基于多学科诊疗模式的胰腺癌综合治疗

马坦途; 李星霏; 李涛

doi:10.12449/JCH241229

基于多学科诊疗模式的胰腺癌综合治疗

DOI: 10.12449/JCH241229

北京大学人民医院肝胆外科，北京 100044

基金项目:

北京市自然科学基金 (7192212);

湖北陈孝平科技发展基金会临床研究专项基金 (CXPJJH122002-061)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：马坦途负责查找文献，撰写文稿；李星霏负责修改文稿；李涛负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
李涛， litao3261@pkuph.edu.cn （ORCID： 0009-0001-2428-8104）

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出版历程
- 收稿日期: 2024-03-27
- 录用日期: 2024-06-19
- 出版日期: 2024-12-25

Comprehensive treatment of pancreatic cancer based on multidisciplinary diagnosis and treatment

Department of Hepatobiliary Surgery，Peking University People’s Hospital，Beijing 100044，China

Research funding:

Beijing Municipal Natural Science Foundation (7192212);

Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province-Clinical Research Special Fund (CXPJJH122002-061)

More Information

Corresponding author: LI Tao， litao3261@pkuph.edu.cn （ORCID： 0009-0001-2428-8104）

摘要

摘要: 胰腺癌是消化道常见的恶性肿瘤之一，近年发病率逐步升高。其病理类型主要包括导管腺癌、小腺体癌、腺泡细胞癌等，其中导管腺癌是最常见的病理类型。多学科诊疗（MDT）是胰腺癌的新诊疗模式，通过集合不同的医疗团队，包括肝胆外科、消化内科、内分泌科、影像科和放疗科等，共同讨论患者的病情、制订治疗方案及后续管理，以确定最佳的个体化治疗方案。随着精准治疗的概念不断明确和发展、相关基因突变的发现，使得胰腺癌治疗前景更加广泛，个体化治疗更加深入，为改善患者治疗结果提供了机会。本文归纳了在MDT医疗模式下各学科之间的交互情况，并总结该模式下胰腺癌治疗方案的发展趋势和选择方向，指出了目前正在开展的工作及围绕未来胰腺癌MDT的研究方向。
- 胰腺肿瘤 /
- 学科间信息交流 /
- 诊断 /
- 治疗学
Abstract: Pancreatic cancer is a common malignant tumor of the digestive tract， and the incidence of pancreatic cancer has been gradually increasing in recent years. The main pathological types of pancreatic cancer include ductal adenocarcinoma， small gland carcinoma， and acinar cell carcinoma， among which duct adenocarcinoma is the most common pathological type. Multidisciplinary diagnosis and treatment （MDT） is a new diagnostic and therapeutic mode for pancreatic cancer， and different medical teams， including hepatobiliary surgery， gastroenterology， endocrinology， radiology， and radiotherapy， are gathered to discuss the conditions of patients and develop treatment regimens and subsequent management measures， so as to determine the optimal individualized treatment regimen. With the continuous clarification and development of the concept of precision therapy and the discovery of related gene mutations， promising prospects and individualized treatment have been achieved for the treatment of pancreatic cancer， thereby providing opportunities for improving the treatment outcome of patients. This article analyzes the interaction between different disciplines under the model of MDT， discusses the development trend and directions of the treatment regimens for pancreatic cancer， summarizes the current research work for pancreatic cancer， and proposes the future research directions for MDT in pancreatic cancer.
- Pancreatic Neoplasms /
- Interdisciplinary Communication /
- Diagnosis /
- Therapeutics

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参考文献(28)

