BACKGROUND: The aim of this study was to compare trends in mortality and incidence, clinicopathological features and survival of patients diagnosed with pancreatic ductal adenocarcinoma under 50 years of age (early-onset pancreatic cancer [EOPC]) with patients diagnosed over 50 years of age (late-onset pancreatic cancer [LOPC]). METHODS: The national oncological registry of the Czech Republic was reviewed to identify all patients with histologically confirmed pancreatic ductal adenocarcinoma diagnosed between the years 1985 and 2015. Incidence, mortality, clinicopathological and survival data were analyzed and compared between patients with EOPC and LOPC. RESULTS: From a total of 18 888 patients included in the study, 1324 patients were under the age of 50 years (7.0%). The average annual percentage changes (AAPC) in incidence of all patients with EOPC was -1.0%. The APPC for male patients with EOPC was -2.0% and for female patients was +0.6%. The AAPC in incidence for LOPC was +1.3%. There were no differences in tumor stage, grade or location between EOPC and LOPC. Young patients were more frequently male (64.4% vs. 52.9%), more frequently underwent treatment and had better overall survival. The median survival interval for EOPC was 5.9 months and for LOPC was 4.5 months (p < .001). CONCLUSIONS: The clinicopathological features of pancreatic ductal adenocarcinoma were similar in patients under and over the age of 50 years. Patients with EOPC survived longer than patients with LOPC. Continued efforts should be made to diagnose early and treat young patients aggressively.

• MeSH
• duktální karcinom pankreatu * epidemiologie   terapie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory slinivky břišní * epidemiologie   terapie   diagnóza   MeSH
• registrace MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika MeSH

Kazuistika popisuje případ pacienta s karcinomem pankreatu, u kterého došlo po chirurgickém výkonu k časné generalizaci během adjuvantní chemoterapie. Následná léčba generalizovaného karcinomu byla spojena s nečekaně dobrou odpovědí - s dosažením kompletní remise. Po relapsu onemocnění opětovná léčba stejným režimem vedla k 6měsíční stabilizaci onemocnění s ústupem symptomatologie.

We describe a case-report of patient with resected pancreatic adenocarcinoma. There was early dissemination during adjuvant chemotherapy. Subsequent treatment of metastatic disease yielded surprisingly long term response; we even observed complete remission. After disease recurrence, the same chemotherapy regimen was re-introduced with observed benefit for next 6 months.

• MeSH
• antitumorózní látky farmakologie   terapeutické užití   MeSH
• deoxycytidin farmakologie   terapeutické užití   MeSH
• duktální karcinom pankreatu terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory slinivky břišní * terapie   MeSH
• paclitaxel farmakologie   terapeutické užití   MeSH
• přežívající onkologičtí pacienti MeSH
• protokoly antitumorózní kombinované chemoterapie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Pancreatic ductal adenocarcinoma represents a disease with increasing incidence. Its prognosis is the worst among all malignancies despite the aggressive combined multimodal treatment across all stages. In metastatic disease, median survival is approximatelly one year. The mainstay of treatment is chemotherapy (neo/adjuvant, palliative) and in selected subgroups of patients even radiotherapy. Nevertheless, nowadays there are very few prognostic and/or predictive biomarkers available that can be used to identify and better stratify patients based on risk to tailored treatment. Potentially, promising areas of research are circulating tumor cells and circulating tumor DNA, which can be easily obtained from peripheral blood - so called liquid biopsy. They may serve as a tool to assess response to applied treatment, and to detect the emergence of treatment-resistant clones or early disease relapse. Moreover, their study may allow identification of potentially tumor-specific alterations, which may serve as target structures for targeted (tailored) therapy. Alternatively, different prognostic indexes/scores calculated by analysis of selected parameters of blood and/or biochemistry can be used to better stratify patients based on risk and better predict prognosis. The aim of this mini-review is to provide a basic overview of the current state of the art in this area and its potential significance for clinical practice.

