Pancreatic Cancer: A Review.
Pancreatic Cancer: A Review.
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DOI：
10.1001/jama.2021.13027
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发表时间：
2021-09-07
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胰腺导管腺癌(PDAC)是一种相对少见的癌症，预计2021年美国约有60430例新诊断。PDAC的发病率每年以0.5%到1.0%的速度增长，预计到2030年将成为癌症相关死亡的第二大原因。对于PDAC没有有效的筛查，大多数患者在确诊时存在局部晚期(30%-35%)或转移性(50%-55%)疾病。建议采用多学科管理方法。根据肿瘤侵犯动脉和静脉的程度，局限性胰腺癌包括可切除、交界性可切除(局限性并累及主要血管结构)和局部晚期(不可切除)疾病，通常是肠系膜上血管。对于表现为可切除疾病的患者(10%-15%)，手术后辅以FOLFIRINOX(氟尿嘧啶、伊立替康、亚叶酸钙、奥沙利铂)化疗是一种标准的治疗方法，预计中位总生存期为54.4个月，而单药吉西他滨为35个月(死亡的分层风险比为0.64[95%CI，0.48-0.86]；P=.003)。对于可切除和边缘可切除的疾病，新辅助系统治疗加或不加放疗，然后评估手术效果，是一种公认的治疗方法。对于局部晚期和因广泛血管受累而无法切除的疾病的患者，全身治疗后再进行放射治疗是确定局部疾病控制的一种选择。对于晚期(局部晚期和转移性)PDAC患者，多药化疗方案，包括FOLFIRINOX、吉西他滨/NAB-紫杉醇和纳米脂质体伊立替康/氟尿嘧啶，与单药吉西他滨相比，都有2至6个月的生存益处。对于5%到7%的BRCA致病种系变异和转移性PDAC患者来说，奥拉帕利是一种多(二磷酸腺苷[ADB]-核糖)聚合酶抑制剂，是一种维持选择，可以改善最初基于铂的治疗后的无进展存活率。每年约有60000例新诊断的PDAC病例，约50%的患者在确诊时已是晚期疾病。PDAC的发病率呈上升趋势。目前可用的细胞毒疗法对晚期疾病是适度有效的。对于所有患者，建议进行多学科管理、全面的生殖系检测和综合支持护理。
Pancreatic ductal adenocarcinoma (PDAC) is a relatively uncommon cancer, with approximately 60 430 new diagnoses expected in 2021 in the US. The incidence of PDAC is increasing by 0.5% to 1.0% per year, and it is projected to become the second-leading cause of cancer-related mortality by 2030. Effective screening is not available for PDAC, and most patients present with locally advanced (30%–35%) or metastatic (50%–55%) disease at diagnosis. A multidisciplinary management approach is recommended. Localized pancreas cancer includes resectable, borderline resectable (localized and involving major vascular structures), and locally advanced (unresectable) disease based on the degree of arterial and venous involvement by tumor, typically of the superior mesenteric vessels. For patients with resectable disease at presentation (10%–15%), surgery followed by adjuvant chemotherapy with FOLFIRINOX (fluorouracil, irinotecan, leucovorin, oxaliplatin) represents a standard therapeutic approach with an anticipated median overall survival of 54.4 months, compared with 35 months for single-agent gemcitabine (stratified hazard ratio for death, 0.64 [95% CI, 0.48–0.86]; P = .003). Neoadjuvant systemic therapy with or without radiation followed by evaluation for surgery is an accepted treatment approach for resectable and borderline resectable disease. For patients with locally advanced and unresectable disease due to extensive vascular involvement, systemic therapy followed by radiation is an option for definitive locoregional disease control. For patients with advanced (locally advanced and metastatic) PDAC, multiagent chemotherapy regimens, including FOLFIRINOX, gemcitabine/nab-paclitaxel, and nanoliposomal irinotecan/fluorouracil, all have a survival benefit of 2 to 6 months compared with a single-agent gemcitabine. For the 5% to 7% of patients with a BRCA pathogenic germline variant and metastatic PDAC, olaparib, a poly (adenosine diphosphate [ADB]-ribose) polymerase inhibitor, is a maintenance option that improves progression-free survival following initial platinum-based therapy. Approximately 60 000 new cases of PDAC are diagnosed per year, and approximately 50% of patients have advanced disease at diagnosis. The incidence of PDAC is increasing. Currently available cytotoxic therapies for advanced disease are modestly effective. For all patients, multidisciplinary management, comprehensive germline testing, and integrated supportive care are recommended.