Jun Wang

Objective: Recurrence affects 65%-75% of pancreatic cancer (PC) patient post-resection. Established salvage strategies for recurrent PC are lacking, and systemic chemotherapy offers limited survival benefits. This study aimed to evaluate the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with different chemotherapy in patients with recurrent PC, specifically FOLFIRINOX (a combination of 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and Gemcitabine plus Nab-paclitaxel (AG). Materials and methods: We retrospectively screened 201 patients with recurrent PC between March 2016 and September 2022. A total of 113 eligible patients were enrolled, including 23 in the chemotherapy combined with ICIs group and 90 in the chemotherapy-only group. The primary endpoint was overall survival (OS), and secondary endpoints included progression-free survival (PFS). Subgroup analyses were performed based on chemotherapy regimens (FOLFIRINOX vs. AG). Results: In the overall cohort, the chemotherapy combined with ICIs group demonstrated a trend toward improved survival compared to the chemotherapy group. Subgroup analysis revealed that among patients receiving the FOLFIRINOX regimen, the addition of ICIs was significantly associated with improved OS (median OS: not reached vs. 14.9 months; HR = 0.266 [95% CI: 0.077-0.919]; log-rank P = 0.025; Cox P = 0.036) and showed a superior trend in PFS ( P = 0.080) compared to FOLFIRINOX alone. Conversely, no significant survival benefit was observed in the AG subgroup ( P > 0.05). Conclusion: Combining ICIs with FOLFIRINOX-based chemotherapy was significantly associated with improved OS in patients with recurrent PC with an acceptable safety profile. This combination strategy represents a promising therapeutic option for recurrent PC, particularly when paired with the FOLFIRINOX backbone.

Treatment of locally advanced pancreatic cancer with irreversible electroporation and intraoperative radiotherapy

Locally advanced pancreatic cancer (LAPC) represents more than one third of pancreatic cancers and owns poor survival after the standard chemotherapy. Irreversible electroporation (IRE) is a novel method and has been recently used in LAPC. The aim of this study was to compare the efficacy of IRE and radiotherapy after induction chemotherapy for patients with LAPC. From August 2015 to August 2017, a total of 76 patients with biopsy proven LAPC and who had received IRE or radiotherapy after chemotherapy were included. Thirty-two pairs of patients were selected through propensity score matching (PSM) analysis and the efficacy of two treatments was compared. Before PSM analysis, after induction chemotherapy, patients with LAPC benefited more in terms of overall survival (OS) and progression free survival (PFS) from IRE, compared with radiotherapy (2-year OS rates, 53.5% vs 26.9%, p = 0.039; 2-year PFS rates, 28.4% vs 13.3%, p = 0.045). After PSM analysis, the survival benefits of OS and PFS of patients after induction chemotherapy followed by IRE were more obvious than those of patients treated with radiotherapy (2-year OS rates, 53.5% vs 20.7%, p = 0.011; 2-year PFS rates, 28.4% vs 5.6%, p = 0.004). Multivariate Cox regression analysis indicated that IRE after induction chemotherapy was identified as a significant favourable factor for both OS and PFS in both the whole and matched cohort. Induction chemotherapy followed by IRE is superior to induction chemotherapy followed by radiotherapy for treating LAPC. A randomized clinical trial comparing the efficacy of IRE and radiotherapy after the induction chemotherapy is therefore considerable.

Diaphragmatic resection is not common in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). This study aims to evaluate retrospectively the clinical characteristics and surgical results of HCC patients undergoing hepatectomy plus diaphragmatic resection. Between January 2000 and December 2013, 52 HCC patients underwent curative resections combined with diaphragmatic resection, with 11 patients had pathological diaphragmatic invasion (DI), 41 patients had diaphragmatic fibrous adhesion (DFA). The clinicopathological features and results were compared between the two groups. 86.5% of the patients had HBV infection. Diameter of tumors was 8.6 ± 3.4 cm, and 34.6% had multiple tumors. In addition, 28.8% had microvascular invasion, 3.8% had macrovascular invasion, but none of the patients had lymph node metastasis or distant metastasis. Moreover, 21.2% had tumor rupture before surgical resection. The DI group exhibited similar clinicopathological features with the DFA group. There were no treatment-related deaths, and major complication was postoperative pleural effusion (46.2%). Other clinical pulmonary issues, such as pneumothorax (5.8%) and pneumonia (3.8%), were also detected. OS at 1, 3 and 5 years was 82.0%, 41.2% and 35.7%, respectively. There was no significant difference in OS and DFS between the DI and DFA groups (P = 0.499 and P = 0.956, respectively). En bloc resection of diaphragm was associated with acceptable morbidity and mortality, and there was no difference in OS and DFS between HCC patients with DI or DFA. Therefore, it would be advisable to perform en bloc diaphragmatic resection when HCC patients present with gross diaphragmatic involvement.

The purpose of this study was to evaluate the antioxidant nature of tea polyphenol on S180 cells induced liver cancer in mice. In the present study, hepatocellular carcinoma was induced by tumor transplantation of liver in situ. The antitumor activity of tea polyphenol has been determined in vivo in hepatocellular carcinoma mice after treatment of drug (50, 100, 150 mg/kg body weight) by gavage for 20 days. Results showed that a significant increase in serum aspartate transaminase (AST), alkaline phosphatase (ALP), alanine aminotransfere (ALT), malondialdehyde (MDA) level, decrease in serum white blood cells (WBC), serum total protein (TP), albumin (ALB), A/G, tumor necrosis factor-α (TNF-α) and interferon-gamma (IFN-γ), liver reduced glutathione (GSH) levels were observed. In addition, the levels of enzymic and non-enzymic antioxidants were decreased when subjected to S180 cells induction. These altered enzyme levels were ameliorated significantly by administration of tea polyphenol at the concentration of 50, 100, 150 mg/kg body weight in drug-treated animals. These results indicate that the protective effect of tea polyphenol was associated with inhibition of MDA induced by S180 cells and to maintain the antioxidant enzyme levels.