Pancreatic cancer can arise from ei

Pancreatic cancer can arise from either the exocrine or endocrine cells. Cancer of the endocrine pancreas, also known as pancreatic neuroendocrine tumor, is uncommon and has a relatively better prognosis than pancreatic adenocarcinoma (cancer of the exocrine pancreas). In the United States, approximately 48960 people are diagnosed with cancer of the exocrine pancreas each year, and an estimated 40560 people will die from their disease; it is the fourth leading cause of cancer mortality in men and women[1]. Globally, it is the seventh leading cause of cancer mortality in men and women, causing more than 300000 deaths annually[2]. Most patients with pancreatic adenocarcinoma will die within two years of diagnosis, and the 5-year survival rate is less than 5%[3]. The lack of a low cost screening test with high sensitivity and specificity contributes to most cases being diagnosed at an advanced stage. Staging of pancreatic adenocarcinoma is usually done with tri-phasic pancreatic-protocol computed tomography scan of abdomen and pelvis and chest imaging. Based upon imaging, the tumor is classified as resectable, borderline resectable, locally advanced, or metastatic. Approximately 15% to 20% of patients are diagnosed with resectable disease and 45%-55% of patients are diagnosed with metastatic disease[4]. Appropriate staging allows the selection of patients who will have the best chance for curative intent resection (R0). Patients with borderline resectable disease are often given neoadjuvant treatment for tumor downstaging to render resection afterwards. Up to about onethird of patients with borderline-resectable tumors could have resectable disease after neoadjuvant treatment[5]. However, the role of neoadjuvant treatment for resectable pancreatic cancer remains unclear. Surgical resection remains the only curative treatment for pancreatic cancer. A tumor is considered resectable if there is no arterial tumor contact [celiac axis (CA), superior mesenteric artery (SMA), common hepatic artery] and there is no tumor contact with the superior mesenteric vein (SMV) or portal vein (PV) or ≤ 180-degrees contact without vein contour irregularity on imaging study[6]. A tumor is considered unresectable if there is distant metastasis or unreconstructible SMV/PV due to tumor; if the tumor involves the pancreatic head it is unresectable if there is more than 180-degree encasement of the SMA or CA; a tumor of the pancreatic body or tail is unresectable if there is more than 180-degree encasement of the SMA or CA or tumor contact with the CA and aortic involvement[6].
Surgical management may include pancreaticoduodenectomy or pancreatectomy. It has been shown that pancreatic cancer patients undergoing surgery have better outcomes at high-volume hospitals, and the multidisciplinary approach and experienced surgeon seem to contribute most to the outcome of patients receiving pancreatic surgery[7]. The incomplete resection with positive surgical margins is frequent, reported 40% to 50% in most series[8]. The survival rate for patients with positive surgical margins is similar to that of patients who have locally-advanced disease[9]. The long-term survival after surgery remains low due to high rate of systemic recurrence: About 10% for node-positive disease and about 25% to 30% for nodenegative disease[10-13]. Adjuvant treatment has been shown to improve survival as demonstrated in studies such as ESPAC-1, CONKO-001, ESPAC-3, RTOG 9704, and GITSG[14]. However, the delivery of postoperative treatment can be problematic with up to 50% of patients not receiving the intended treatment due to postoperative complications[15,16]. About 15% of patients may develop overt metastatic disease during postoperative recovery period, therefore early initiation of adjuvant chemotherapy within 20 d after surgery has been shown to improve disease-free and overall survival[8,17].

結果 (中文) 1:

