tertiles ( ≥ 3.343 µmol/g Cr) were 0.69 (0.49-0.97) and 0.47(0.33-0.68), respectively, Ptrend<0.01.High levels of cruciferous vegetables or ITC consumption were associated with a reduced risk of pancreatic cancer (all P trend <0.05).

CONCLUSIONindicated that high levels of dietary ITC exposure might reduce the risk of pancreatic cancer.

Adult ; Aged ; Brassicaceae ; Case-Control Studies ; Diet ; Female ; Humans ; Isothiocyanates ; urine ; Logistic Models ; Male ; Middle Aged ; Pancreatic Neoplasms ; epidemiology ; Risk Factors

Background and purpose:Ultrasound is a regular screening method of solid pseudopapillary tumor of the pancreas (SPTP). This study was to summarize the diagnostic value of ultrasound to SPTP.Methods:Clinical and ultrasound data of 62 SPTP cases in Fudan University Shanghai Cancer Center were retrospectively collected and analyzed.Results:Five cases of SPTP were undetected by ultrasound in the group. The features of ultrasound including: large mass located at the body and tail of the pancreas, clear boundary and regular shape, low ultrasound with uneven signal, or low signal mixed with no signal. A few cases have calciifcation and blood signal. Most of the cases presented no dilation of main pancreatic duct and bile duct and regional lymph nodes enlargement. Conclusion:Ultrasound can be used to detect SPTP which has special ultrasound signal features.

10.3969/j.issn.1007-3969.2013.05.011

ObjectiveTo explore the role of β-catenin in the proinvasive consequences of hypoxia in hepatocellular carcinoma (HCC).MethodsWe established in vitro and in vivo hypoxic models using the highly metastatic MHCC97 and the stable red fluorescent protein-expressing MHCC97-R cells.The role of β-catenin in hypoxia-mediated aggressiveness was investigated by β-catenin knockdown.ResultsHypoxia caused a pronounced arrest of proliferation in MHCC97 cells,suppressed tumor growth in MHCC97-R xenografts,but promoted in vitro invasiveness and in vivo metastasis.β-Catenin-silencing by short hairpin significantly inhibited the enhanced invasiveness of MHCC97 cells due to hypoxia,reduced the increase in distant metastasis by hepatic arterial ligation,but failed to further restrain cell proliferation.Conclusionβ-Catenin in HCC cells plays an essential role in the hypoxia-induced metastatic potential.A reduction of βcatenin expression inhibited the proinvasive consequences of hypoxia in HCC.