[1]	SIEGEL RL, MILLER KD, WAGLE NS, et al. Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73( 1): 17- 48. DOI: 10.3322/caac.21763.
[2]	HAN B, ZHENG R, ZENG H, et al. Cancer incidence and mortality in China, 2022[J]. J Natl Cancer Cent, 2024, 4( 1): 47- 53. DOI: 10.1016/j.jncc.2024.01.006.
[3]	SHEN ZY, ZHANG J, ZHAO SW, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis[J]. Pancreatology, 2020, 20( 3): 529- 536. DOI: 10.1016/j.pan.2020.02.002.
[4]	NEHME F, LEE JH. Preoperative biliary drainage for pancreatic cancer[J]. Dig Endosc, 2022, 34( 3): 428- 438. DOI: 10.1111/den.14081.
[5]	SHYR YM, WANG SE, CHEN SC, et al. Robotic pancreaticoduodenectomy in the era of minimally invasive surgery[J]. J Chin Med Assoc, 2020, 83( 7): 639- 643. DOI: 10.1097/JCMA.0000000000000333.
[6]	GENG XP. Debate between minimally invasive and open hepatopancreatobiliary surgery in the era of artificial intelligence[J]. Chin J Pract Surg, 2022, 42( 8): 845- 849. DOI: 10.19538/j.cjps.issn1005-2208.2022.08.02. 耿小平. 人工智能时代肝胆胰外科微创技术与开放手术之争[J]. 中国实用外科杂志, 2022, 42( 8): 845- 849. DOI: 10.19538/j.cjps.issn1005-2208.2022.08.02.
[7]	VERSTEIJNE E, VOGEL JA, BESSELINK MG, et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer[J]. Br J Surg, 2018, 105( 8): 946- 958. DOI: 10.1002/bjs.10870.
[8]	General Office of National Health Commission. Standard for diagnosis and treatment of pancreatic cancer(2022 edition)[J]. J Clin Hepatol, 2022, 38( 5): 1006- 1015. DOI: 10.3969/j.issn.1001-5256.2022.05.007. 国家卫生健康委办公厅. 胰腺癌诊疗指南(2022年版)[J]. 临床肝胆病杂志, 2022, 38( 5): 1006- 1015. DOI: 10.3969/j.issn.1001-5256.2022.05.007.
[9]	VERSTEIJNE E, van DAM JL, SUKER M, et al. Neoadjuvant chemoradiotherapy versus upfront surgery for resectable and borderline resectable pancreatic cancer: Long-term results of the Dutch randomized PREOPANC trial[J]. J Clin Oncol, 2022, 40( 11): 1220- 1230. DOI: 10.1200/JCO.21.02233.
[10]	MA M, NIU TT, HAO Q, et al. Clinical analysis of stereotactic radiotherapy combined with concurrent chemoradiotherapy for pancreatic cancer[J]. Trauma Crit Care Med, 2022, 10( 5): 380- 381. DOI: 10.16048/j.issn.2095-5561.2022.05.18. 马明, 牛婷婷, 郝倩, 等. 立体定向放射治疗联合同步放化疗治疗胰腺癌临床效果分析[J]. 创伤与急危重病医学, 2022, 10( 5): 380- 381. DOI: 10.16048/j.issn.2095-5561.2022.05.18.
[11]	PERRI G, MARCHEGIANI G, MALLEO G, et al. Neoadjuvant therapy in resectable pancreatic cancer-is this the way forward?-a narrative review[J]. Chin Clin Oncol, 2021, 10( 5): 47. DOI: 10.21037/cco-21-51.
[12]	MELISI D, ZECCHETTO C, MERZ V, et al. Perioperative NALIRIFOX in patients with resectable pancreatic ductal adenocarcinoma: The open-label, multicenter, phase II nITRO trial[J]. Eur J Cancer, 2024, 196: 113430. DOI: 10.1016/j.ejca.2023.113430.
[13]	TANG R, XU J, WANG W, et al. Targeting neoadjuvant chemotherapy-induced metabolic reprogramming in pancreatic cancer promotes anti-tumor immunity and chemo-response[J]. Cell Rep Med, 2023, 4( 10): 101234. DOI: 10.1016/j.xcrm.2023.101234.
[14]	KLEEFF J, KORC M, APTE M, et al. Pancreatic cancer[J]. Nat Rev Dis Primers, 2016, 2: 16022. DOI: 10.1038/nrdp.2016.22.
