Pancreatic ductal adenocarcinoma: Long-term survival does not equal cure

Ferrone, Cristina R.; Pieretti-Vanmarcke, Rafael; Bloom, Jordan P.; Zheng, Hui; Szymonifka, Jackye; Wargo, Jennifer A.; Thayer, Sarah P.; Lauwers, Gregory Y.; Deshpande, Vikram; Mino‐Kenudson, Mari; Castillo, Carlos Fernández‐del; Lillemoe, Keith D.; Warshaw, Andrew L.

doi:10.1016/j.surg.2012.05.020

Cited by 189 publications

(127 citation statements)

References 23 publications

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“…Late diagnosis of PDAC and the limited response to current treatments result in an exceptionally poor prognosis (Ferrone et al, 2012). At present, prognostic biomarkers of PDAC are relatively lacked which also results in a relatively unavailable monitoring of the progressing (Winter et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Annexin A1 Expression in Pancreatic Ductal Adenocarcinoma

Chen¹,

Shen²,

Wang³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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Annexin A1 is a 37-kDa calcium-and phospholipid-binding protein of the annexin superfamily considered to play an important role in tumorigenesis. However, associations with clinicopathological features in pancreatic ductal adenocarcinoma (PDAC) cases have yet to be fully defined. We therefore investigated the prognostic value of annexin A1 protein as a PDAC biomarker in 83 tumor and matched non-cancerous tissues or normal pancreas tissues. Expression was analyzed using real-time RT-PCR, Western blotting and immunohistochemistry. In non-tumor tissue, myoepithelial cells showed no or weak expression of annexin A1 while expression was strong and sometimes even located in the nuclei of endothelial cells in tumor tissue. High expression was significantly associated with advanced stage (P <0.05) and a worse overall survival (P <0.05). These results provide new insights to better understand the role of annexin A1 in PDAC survival, and might be relevant to prediction of prognosis and development of more effective therapeutic strategies aimed at improving survival.

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Section: Introductionmentioning

confidence: 99%

Prognostic Significance of Annexin A1 Expression in Pancreatic Ductal Adenocarcinoma

Chen¹,

Shen²,

Wang³

et al. 2012

Asian Pacific Journal of Cancer Prevention

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“…Underpinning this trend is the fact that pancreatic cancer tends to present late and that complete surgical resection still offers the best chance of disease-specific survival [3,14,15]. Indeed, various papers have reported improved 5-year survival rates of between 12% and as high as 27% after resection in recent years [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience

Low

Koh

Teo

et al. 2017

Gastrointest Tumors

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Background/Aims: The International Study Group of Pancreatic Surgery recently published a consensus statement on the definition of extended pancreatectomy (EP). We aimed to determine the safety profile and short-term outcomes of EP compared to standard pancreatectomy (SP). To mitigate surgeon bias, only pancreatectomies performed by a single surgeon were included. Methods: Ninety consecutive patients who underwent pancreatectomy by a single surgeon over a period of 5 years and who met our study criteria were classified into an SP or an EP group. Sixty-two patients underwent pancreaticoduodenectomy (PD), including total pancreatectomy, and 28 patients underwent distal pancreatectomy. Results: The 25 patients who underwent EP had significantly increased operation time, estimated blood loss, postoperative intensive care unit (ICU) transfer, and postoperative stay compared to the 65 patients who underwent SP. There was 1 (1.1%) 30-day mortality and 4 (4.4%) in-hospital mortalities. Postoperative morbidity and mortality were similar between both groups. Subgroup analysis of the patients who underwent PD demonstrated that the EP group (n = 22) had significantly increased operation time and postoperative ICU transfers. Conclusion: Although patients who underwent EP experienced significantly increased operative time, blood loss, and postoperative stay, they did not experience significantly higher postoperative morbidity or mortality compared to patients who underwent SP.

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“…Significant advances have been made in the technical aspects of surgical resection with decreases in short-term morbidity and mortality at major centers [Winter et al 2012]. Yet even in the most experienced centers, longterm survival after surgery is poor [Farnell et al 2005;Ferrone et al 2012], with tumors recurring in virtually all patients [Allison et al 1998]. Due to the high rate of recurrence, local targeted therapy with radiation has been suggested following surgery.…”

Section: The Limited Effect Of Local Therapiesmentioning

confidence: 99%

Pancreatic cancer: why is it so hard to treat?

Oberstein

Olive

2013

Therap Adv Gastroenterol

280

201

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Abstract:No common malignancy is as rapidly and inevitably fatal as pancreatic ductal adenocarcinoma (PDA). This grim fact has driven substantial research efforts into this disease in recent decades. Unfortunately, the investment has yet to result in a meaningful increase in 5-year survival. This has prompted many pancreatic cancer researchers and advocates to redouble their efforts, but also requires one to step back and ask why the previous efforts were lacking and to consider why pancreatic cancer is so difficult to treat. The difficulties are legion. PDA is characterized by an insidious clinical syndrome, but is rarely diagnosed at a time when surgical resection is feasible. We lack markers of early detection and screening programs remain unproven even in high risk populations. The location of the tumor in the retroperitoneum, the advanced age of patients, and the systemic effects of disease limit the options for local therapy. Chemotherapy may provide a small benefit, but most efforts to improve on the current regimens consistently and stubbornly fail in advanced clinical trials. The molecular and cellular features of ductal pancreatic tumors are aggressive and underlay multiple levels of therapeutic resistance. Non-cell-autonomous features including stromal proliferation, reduced vascular density and immune suppression also contribute to therapeutic resistance. Growing awareness of these the fundamental features of PDA has begun to guide ongoing research efforts. Clinical trials are now specifically targeting these tumor properties and actively focusing on the therapeutic implications of tumor stroma. As reviewed here, reflecting on the fundamental question of why pancreatic cancer is so difficult to treat is a necessary and informative exercise that will aid our efforts to improve patient outcomes. These efforts will lead to improvements in clinical trial design, expand our focus to include the molecular and histologic implications of novel treatment paradigms, and ultimately change the lives of our patients.

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Pancreatic ductal adenocarcinoma: Long-term survival does not equal cure

Cited by 189 publications

References 23 publications

Prognostic Significance of Annexin A1 Expression in Pancreatic Ductal Adenocarcinoma

Prognostic Significance of Annexin A1 Expression in Pancreatic Ductal Adenocarcinoma

Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience

Pancreatic cancer: why is it so hard to treat?

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