胰腺癌患者可以出现从外分泌或内分泌细胞。癌症的胰腺内分泌，也被称为胰腺神经内分泌肿瘤，为罕见，预后相对较好，胰腺腺癌 （胰腺外分泌癌症）。在美国，大约有 48960 人被诊断为癌症的胰腺外分泌每年和估计 40560 人将死于他们的疾病;它是癌症死亡率在男性和女性 [1] 的第四个主要原因。就全球而言，它是癌症死亡率在男性和女性，造成超过 300000 人死亡每年 [2] 的第七个主要原因。大多数患者胰腺腺癌的诊断，两年内会死和 5 年生存率是小于 5%[3]。低成本甄别试验具有较高的灵敏度和特异性的缺乏导致了大多数情况下，被诊断出晚期。胰腺癌分期通常是与三阶段性胰腺协议进行计算机断层扫描的腹部和骨盆及胸部影像学。基于成像，肿瘤被归类为手术切除，切除、 局部晚期或转移性的界线。大约有 15%到 20%的患者在诊断时可切除性疾病和 45%-55%的患者被诊断为转移性疾病 [4]。适当转移允许选择的病人会有意向根治 (R0) 的最好机会。交界性切除病患者往往给出肿瘤之呈现切除之后的新辅助治疗。达约三分之一的边缘切除肿瘤患者可以有可切除性疾病后新辅助治疗 [5]。然而，切除胰脏癌的新辅助治疗的作用仍不清楚。手术切除仍是唯一的治疗胰腺癌。如果没有动脉肿瘤接触 [腹腔轴 (CA)，肠系膜上动脉 (SMA)，肝总动脉] 并没有肿瘤接触与肠系膜上静脉 (SMV) 或门静脉 (PV) 或 ≤ 180 度联系人没有静脉成像研究 [6] 的轮廓不规则，肿瘤被视为可切除性。肿瘤被认为是不能手术切除是否有远处转移或冥顽 SMV/光伏肿瘤;如果涉及到是否比 180 度装箱的 SMA 或 CA; 更是一个不能切除的胰头肿瘤肿瘤的胰体或尾巴是不能切除，如果还有更多比 180 度装箱的 SMA 或 CA 或肿瘤的联系人的 CA 和主动脉参与 [6]。外科治疗可能包括胰十二指肠切除术或胰腺切除术。结果表明手术胰腺癌患者有更好的结果，在高容量医院和多学科的方法和经验的外科医生似乎最有助于患者胰腺外科 [7] 的结果。不完整切除术手术切缘阳性是频繁报道，40%至 50%在大多数系列 [8]。手术切缘阳性患者的生存率是类似于的病人有局部晚期疾病 [9]。后手术仍然是高系统性复发率较低的长期生存︰ 约 10%为淋巴结阳性疾病，约有 25%至 30 %nodenegative 疾病 [10-13]。辅助治疗已证实能够提高生存研究例如 RTOG 9704 与 GITSG [14]，ESPAC-1、 CONKO-001、 ESPAC-3 所示。然而，术后治疗的交货可以成问题达 50%的病人不接受预定的治疗术后并发症 [15，16]。约 15%的患者可能在术后恢复期间，因此早期的辅助化疗后手术已被证明提高疾病生存率和总体生存率 [8,17] 20 d 内制定公开转移性疾病。

結果 (中文) 3:

胰腺癌可发生于胰腺外分泌或内分泌细胞。的内分泌胰腺癌，也被称为胰腺神经内分泌肿瘤，是罕见的，有一个比胰腺癌预后相对较好（的外分泌胰腺癌）。在美国，大约有48960人被诊断为每年的胰腺外分泌癌，并估计有40560人将死于他们的疾病；它是男性和女性癌症死亡率的第四[ 1 ]主要原因。在全球范围内，它是男性和女性癌症死亡的第七大原因，每年造成超过300000人死亡[ 2 ]。大多数胰腺癌患者在诊断2年内死亡，5年生存率小于5% [ 3 ]。缺乏一个低成本的筛选试验，具有较高的灵敏度和特异性，有助于大多数情况下被诊断在一个先进的阶段。胰腺癌的分期通常是与协议三期胰腺CT扫描腹部和骨盆和胸部影像学。基于成像，肿瘤归类为可切除，边缘切除，局部晚期或转移性。大约15%到20%的患者诊断为可切除病和45% - 55%的患者被诊断为转移性疾病[ 4 ]。适当的分期的患者有根治性切除术的最佳时机的选择（R0）。边缘性切除的病人往往使切除肿瘤降期后给予新辅助治疗。到了边缘切除肿瘤患者新辅助治疗3能[ 5 ]后切除的病。然而，新辅助治疗可切除胰腺癌的作用尚不明确。手术切除仍然是胰腺癌唯一的治疗方法。肿瘤如果没有动脉瘤接触[腹腔动脉（CA），认为手术切除肠系膜上动脉（SMA）、肝总动脉]和有无肿瘤与肠系膜上静脉（SMV）和门静脉（PV）或≤180度接触无静脉轮廓不规则成像研究[ 6 ]。肿瘤是否有远处转移或不能重建的SMV、PV由于肿瘤不能手术切除；如果肿瘤累及胰头如果有超过180度的装箱的SMA和CA是手术切除；如果有超过180度的装箱的SMA和CA或与CA和主动脉受累[ 6】肿瘤接触的胰腺体尾部肿瘤切除。手术治疗包括胰十二指肠切除术或切除术。它已被证明，胰腺癌患者接受手术有更好的结果在高容量的医院，多学科的方法和经验丰富的外科医生似乎有助于大多数患者接受胰腺外科手术的结果[ 7 ]。手术切缘阳性的不完全切除是常见的，在大多数系列报道的40%至50% [ 8 ]。手术切缘阳性的患者的生存率与局部晚期疾病患者的生存率相似[ 9 ]。术后长期生存率仍然很低，由于全身复发率高：10%淋巴结阳性的疾病，约25%至30%为阴性病[ 13 ]。辅助治疗已被证明是提高生存率在研究如中，conko-001，RTOG 9704组，证明，和胃肠肿瘤研究组[ 14 ]。然而，术后治疗的交付可高达由于术后并发症[15,16]没有收到预期治疗的患者50%有问题。约15%的患者术后恢复期可能会形成明显的转移性疾病，因此，早期开始辅助化疗，术后20 d内已被证明可以改善无病生存率和总生存[ 8,17 ]。