[15]	STOCKEN DD, BÜCHLER MW, DERVENIS C, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer[J]. Br J Cancer, 2005, 92( 8): 1372- 1381. DOI: 10.1038/sj.bjc.6602513.
[16]	TEMPERO MA, PELZER U, O’REILLY EM, et al. Adjuvant nab-paclitaxel+gemcitabine in resected pancreatic ductal adenocarcinoma: Results from a randomized, open-label, phase III trial[J]. J Clin Oncol, 2023, 41( 11): 2007- 2019. DOI: 10.1200/JCO.22.01134.
[17]	REDDY AV, HILL CS, SEHGAL S, et al. Stereotactic body radiation therapy for the treatment of locally recurrent pancreatic cancer after surgical resection[J]. J Gastrointest Oncol, 2022, 13( 3): 1402- 1412. DOI: 10.21037/jgo-22-38.
[18]	WAINBERG ZA, MELISI D, MACARULLA T, et al. NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma(NAPOLI 3): A randomised, open-label, phase 3 trial[J]. Lancet, 2023, 402( 10409): 1272- 1281. DOI: 10.1016/S0140-6736(23)01366-1.
[19]	NCCN Guidelines Panel Disclosures. NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma[EB/OL].[ 2024-08-02]. http://www.nccn.org/patients. http://www.nccn.org/patients
[20]	JIN RT, HAN X, SUN ZQ, et al. Advances in the treatment of hepatic oligometastatic pancreatic cancer[J]. J Hepatopancreatobiliary Surg, 2022, 34( 10): 636- 641. DOI: 10.11952/j.issn.1007-1954.2022.10.013. 金若棠, 韩鑫, 孙忠权, 等. 胰腺癌伴肝脏寡转移治疗进展[J]. 肝胆胰外科杂志, 2022, 34( 10): 636- 641. DOI: 10.11952/j.issn.1007-1954.2022.10.013.
[21]	MULLER M, TOUGERON D. KRAS G12C inhibitors: Also a new promising new targeted therapy in advanced pancreatic adenocarcinoma?[J]. Transl Cancer Res, 2023, 12( 12): 3227- 3232. DOI: 10.21037/tcr-23-1629.
[22]	STRICKLER JH, SATAKE H, GEORGE TJ, et al. Sotorasib in KRAS p.G12C-mutated advanced pancreatic cancer[J]. N Engl J Med, 2023, 388( 1): 33- 43. DOI: 10.1056/NEJMoa2208470.
[23]	HALLIN J, BOWCUT V, CALINISAN A, et al. Anti-tumor efficacy of a potent and selective non-covalent KRAS^G12D inhibitor[J]. Nat Med, 2022, 28( 10): 2171- 2182. DOI: 10.1038/s41591-022-02007-7.
[24]	HILMI M, DELAYE M, MUZZOLINI M, et al. The immunological landscape in pancreatic ductal adenocarcinoma and overcoming resistance to immunotherapy[J]. Lancet Gastroenterol Hepatol, 2023, 8( 12): 1129- 1142. DOI: 10.1016/S2468-1253(23)00207-8.
[25]	ROJAS LA, SETHNA Z, SOARES KC, et al. Personalized RNA neoantigen vaccines stimulate T cells in pancreatic cancer[J]. Nature, 2023, 618( 7963): 144- 150. DOI: 10.1038/s41586-023-06063-y.
[26]	NITSCHE U, WENZEL P, SIVEKE JT, et al. Resectability after first-line FOLFIRINOX in initially unresectable locally advanced pancreatic cancer: A single-center experience[J]. Ann Surg Oncol, 2015, 22( Suppl 3): S1212- S1220. DOI: 10.1245/s10434-015-4851-2.
[27]	MURPHY JE, WO JY, RYAN DP, et al. Total neoadjuvant therapy with FOLFIRINOX in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: A phase 2 clinical trial[J]. JAMA Oncol, 2019, 5( 7): 1020- 1027. DOI: 10.1001/jamaoncol.2019.0892.
[28]	HANK T, KLAIBER U, HINZ U, et al. Oncological outcome of conversion surgery after preoperative chemotherapy for metastatic pancreatic cancer[J]. Ann Surg, 2023, 277( 5): e1089- e1098. DOI: 10.1097/SLA.0000000000005481.