Controversy on the time to progression of pancreatic ductal adenocarcinoma
Controversy on the time to progression of pancreatic ductal adenocarcinoma
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胰腺导管腺癌进展时间的争议
DOI：
10.1136/gutjnl-2014-309066
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发表时间：
2015
期刊：
影响因子：
24.5
通讯作者：
Gress TM
中科院分区：
文献类型：
--
作者：
Gallmeier E;Hernaez R;Gress TM
胰腺导管腺癌（PDAC）被临床医生认为是一种高度侵袭性和快速进展的疾病，这也是患者通常出现在疾病晚期且预后不良的原因之一。1事实上，这似乎被基于人群的登记中记录的小胰腺癌数量较少所证实。在SEER数据库（美国国家癌症研究所的监测、流行病学和最终结果）中，13131例胰腺癌患者中只有1.4%的肿瘤< 1 cm，即使在这些病例中，30.1%的患者有区域转移，10.1%的患者有远处转移。2这些观察结果受到了基因组序列数据的计算建模的挑战，这些数据是通过对匹配的原发性胰腺癌和7例终末期胰腺癌患者的不同转移灶进行比较性病变测序而产生的。3 Yachida等3预测从开始PDAC突变到患者死亡的时间间隔约为21年，4并估计胰腺癌仅限于胰腺近十年，因此为筛查肿瘤前病变或早期癌症打开了一个广阔的机会窗口。Yu et al 2介绍了一项旨在估计胰腺癌进展至不同局部或局部晚期肿瘤阶段所需时间的研究。为此，作者分析了在SEER数据库中登记的13131例胰腺癌患者的患者年龄、肿瘤大小、分期和人口统计学信息（2004-2011年）。该研究基于这样的假设，即胰腺癌通过不同肿瘤阶段进展所需的平均时间应反映在疾病每个阶段诊断的患者的平均年龄中。通过比较诊断时肿瘤大小不同的患者的平均年龄，作者得出结论，疾病进展迅速，T1胰腺癌进展到T4阶段的平均估计时间为14个月。作者认为，这些结果与以下假设一致：一旦PDAC在临床上可检测到，其从低阶段到晚期疾病的进展是迅速的。这些数据与设计针对高危个体的胰腺癌筛查计划和可切除PDAC的治疗策略相关。鉴于系统治疗方案对晚期胰腺癌患者的有效性有限，1识别可通过手术切除治愈的癌前病变或早期胰腺癌必须是我们的主要目标之一。对于胰腺癌高风险患者，如家族性胰腺癌家族成员，尤其如此。大多数参与使用内镜超声（EUS）和/或MRI对家族性胰腺癌高危个体进行筛查的临床医生会认为，在基线和随访时检测和治疗浸润性癌症-T1 N 0 M0，以及在基线时切除阴性切缘的浸润性癌症> T1 N 0 M0是该计划的成功。5-7在基线时没有胰腺异常的情况下，参加最近共识会议（CAPS-summit）的大多数专家建议12个月的筛查间隔是足够的，因为大多数异常通常在基线筛查后12个月被检测到或发展。如果从T1进展到T4确实只需要大约14个月，正如Yu及其同事估计的那样，这个筛选间隔可能太长了，我们可能不得不重新考虑筛选间隔。此外，Yu等人提供的数据可能是...
Pancreatic ductal adenocarcinoma (PDAC) is considered to be a highly aggressive and rapidly progressive disease by clinicians, which is one of the reasons why patients usually present at advanced stages of the disease and have a poor prognosis. 1 In fact, this appears to be confirmed by the low number of small pancreatic cancers documented in population-based registries. Only 1.4% of 13 131 patients with pancreatic cancer in the SEER database (US National Cancer Institute’s Surveillance, Epidemiology, and End Results) had tumours< 1 cm, and even in these cases 30.1% had regional and 10.1% had distant metastases. 2 These observations have been challenged by computational modelling of genome sequence data generated by comparative lesion sequencing of matched primary pancreatic cancers and distinct metastases of seven patients with end-stage pancreatic cancer. 3 Yachida et al 3 predicted a long time interval of approximately 21 years from the initiating PDAC mutation until the patient’s death, 4 and estimated that pancreatic cancers remain confined to the pancreas for almost a decade, thus opening a broad window of opportunity to screen for preneoplastic lesions or early cancer. Yu et al 2 present a study that was designed to estimate the time it takes for a pancreatic cancer to progress through different localised or locally advanced tumour stages. For this purpose, the authors analysed patient age, tumour size, stage and demographic information of 13131 patients with pancreatic cancer registered in the SEER database over an extensive time period (2004–2011). The study is based on the hypothesis that the average time required for pancreatic cancers to progress through different tumour stages should be reflected in the average age of patients diagnosed at each stage of the disease. By comparing the mean age of patients with different tumour sizes at diagnosis, the authors conclude that disease progression is rapid, with an average estimated time of 14 months for a T1 pancreatic cancer to progress to the T4 stage. The authors suggest that these results are consistent with the hypothesis that once PDACs become clinically detectable, their progression from low-stage to advanced-stage disease is rapid.These data are relevant for the design of pancreatic cancer screening programmes for high-risk individuals and treatment strategies for resectable PDAC. In view of the limited effectiveness of systemic treatment options for patients with advanced disease, 1 identification of preneoplastic lesions or early stages of pancreatic cancer that are curable by surgical resection must be one of our major goals. This is, in particular, true for patients at high risk for pancreatic cancer such as members of familial pancreatic cancer families. Most clinicians involved in screening programmes using endoscopic ultrasound (EUS) and/or MRI in high-risk individuals for familial pancreatic cancer would consider the detection and treatment of invasive cancer-T1N0M0 at baseline and follow-up, as well as of invasive cancer> T1N0M0 resected with negative margins at baseline as a success of the programme. 5–7 In the absence of pancreatic abnormalities at baseline, the majority of experts who attended a recent consensus conference (CAPS-summit) suggested that a 12-month screening interval is sufficient, since most abnormalities are usually detected at, or develop> 12 months after baseline screening. If progression from T1 to T4 indeed takes only around 14 months as estimated by Yu and colleagues, this screening interval may be too long and we may have to reconsider screening intervals. In addition, the data presented by Yu et al may be …
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DOI：
--
发表时间：
1997
期刊：
影响因子：
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作者：
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通讯作者：
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影响因子：
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通讯作者：
American Cancer of the Pancreas Screening (CAPS) Consortium
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影响因子：
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DOI：
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发表时间：
2015
期刊：
影响因子：
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作者：
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