RESUMEN
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with increasing incidence and high mortality. Surgical resection is the only potentially curative treatment of patients with PDAC. Because of the late presentation of the disease, about 20 percent of patients are candidates for this treatment. The average survival of resected patients is between 12 and 20 months, with a high probability of relapse. Standard chemo and radiation therapies do not offer significant improvement of the survival of these patients. Furthermore, novel treatment options aimed at targeting oncogenes or growth factors in pancreatic cancer have proved unsuccessful. Thereby, identifying new biomarkers that can detect early stages of this disease is of critical importance. Among these biomarkers, microRNAs (miRNAs) have supplied a profitable recourse and become an attractive focus of research in PDAC. MiRNAs regulate many genes involved in the development of PDAC through mRNA degradation or translation inhibition. The possibility of intervention in the molecular mechanisms of miRNAs regulation could begin a new generation of PDAC therapies. This review summarizes the reports describing miRNAs involvement in cellular processes involving pancreatic carcinogenesis and their utility in diagnosis, survival and therapeutic potential in pancreatic cancer.
Asunto(s)
Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patología , MicroARNs/genética , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patología , Biomarcadores de Tumor/genética , Carcinoma Ductal Pancreático/tratamiento farmacológico , Ciclo Celular , Diferenciación Celular , Movimiento Celular , Proliferación Celular , Progresión de la Enfermedad , Regulación Neoplásica de la Expresión Génica , Humanos , Terapia Molecular Dirigida , Neoplasias Pancreáticas/tratamiento farmacológico , Pronóstico , Tasa de SupervivenciaRESUMEN
BACKGROUND: Transcatheter aortic valve replacement (TAVR) using transcarotid access may improve outcomes compared with transapical or transaortic access. METHODS: This study retrospectively evaluated 165 patients who were undergoing alternate access TAVR using transcarotid (n = 84), transapical (n = 48), and transaortic (n = 33) access. The 30-day outcomes and 2-year Kaplan-Meier survival were analyzed using a multivariable Cox proportional hazards model. RESULTS: The median Society of Thoracic Surgeons predicted risk of mortality was similar among patients treated by transcarotid, transapical, and transaortic access (9.0% [interquartile range (IQR), 6.6, 12.0] vs 9.1% [IQR, 7.0, 11.7] vs 10.0% [IQR, 8.5, 13.0]; p = 0.14), respectively. Patients treated with transcarotid TAVR had a trend toward lower 30-day mortality (3.6% [3 of 84] vs 6.3% [3 of 48] vs 15.2% [5 of 33]; p = 0.09) and significantly better 2-year survival (88.4% vs 79.2% vs 63.6%; p = 0.004) compared with patients treated by transapical and transaortic access, respectively. In addition, transcarotid access was associated with a shorter median length of stay (3.0 days [IQR, 2.0, 5.0] vs 6.5 days [IQR. 5.0, 9.5] vs 7.0 days [IQR, 5.0, 9.0]; p < 0.001), lower transfusion rate (4.8% [4 of 84] vs 12.0% [12 of 48] vs 24.2% [8 of 33]; p < 0.001), higher likelihood of discharge to home without home health care (89.3% [75 of 84] vs 54.2% [26 of 48] vs 42.4% [14 of 33]; p < 0.001), and similar 30-day stroke rates (2.4% [2 of 84] vs 2.1% [1 of 48] vs 3.0% [1 of 33];p = 0.9). CONCLUSIONS: Transcarotid compared with transapical and transaortic access for TAVR is associated with shorter length of stay, fewer transfusions, more frequent discharge to home, and better 2-year survival.