• MeSH
• cirkulující nádorová DNA * genetika   MeSH
• duktální karcinom pankreatu * diagnóza   genetika   terapie   MeSH
• lidé MeSH
• lokální recidiva nádoru MeSH
• nádorové biomarkery genetika   MeSH
• nádorové cirkulující buňky * MeSH
• nádory slinivky břišní * diagnóza   genetika   terapie   MeSH
• prognóza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Pancreatic carcinoma remains one of the leading cancer-related causes of death worldwide and is generally characterized by a dismal prognosis and limited potential for oncologic treatment. A rare subvariant of pancreatic cancer, undifferentiated carcinoma with osteoclast-like giant cells (UCOGC), has an unpredictable prognosis according to many previous studies, with unexpectedly long survival in individual cases. In this study, we collected, retrospectively, 13 cases of well-documented UCOGCs and performed immunohistochemistry focused on the expression of the programmed death-ligand 1 (PD-L1) and several other potential therapeutic and predictive markers (PanTRK, p53, MSH2, PMS2, and the number of tumor-infiltrating lymphocytes), to explore their correlation with the follow-up of the patients. As a control group, we examined 24 cases of conventional pancreatic ductal adenocarcinoma (PDAC). In our results, PanTRK was negative in all 24 cases. P53 did not show any significant differences between UCOGCs and PDACs, and the entire cohort was MSH2, MLH1, PMS2, and MSH6 positive. Significant differences were present in the analysis of PD-L1: UCOGCs were found to express PD-L1 significantly more frequently and have a higher number of tumor-infiltrating lymphocytes than PDAC. The expression of PD-L1 was related to significantly shorter survival in patients with UCOGC and in the entire cohort. Patients with PD-L1 negative UCOGCs displayed surprisingly long survival in comparison to PD-L1 positive UCOGCs and PDACs (both PD-L1+ and PD-L1-). We compared our results with previously published data, and, after statistical analysis, we were able to identify PD-L1 as an effective prognostic marker of UCOGC and suggest a strong need for a clinical trial of immune checkpoint immunotherapy in patients with advanced PD-L1 positive UCOGC.

• MeSH
• antigeny CD274 analýza   MeSH
• buněčná diferenciace * MeSH
• dospělí MeSH
• duktální karcinom pankreatu imunologie   mortalita   patologie   terapie   MeSH
• imunohistochemie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorové biomarkery analýza   MeSH
• nádory slinivky břišní imunologie   mortalita   patologie   terapie   MeSH
• obrovské buňky imunologie   patologie   MeSH
• osteoklasty imunologie   patologie   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• tumor infiltrující lymfocyty imunologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• srovnávací studie MeSH

Incidence duktálního adenokarcinomu slinivky břišní (PDAC) v populaci České republiky stejně jako v jiných vyspělých zemích vytrvale stoupá. Ještě závažnější je však vysoká mortalita tohoto onemocnění, která se ani po intenzivní léčbě příliš nemění. Pětileté přežití představuje dohromady pouhých 7-9 % pacientů. Odhady o PDAC v blízké budoucnosti hovoří jako jedné z předních příčin úmrtí na nádorové onemocnění (1). Jedná se tedy o velmi palčivý celosvětový problém současné onkologie. Výrazné pokroky nejen v léčbě, ale i ve včasné diagnostice pacientů a hlavně prevenci jsou nezbytné.

The incidence of pancreatic ductal adenocarcinoma (PDAC) in the population of the Czech Republic as well as in other developed countries has been increasing continuously. What is even more serious, however, is the high mortality rate of this disease that remains nearly unchanged even in the setting of intensive treatment. The overall five-year survival is only 7-9% of patients. Near-future estimates mention PDAC as one of the leading causes of death from tumour disease. Thus, it is a very pressing global issue in contemporary oncology. Major advances not only in treatment, but also in early diagnosis of patients and prevention are vital.

