Evidence-based diagnosis and staging of pancreatic cancer

Michl, Patrick; Pauls, Sandra; Gress, Thomas M.

doi:10.1016/j.bpg.2005.10.005

Cited by 106 publications

(80 citation statements)

References 115 publications

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“…In experienced hands, accuracy of endoscopic ultrasound is 75-95 and 74-87% in assessing T and N stages, respectively (12)(13)(14). Endoscopic ultrasound is particularly useful in identifying lesions <2 cm, and may characterize the presence of vascular invasion or venous thrombosis (12)(13)(14). There are limited data on the role of positron emission tomography (PET)/CT in the staging of potentially resectable tumors.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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Abstract. Pancreatic cancer is the fourth leading cause of cancer mortality and is associated with a poor overall survival even when diagnosed early and considered resectable. Complete surgical removal with negative histological margins is an independent predictor of survival and remains the only potential curative treatment. In borderline resectable pancreatic adenocarcinoma (BRPAC), preoperative systemic therapy may increase resectability and margin-negative resection rate. There is no current consensus on the optimal chemotherapy regimen for BRPAC. The present case describes a patient with BRPAC who achieved a pathological complete response to neoadjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin), but early relapse following a pancreaticoduodenectomy without vascular resection, with an uneventful postoperative course, except for a pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

2017

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“…Staging has improved over time, with significant advances in imaging in the last 5 years following the advent of multidetector row helical CT with or without positron emission tomography (Michl et al, 2005). The frontline approaches to staging today are contrast-enhanced multi-detector row helical CT, with its high sensitivity for identifying vascular invasion, and endoscopic ultrasound, which can pick up tumours as small as 2 -3 mm.…”

Section: à2mentioning

confidence: 99%

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

et al. 2007

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There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003;Banu et al, 2005;Liang, 2005;Bria et al, 2006;Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality therapy) vs best supportive care (ii) radiotherapy vs chemoradiation (iii) radiotherapy vs combined modality therapy (iv) chemotherapy vs combined modality therapy (v) 5FU-based combined modality treatment vs another-agent-based combined modality therapy. Relevant randomised controlled trials were identified by searching databases, trial registers and conference proceedings. The primary end point was overall survival and secondary end points were progression-free survival/time-to-progression, response rate and adverse events. Survival data were summarised using hazard ratio (HR) and response-rate/adverse-event data with relative risk. Eleven trials involving 794 patients met the inclusion criteria. Length of survival with chemoradiation was increased compared with radiotherapy alone (two trials, 168 patients, HR 0.69; 95% confidence interval (CI) 0.51 -0.94), but chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone (two trials, 134 patients, HR 0.79; CI 0.32 -1.95). Meta-analyses could not be performed for the other comparisons. A survival benefit was demonstrated for chemoradiation over radiotherapy alone. Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone, but important clinical differences cannot be ruled out due to the wide CI.

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“…Most patients diagnosed with pancreatic cancer develop clinical symptoms late in the course of the disease (1). Therefore, only 20% will be amenable to potentially curative therapy and only 3% to 5% of patients survive 5 years or more (2). Earlier diagnosis of the disease and early relapse monitoring are probably the best available options to improve patient survival (3).…”

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confidence: 99%

Serum Peptidome Profiling Revealed Platelet Factor 4 as a Potential Discriminating Peptide Associated with Pancreatic Cancer

Fiedler¹,

Leichtle²,

Kase³

et al. 2009

Clinical Cancer Research

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Purpose: Mass spectrometry-based serum peptidome profiling is a promising tool to identify novel disease-associated biomarkers, but is limited by preanalytic factors and the intricacies of complex data processing. Therefore, we investigated whether standardized sample protocols and new bioinformatic tools combined with external data validation improve the validity of peptidome profiling for the discovery of pancreatic cancerassociated serum markers. Experimental Design: For the discovery study, two sets of sera from patients with pancreatic cancer (n = 40) and healthy controls (n = 40) were obtained from two different clinical centers. For external data validation, we collected an independent set of samples from patients (n = 20) and healthy controls (n = 20). Magnetic beads with different surface functionalities were used for peptidome fractionation followed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). Data evaluation was carried out by comparing two different bioinformatic strategies. Following proteome database search, the matching candidate peptide was verified by MALDI-TOF MS after specific antibody-based immunoaffinity chromatography and independently confirmed by an ELISA assay. Results: Two significant peaks (m/z 3884; 5959) achieved a sensitivity of 86.3% and a specificity of 97.6% for the discrimination of patients and healthy controls in the external validation set. Adding peak m/z 3884 to conventional clinical tumor markers (CA 19-9 and CEA) improved sensitivity and specificity, as shown by receiver operator characteristics curve analysis (AUROC combined = 1.00). Mass spectrometry-based m/z 3884 peak identification and following immunologic quantitation revealed platelet factor 4 as the corresponding peptide. Conclusions: MALDI-TOF MS-based serum peptidome profiling allowed the discovery and validation of platelet factor 4 as a new discriminating marker in pancreatic cancer.

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Evidence-based diagnosis and staging of pancreatic cancer

Cited by 106 publications

References 115 publications

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

Serum Peptidome Profiling Revealed Platelet Factor 4 as a Potential Discriminating Peptide Associated with Pancreatic Cancer

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