Pathogenese und Diagnostik beim Pankreaskarzinom

Trotz komplexer multimodaler Behandlungsansätze sterben ca. 90 % der Patienten am Pankreaskarzinom. In den letzten Jahren hat vor allem die bessere Aufarbeitung genetischer Alterationen das Verständnis zur Pathogenese des Pankreaskarzinoms verbessern können. Wir fassen die neuen Erkenntnisse zur Pathogenese zusammen und erläutern Methoden zur Detektion und diagnostischen Aufarbeitung.

• Literatur

• 1 Basturk O, Hong SM, Wood LD. et al. A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas. Amer J Surg Pathol 2015; 39: 1730-1741
• 2 Ott C, Heinmöller E, Gaumann A. et al. Intraepitheliale Neoplasien (PanIN) und intraduktale papillär-muzinöse Neoplasien (IPMN) des Pankreas als Vorläufer des Pankreaskarzinoms. Med Klinik 2007; 102: 127-135
• 3 Vincent A, Herman J, Schulick R. et al. M. Pancreatic cancer. Lancet 2011; 378: 607-620
• 4 Mateos R, Conlon KC. Pancreatic cancer. Surgery 2016; 34: 282-291
• 5 Haugk B, Raman S. Pancreatic pathology: an update. Surgery 2016; 34: 273-281
• 6 Kamisawa T, Wood LD, Itoi T. et al. Pancreatic cancer. Lancet 2016; 388: 73-85
• 7 Jones S, Zhang X, Parsons DW. et al. Core Signaling Pathways in Human Pancreatic Cancers Revealed by Global Genomic Analyses. Science 2008; 321: 1801
• 8 Gukovsky I, Li N, Todoric J. et al. Inflammation, Autophagy, and Obesity: Common Features in the Pathogenesis of Pancreatitis and Pancreatic Cancer. Gastroenterol 2013; 144: 1199-1209.e4
• 9 Ansari D, Gustafsson A, Andersson R. Update on the management of pancreatic cancer: Surgery is not enough. World J Gastroenterol 2015; 21: 3157-3165
• 10 Korc M. Smad4-TGF-β Signaling Pathways in Pancreatic Cancer Pathogenesis. Pancreatic Cancer 2018; Second edition: 431-455 . doi:10.1007/978-1-4939-7193-0_17
• 11 Tanaka S. Molecular Pathogenesis and Targeted Therapy of Pancreatic Cancer. Ann Surg Oncol 2016; 23: 197-205
• 12 Yamada S, Fujii T, Shimoyama Y. et al. SMAD4 Expression Predicts Local Spread and Treatment Failure in Resected Pancreatic Cancer. Pancreas 2015; 44: 660-664
• 13 Lennon A, Wolfgang CL, Canto MI. et al. The Early Detection of Pancreatic Cancer: What Will It Take to Diagnose and Treat Curable Pancreatic Neoplasia?. Cancer Res 2014; 74: 3381-3389
• 14 Waddell N, Pajic M, Patch AM. et al. Whole genomes redefine the mutational landscape of pancreatic cancer. Nature 2015; 518: 495-501
• 15 Conroy T, Desseigne F, Ychou M. et al. FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer. N Engl J Med 2011; 364: 1817-1825
• 16 Suker M, Beumer BR, Sadot E. et al. FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Lancet Oncol 2016; 17: 801-810
• 17 Feig C, Gopinathan A, Neesse A. et al. The Pancreas Cancer Microenvironment. Clin Cancer Res 2012; 18: 4266-4276
• 18 Ryan DP, Hong TS, Bardeesy N. Pancreatic Adenocarcinoma. N Engl J Med 2014; 371: 1039-1049
• 19 Choe JH. Emerging Therapeutic Targets in Pancreatic Adenocarcinoma. Springer 2018;
• 20 Perera RM, Bardeesy N. Pancreatic Cancer Metabolism: Breaking It Down to Build It Back Up. Cancer Discov 2015; 5: 1247-1261
• 21 Iodice S, Gandini S, Maisonneuve P. et al. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbeck’s Arch Surg 2008; 393: 535-545
• 22 Raimondi S, Lowenfels AB, Morselli-Labate AM. et al. Pancreatic cancer in chronic pancreatitis; aetiology, incidence, and early detection. Best Practice & Research Clin Gastroenterol 2010; 24: 349-358
• 23 Bosetti C, Rosato V, Li D. et al. Diabetes, antidiabetic medications, and pancreatic cancer risk: an analysis from the International Pancreatic Cancer Case-Control Consortium. Ann Oncol 2014; 25: 2065-2072
• 24 Jacobs EJ, Chanock SJ, Fuchs CS. et al. Family history of cancer and risk of pancreatic cancer: A pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Int J Cancer 2010; 127: 1421-1428
• 25 AWMF. S3-Leitlinie Exokrines Pankreaskarzinom, Langversion 1.0. 2013 www.awmf.org/leitlinien/detail/ll/032-010OL.html , abgerufen am 3.2.2019
• 26 NCCN. NCCN Clinical Practice Guidelines in Oncology Pancreatic adenocarcinoma. 2016 www.nccn.org/professionals/physician_gls/default.aspx , abgerufen am 3.2.2019
• 27 Walters DM, LaPar DJ, de Lange EE. et al. Pancreas-Protocol Imaging at a High-Volume Center Leads to Improved Preoperative Staging of Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 2011; 18: 2764-2771
• 28 Bipat S, Phoa SS, van Delden OM. et al. Ultrasonografy, Computed Tomografy and Magnetic Resonance Imaging for Diagnosis and Determining Resectability of Pancreatic Adenocarcinoma. J Comp Assist Tomogr 2005; 29: 438-445
• 29 Isaji S, Mizuno S, Windsor JA. et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatol 2018; 18: 2-11
• 30 Chiorean E, von Hoff DD, Reni M. et al. CA19-9 decrease at 8 weeks as a predictor of overall survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel plus gemcitabine versus gemcitabine alone in patients with metastatic pancreatic cancer. Ann Oncology 2016; 27: 654-660