• MeSH
• duktální karcinom pankreatu * diagnóza   klasifikace   patofyziologie   terapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Pancreatic ductal adenocarcinoma (PDAC) has an extremely poor prognosis, caused by various factors, such as the aggressiveness of the disease, the limited therapeutic options and the lack of early detection and risk markers. The ATP binding cassette subfamily C member 2 (ABCC2) protein plays a critical role in response to various drugs and is differentially expressed in gemcitabine sensitive and resistant cells. Moreover, single nucleotide polymorphisms (SNPs) in the gene have been associated with differential outcomes and prognosis in several tumour types. The aim of this study was to investigate the possible association between SNPs in the ABCC2 gene and overall survival (OS) in PDAC patients. We analysed 12 polymorphisms, including tagging-SNPs covering all the genetic variability of the ABCC2 gene and genotyped them in 1415 PDAC patients collected within the Pancreatic Disease ReseArch (PANDoRA) consortium. We tested the association between ABCC2 SNPs and PDAC OS using Cox proportional hazard models. We analysed PDAC patients dividing them by stage and observed that the minor alleles of three SNPs showed an association with worse OS [rs3740067: hazard ratio (HR) = 3.29, 95% confidence interval (CI) = 1.56-6.97, P = 0.002; rs3740073: HR = 3.11, 95% CI = 1.52-6.38, P = 0.002 and rs717620: HR = 2.90, 95% CI = 1.41-5.95, P = 0.004, respectively] in stage I patients. In patients with more advanced PDAC, we did not observe any statistically significant association. Our results suggest that rs3740067, rs3740073 and rs717620 could be promising prognostic markers in stage I PDAC patients.

• MeSH
• duktální karcinom pankreatu genetika   mortalita   patologie   terapie   MeSH
• genotyp MeSH
• jednonukleotidový polymorfismus * MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• nádorové biomarkery genetika   MeSH
• nádory slinivky břišní genetika   mortalita   patologie   terapie   MeSH
• následné studie MeSH
• prognóza MeSH
• proteiny spojené s mnohočetnou rezistencí k lékům genetika   MeSH
• regulace genové exprese u nádorů MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• adenokarcinom * diagnóza   terapie   MeSH
• duktální karcinom pankreatu * diagnóza   terapie   MeSH
• lidé MeSH
• staging nádorů klasifikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Pancreatic cancer (PC) behaves very differently in comparison with other malignancies. Its incidence has been increasing continuously; mortality has not decreased, the diagnosis is frequently late, radical surgery is performed only in 15-20% of patients, and chemotherapy is only palliative. PC occurs in three different forms. Sporadic PC accounts for 90% of all PCs. Its most frequent form is the pancreatic ductal adenocarcinoma. The remaining 10% constitute two minority groups: familial PC (7%) and PC as a manifestation of a genetic cancer syndrome (3%). PCs are preceded by a precancerous lesion (precursor). At present, six different precursors are known. They have different histomorphological characteristics and malignant potential. The recognition and correct interpretation of individual precursors influences adequate clinical decision-making. The publication surveys the present knowledge of individual precursors and their role in the early pancreatic carcinogenesis.

• MeSH
• časná detekce nádoru MeSH
• duktální karcinom pankreatu genetika   metabolismus   patologie   terapie   MeSH
• epigeneze genetická MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádorová transformace buněk genetika   metabolismus   patologie   MeSH
• nádorové biomarkery genetika   metabolismus   MeSH
• nádory slinivky břišní genetika   metabolismus   patologie   terapie   MeSH
• prekancerózy genetika   metabolismus   patologie   terapie   MeSH
• prognóza MeSH
• regulace genové exprese u nádorů MeSH
• rizikové faktory MeSH
• senioři MeSH
• signální transdukce MeSH
• zvířata MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Sporadic pancreatic cancer amounts to ∼90% of all pancreatic cancers. It is a gloomy depressive disease and the most recalcitrant malignancy, with a very low 5-year survival (3-6%). At present, diagnostic methods are commonly applied, as used half a century ago, after the appearance of local and systemic symptoms (abdominal and back pain, cholestasis, painless jaundice, fatigue, anorexia, weight loss, anemia, peripheral phlebitis, and cachexia). Unfortunately, these symptoms are harbingers of an advanced disease. The subsequent imaging methods may offer additional information on the location, size, and morphology of the lesion, but they do not influence the prognosis. Radical surgery may be offered to 15-20% of patients. The relapses after surgery are frequent and chemotherapy may be palliative. Preventive programs represent the only possibility of improvement. We propose the first multistep and multidisciplinary preventive program for early detection of sporadic pancreatic cancer for the differential identification of average-risk patients who probably have the disease from those who do not.

