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Sekine K, Nagata N, Hisada Y, Yamamoto K, Mukai S, Tsuchiya T, Machitori A, Kojima Y, Yada T, Yamamoto N, Uemura N, Itoi T, Kawai T. Identifying predictors for comorbidities related mortality versus pancreatic cancer related mortality in patients with intraductal papillary mucinous neoplasm. United European Gastroenterol J 2024; 12:614-626. [PMID: 38367226 PMCID: PMC11176910 DOI: 10.1002/ueg2.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/11/2023] [Indexed: 02/19/2024] Open
Abstract
BACKGROUNDS Few data are available for surveillance decisions focusing on factors related to mortality, as the primary outcome, in intraductal papillary mucinous neoplasm (IPMN) patients. AIMS We aimed to identify imaging features and patient backgrounds associated with mortality risks by comparing pancreatic cancer (PC) and comorbidities. METHODS We retrospectively conducted a multicenter long-term follow-up of 1864 IPMN patients. Competing risk analysis was performed for PC- and comorbidity-related mortality. RESULTS During the median follow-up period of 5.5 years, 14.0% (261/1864) of patients died. Main pancreatic duct ≥5 mm and mural nodules were significantly related to all-cause and PC-related mortality, whereas cyst ≥30 mm did not relate. In 1730 patients without high-risk imaging features, 48 and 180 patients died of PC and comorbidity. In the derivation cohort, a prediction model for comorbidity-related mortality was created, comprising age, cancer history, diabetes mellitus complications, chronic heart failure, stroke, paralysis, peripheral artery disease, liver cirrhosis, and collagen disease in multivariate analysis. If a patient had a 5 score, 5- and 10-year comorbidity-related mortality is estimated at 18.9% and 50.2%, respectively, more than 7 times higher than PC-related mortality. The model score was also significantly associated with comorbidity-related mortality in a validation cohort. CONCLUSIONS This study demonstrates main pancreatic duct dilation and mural nodules indicate risk of PC-related mortality, identifying patients who need periodic examination. A comorbidity-related mortality prediction model based on the patient's age and comorbidities can stratify patients who do not require regular tests, especially beyond 5 years, among IPMN patients without high-risk features. CLINICAL TRIAL REGISTRATION T2022-0046.
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Affiliation(s)
- Katsunori Sekine
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Naoyoshi Nagata
- Department of Gastroenterological EndoscopyTokyo Medical UniversityTokyoJapan
| | - Yuya Hisada
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Kenjiro Yamamoto
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Shuntaro Mukai
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takayoshi Tsuchiya
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Akihiro Machitori
- Department of RadiologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Yasushi Kojima
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Tomoyuki Yada
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Natsuyo Yamamoto
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineTokyoJapan
| | - Naomi Uemura
- Department of Gastroenterology and HepatologyNational Center for Global Health and MedicineKohnodai HospitalIchikawaChibaJapan
| | - Takao Itoi
- Department of Gastroenterology and HepatologyTokyo Medical UniversityTokyoJapan
| | - Takashi Kawai
- Department of Gastroenterological EndoscopyTokyo Medical UniversityTokyoJapan
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2
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Lauri G, Apadula L, Archibugi L, Lazzano P, Ponz de Leon Pisani R, Cobreros M, Tacelli M, Marchegiani G, Crippa S, Falconi M, Arcidiacono PG, Capurso G. Association of Smoking with progression from low-risk to high-risk intraductal papillary mucinous neoplasms and pancreatic cancer. Dig Liver Dis 2024:S1590-8658(24)00775-8. [PMID: 38825412 DOI: 10.1016/j.dld.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Factors associated with the risk of pancreatic adenocarcinoma (PDAC) may play a role in the development and progression of Intraductal Papillary Mucinous Neoplasms (IPMNs). However, data are limited. AIM To compare exposome factors in three groups of patients with "high or low-risk" IPMNs, as assessed at diagnosis and during a 24-months follow-up, and with PDAC. METHODS Patients were matched (same sex, age ±5) 1:1. Exposure variables were compared across groups using Kruskal-Wallis, ANOVA, or Chi-square tests with Bonferroni correction. RESULTS A total of 151 patients were enrolled in each of the three groups (453 overall). The proportion of current smokers was progressively higher in "low-risk", "high-risk" IPMNs and PDAC patients (8.1 %, 11.2 %, 23.3 %; p = 0.0002). The three groups did not differ in terms of ever or heavy smoking, BMI, history of diabetes, cancer, cholecystectomy or chronic pancreatitis, use of statins or aspirin, and family history of cancer. A history of peptic ulcer was more common in PDAC (7.2 %) than in either "low-risk" (2.0 %) or "high-risk" (2.6%) IPMNs (p = 0.02, not significant after Bonferroni correction). CONCLUSION Active smoking seems associated with the progression of IPMNs to malignancy, and cessation of active smoking might be advised in patients with IPMN.
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Affiliation(s)
- Gaetano Lauri
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Apadula
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Livia Archibugi
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pilar Lazzano
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ruggero Ponz de Leon Pisani
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Cobreros
- Digestive Diseases Department, Marques de Valdecilla University Hospital, Instituto de investigacion sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Matteo Tacelli
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG)), University of Padua, Padua, Italy
| | - Stefano Crippa
- Pancreatic Surgery and Transplantation Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery and Transplantation Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Capurso
- Pancreatico-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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3
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Pollini T, Adsay V, Capurso G, Molin MD, Esposito I, Hruban R, Luchini C, Maggino L, Matthaei H, Marchegiani G, Scarpa A, Wood LD, Bassi C, Salvia R, Mino-Kenudson M, Maker AV. The tumour immune microenvironment and microbiome of pancreatic intraductal papillary mucinous neoplasms. Lancet Gastroenterol Hepatol 2022; 7:1141-1150. [PMID: 36057265 PMCID: PMC9844533 DOI: 10.1016/s2468-1253(22)00235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 01/19/2023]
Abstract
Pancreatic intraductal papillary mucinous neoplasms (IPMNs) have gained substantial attention because they represent one of the only radiographically identifiable precursors of invasive pancreatic ductal adenocarcinoma. Although most of these neoplasms have low-grade dysplasia and will remain indolent, a subset of IPMNs will progress to invasive cancer. The role of the immune system in the progression of IPMNs is unclear, but understanding its role could reveal the mechanism of neoplastic progression and targets for immunotherapy to inhibit progression or treat invasive disease. The available evidence supports a shift in the immune composition of IPMNs during neoplastic progression. Although low-grade lesions contain a high proportion of effector T cells, high-grade IPMNs, and IPMNs with an associated invasive carcinoma lose the T-cell infiltrate and are characterised by a predominance of immunosuppressive elements. Several possible therapeutic strategies emerge from this analysis that are unique to IPMNs and its microbiome.
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Affiliation(s)
- Tommaso Pollini
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA,Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy
| | - Volcan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine, Istanbul, Turkey
| | - Gabriele Capurso
- Department of Pancreatobiliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele, Milan, