ABSTRACT
Pancreatic cancer is called as "the king of carcinoma" owing to its poor prognosis. The current treatment methods range from the world-famous Whipple surgery to combination chemotherapy, neoadjuvant radiotherapy and chemotherapy, and emerging immunological checkpoint inhibitors. However, they all have certain limitations and the overall survival rate of pancreatic cancer has not been improved significantly in recent decades. With the further study of tumor immunology, tumor immunotherapy has gradually become the focus of cancer therapy. As a novel immunotherapy idea, oncolytic virus therapy is gradually accepted by scholars for its safety and effectiveness. Oncolytic virus can specifically infect and lyse tumor cells. It can not only directly lyse tumor cells by self-replication but also release immune molecules and tumor antigens by lysing tumor cells, which further enhance immune anti-tumor effect without damaging normal tissues. In addition, the oncolytic virus can carry the abundant exogenous target gene through gene editing technology to further enhance the anti-tumor effect of the oncolytic virus. Due to the complexity of the microenvironment of pancreatic cancer, the oncolytic virus monotherapy has limited effects, and combination therapy has shown promising prospects. Compared with other tumor immunotherapy, oncolytic virus therapy displays high killing efficiency, targeting ability and small adverse reaction, multiple anti-tumor pathways to avoid drug resistance and low cost, and is expected to become an ideal new way for oncotherapy. Based on domestic and overseas literatures, the authors have reviewed the development of ancolytic virus therapy, treatment mechanism of oncolytic virus and its advances in pancreatic cancer in this article.
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Objective:To systematically evaluate the clinical efficacy of programmed death-1 and programmed death ligand 1 (PD-1/PD-L1) inhibitors versus traditional first-line regimens for the treatment of solid tumors.Methods:Databases including PubMed, Embase and Cochrane Library were searched for literatures from the date of their establishment to October 2018 with the key words including "PD-1/PD-L1, solid tumors, melanoma, non-small cell lung cancer, renal cell carcinoma, immunotherapy" . The randomized controlled trial or non randomized controlled trial of high quality about PD-1/PD-L1 inhibitors and traditional fist-line regimens for the treatment of solid tumors were received and enrolled. Patients underwent PD-1/PD-L1 inhibitors immunotherapy were allocated into treatment group, patients underwent traditional first-line regimens treatment were allocated into control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as odds ratio ( OR) and 95% confidence interval (95% CI). The heterogeneity of the studies included was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included≥5, and no test was needed if the studies included<5. Results:(1) Document retrieval: a total of 11 available randomized clinical trials were included. There were 5 161 patients, including 2 677 in the treatment group and 2 484 in the control group. (2) Results of Meta analysis. ① There was a significant difference in the objective response rate between the treatment group and the control group ( OR=4.49, 95% CI: 3.01-6.68, P<0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies, suggesting that publication bias had little influence on results of Meta analysis. ② There was no significant difference in the disease control rate between the treatment group and the control group ( OR=1.53, 95% CI: 1.01-2.32, P=0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies, suggesting that publication bias had little influence on results of Meta analysis. ③ There was a significant difference in disease stability rate between the treatment group and the control group ( OR=0.49, 95% CI: 0.33-0.73, P<0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies, suggesting that publication bias had little influence on results of Meta analysis. ④ There was no significant difference in disease progression rate between the treatment group and the control group ( OR=0.71, 95% CI: 0.45-1.15, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 9 studies, suggesting that publication bias had little influence on results of Meta analysis. ⑤ There were significant differences in overall incidence of adverse events and incidence of adverse events not less than three levels between the treatment group and the control group ( OR=0.53, 0.54, 95% CI: 0.38-0.74, 0.31-0.93, P<0.05). The bilateral symmetry was presented in the funnel plot based on the 11 studies, suggesting that publication bias had little influence on results of Meta analysis. Conclusion:Compared with traditional first-line regimens treatment, PD-1/PD-L1 inhibitors immunotherapy can improve the objective response rate and decrease the incidence of adverse events.
ABSTRACT
The 13th World Congress of the International Hepato-Pancreato-Biliary Association was held from 4th to 7th September 2018 in Geneva,Switzerland.Thousands of wellknown specialists and scholars from 96 countries around the world were invited for the great event.The congress aimed to explore the latest achievements of diagnosis and treatment of hepatobiliary and pancreatic diseases from both the clinical and basic perspective.In this article,authors reviewed and analyzed the up-to-date research information and combined clinical researches of the author team,in order to share the experience and achievements in the field of hepato-pancreato-biliary surgery with colleagues and provide new information and inference for optimization of diagnosis and treatment in this field.