• MeSH
• časná detekce nádoru * MeSH
• časové faktory MeSH
• duktální karcinom pankreatu diagnóza   mortalita   terapie   MeSH
• hodnocení rizik MeSH
• lidé MeSH
• nádory slinivky břišní diagnóza   mortalita   terapie   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

AIM: To analyze pancreatic cancer patients who developed metachronous pulmonary metastases (MPM) as a first site of recurrence after the curative-intent surgery. METHODS: One-hundred-fifty-nine consecutive pancreatic ductal adenocarcinoma (PDAC) patients who underwent radical pancreatic surgery between 2006 and 2013 were included in this retrospective analysis. The clinical data including age, sex, grade, primary tumor location, pTNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered, and follow-up were all obtained from medical records. Further analysis covered only patients with metachronous metastases. Clinical and histopathological data (age, sex, grade, primary tumor location, pTNM stage, lymph node infiltration, microangioinvasion, perineural invasion, lymphovascular invasion, the therapy administered and follow-up) of patients with metachronous non-pulmonary metastases and patients with metachronous pulmonary metastases were statistically assessed. Disease-free survival (DFS) from pancreas resection until metastases onset and overall survival (OS) were calculated. Wilcoxon test, χ2 test and survival functions computed by the Kaplan-Meier method were used. Statistical significance was evaluated by the log-rank test using SPSS. A P-value of less than 0.05 was considered statistically significant. RESULTS: Metachronous pulmonary metastases were observed in 20 (16.9%) and were operable in 3 (2.5%) of PDAC patients after a prior curative-intent surgery. Patients with isolated pulmonary metastases (oligometastases and multiple metastases) had estimated prior DFS and OS of 35.4 and 81.4 mo, respectively, and those with metachronous pulmonary metastases accompanied by other metastases had prior DFS and OS of 17.3 and 23.4 mo, respectively. Patients with non-pulmonary metastases had prior DFS and OS of 9.4 and 15.8 mo, respectively. Different clinical scenarios according to the presentation of MPM were observed and patients could be divided to three subgroups with different prognosis which could be used for the selection of treatment strategy: isolated pulmonary oligometastases, isolated multiple pulmonary metastases and pulmonary metastases accompanied by other metastases. CONCLUSION: Surgery should be considered for all patients with isolated pulmonary oligometastases, but the risk of intervention has to be individually weighted for each patient.

• MeSH
• adjuvantní chemoterapie metody   MeSH
• duktální karcinom pankreatu epidemiologie   sekundární   terapie   MeSH
• Kaplanův-Meierův odhad MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru epidemiologie   terapie   MeSH
• lymfatické metastázy MeSH
• nádory plic epidemiologie   sekundární   terapie   MeSH
• nádory slinivky břišní patologie   terapie   MeSH
• následné studie MeSH
• pankreas patologie   chirurgie   MeSH
• pankreatektomie MeSH
• pneumektomie MeSH
• prevalence MeSH
• přežití po terapii bez příznaků nemoci MeSH
• prognóza MeSH
• protokoly antitumorózní kombinované chemoterapie terapeutické užití   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• sexuální faktory MeSH
• staging nádorů MeSH
• stupeň nádoru MeSH
• věkové faktory MeSH
• výběr pacientů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH