Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Biomarcadores de Tumor/sangre , Carcinoma Ductal Pancreático/diagnóstico , Inmunoglobulina G/sangre , Mieloma Múltiple/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pancreatitis/diagnóstico , Anciano de 80 o más Años , Enfermedades Autoinmunes/sangre , Enfermedades Autoinmunes/inmunología , Biomarcadores de Tumor/inmunología , Biopsia , Carcinoma Ductal Pancreático/sangre , Carcinoma Ductal Pancreático/inmunología , Carcinoma Ductal Pancreático/patología , Diagnóstico Diferencial , Errores Diagnósticos , Endosonografía , Femenino , Humanos , Inmunoglobulina G/inmunología , Inmunohistoquímica , Mieloma Múltiple/sangre , Mieloma Múltiple/inmunología , Mieloma Múltiple/patología , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/inmunología , Neoplasias Pancreáticas/patología , Pancreatitis/sangre , Pancreatitis/inmunología , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X , Regulación hacia ArribaAsunto(s)
Fuga Anastomótica/terapia , Nefropatías Diabéticas/cirugía , Drenaje/métodos , Endoscopía/métodos , Conductos Pancreáticos , Complicaciones Posoperatorias/terapia , Uretra , Fuga Anastomótica/diagnóstico por imagen , Cistostomía/métodos , Duodeno/cirugía , Femenino , Humanos , Trasplante de Riñón/métodos , Persona de Mediana Edad , Páncreas/cirugía , Trasplante de Páncreas/métodos , Conductos Pancreáticos/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagenAsunto(s)
Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/patología , Carcinoma Neuroendocrino/diagnóstico por imagen , Carcinoma Neuroendocrino/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Regresión Neoplásica Espontánea , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Femenino , Humanos , Tomografía Computarizada por Rayos XAsunto(s)
Colangitis/etiología , Neoplasias Pancreáticas/complicaciones , Falla de Prótesis/efectos adversos , Stents/efectos adversos , Colangitis/cirugía , Coledocostomía , Drenaje , Endoscopía Gastrointestinal , Femenino , Gastrostomía , Humanos , Persona de Mediana Edad , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Pancreatic ductal carcinoma (PDC) is one of the most lethal human carcinomas. Expression patterns of some genes may predict gemcitabine (GEM) treatment efficacy. We examined predictive indicators of survival in GEM-treated patients by quantifying the expression of several genes in pre-treatment endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples from patients with PDC. METHODS: The expressions of human equilibrative nucleoside transporter 1 (hENT1), deoxycitidine kinase, ribonucleoside reductase 1, ribonucleoside reductase 2 and Notch3 in EUS-FNA tissue samples from 71 patients with unresectable PDC were quantified using real-time reverse transcription-polymerase chain reactions and examined for correlations with GEM sensitivity. RESULTS: The log-rank test detected no significant differences in overall survival between GEM-treated patients with low and high mRNA levels of all genes examined. However, low Notch3 mRNA expression was significantly associated with longer overall survival in a multivariate analysis for survival (P=0.0094). High hENT1 expression level was significantly associated with a longer time to progression (P=0.039). Interaction tests for GEM administration and hENT1 or Notch3 mRNA expression were statistically significant (P=0.0054 and 0.0047, respectively). CONCLUSION: hENT1 and Notch3 mRNA expressions in EUS-FNA specimens were the key predictive biomarkers of GEM effect and GEM sensitivity in patients with unresectable PDC.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Carcinoma Ductal Pancreático/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Tranportador Equilibrativo 1 de Nucleósido/metabolismo , Neoplasias Pancreáticas/tratamiento farmacológico , Receptores Notch/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Desoxicitidina/uso terapéutico , Tranportador Equilibrativo 1 de Nucleósido/genética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , ARN Mensajero/biosíntesis , ARN Mensajero/genética , Receptor Notch3 , Receptores Notch/genética , Estudios Retrospectivos , GemcitabinaRESUMEN
BACKGROUND AND STUDY AIMS: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) of 2 cm or more, which makes radical resection more difficult. This retrospective case review compares the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDC. PATIENTS AND METHODS: Forty-four consecutive patients with LBDC diagnosed between April 2004 and October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32 %). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. RESULTS: In six cases it was not possible to pass the cholangioscope through the tumor sites. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three cases in which ERC was negative were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22 %, 77 %, and 100 % of cases, respectively. CONCLUSIONS: The presence of extensive ITS was correctly detected in 80 % of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy not only of the presence or absence but also of the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15 % of cases.