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Objective To explore the value of the 7th and 8th edition AJCC TNM staging systems for hepatocellular cancer about disease free survival (DFS) after surgery.Methods Clinical data of hepatocellular cancinoma patients were analyzed retrospectively.The difference of the two staging systems in predicting DFS were compared by Kaplan-Meier analytical method and ROC test.Results Based on AJCC 7th edition,there were 114 phase Ⅰ patients,64 phase Ⅱ patients,18 phase Ⅲ patients,4 phase Ⅳ patients,while based on 8th edition,there were 33 phase ⅠA patients,85 Ⅰ B patients,60 phase Ⅱ patients,18 phase Ⅲ patients and 4 phase Ⅳ patients.There was a significant difference in the survival curve between the two stages (x2 =31.177,40.073,P ＜ 0.01).At the same time,the area under the ROC curve in the 8th edition was better than that in the 7th edition.In addition,in the 8th edition the DFS curve of phase ⅠA was superior to that of phase Ⅰ in 7th edition,and to that of phase ⅠB in the 8th edition (x2 =5.701,P =0.017;x2 =7.865,P =0.005).There was no significant difference between that of phase Ⅰ in the 7th edition and that of phase ⅠB in the 8th edition (~ =0.753,P =0.385).Conclusion The value of the 8th AJCC TNM staging in evaluating postoperative DFS is better than the 7th stage,especially for stage I patients.
ABSTRACT
Exocrine pancreatic insufficiency is a commom complication after pancreatic operation with high morbidity.At present,surgeons have insufficient understanding of it,and there is no internationally normalized standard for the diagnosis and treatment of exocrine pancreatic insufficiency.Through systematic reviewing of the relevant literature,this review summarizes the research progress of exocrine pancreatic insufficiency after pancreatic operation,including the definition of exocrine pancreatic insufficiency,aetiological agent,diagnosis,treatment,prevention,and morbidity of pancreatic exocrine insufficiency in different surgical procedures,in order to provide a reference for the improvement of diagnosis and treatment of exocrine pancreatic insufficiency in the future.
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Pancreatic adenocarcinoma is a highly lethal disease with a high morbidity and dismal prognosis.A multidisciplinary consultation based on evidence-based medicine has become the main modality for treatment of pancreatic adenocarcinoma.National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology has been widely recognized and implemented.Recently,the guidelines (version 1.2017) in oncology have been published by NCCN.This article will summarize and interpret the updates of the new version of the NCCN guideline for pancreatic adenocarcinoma.
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Liver is the only organ in the human body that can regenerate to its original size after partial resection.Most studies focus on the mechanisms of the initiation and development of liver regeneration.Recently studies about termination of liver regeneration have been gradually investigating.Exploring the termination of liver regeneration can help us understand the mechanism of "hepatostat",and it can also help us discover the relationship between the destruction of liver regeneration termination process and tumorigenesis.This review will summarize the currently known signaling pathways in termination of liver regeneration.
ABSTRACT
Liver is the only organ in the human body that can regenerate to its original size after partial resection.Most studies focus on the mechanisms of the initiation and development of liver regeneration.Recently studies about termination of liver regeneration have been gradually investigating.Exploring the termination of liver regeneration can help us understand the mechanism of "hepatostat",and it can also help us discover the relationship between the destruction of liver regeneration termination process and tumorigenesis.This review will summarize the currently known signaling pathways in termination of liver regeneration.
ABSTRACT
Hepatocellular carcinoma (HCC) is the most common malignancy in the liver, for which surgical operation remains the primary treatment. However, the surgical treatment is associated with low resection rate and high recurrence rate, which drive studies on the molecule mechanism of initiation, metastasis, and invasion of HCC, in order to develop more effective early diagnosis and treatment methods. By reviewing related literature, this article summarizes the major signaling pathways related to HCC, such as the PI3K/AKT/mTOR signaling pathway, RAS/RAF/MEK/ERK signaling pathway, and VEGF/VEGFR, PDGFR, and FGFR signaling pathway. New advances in the corresponding molecular targeted therapy for HCC are described, and the perspectives on future direction of relevant research are discussed.
ABSTRACT
Hepatocellular carcinoma (HCC)is the most common malignancy in the liver,for which surgical operation remains the primary treatment.However,the surgical treatment is associated with low resection rate and high recurrence rate,which drive studies on the mole-cule mechanism of initiation,metastasis,and invasion of HCC,in order to develop more effective early diagnosis and treatment methods.By reviewing related literature,this article summarizes the major signaling pathways related to HCC,such as the PI3K/AKT/mTOR signaling pathway,RAS/RAF/MEK/ERK signaling pathway,and VEGF/VEGFR,PDGFR,and FGFR signaling pathway.New advances in the cor-responding molecular targeted therapy for HCC are described,and the perspectives on future direction of relevant research are discussed.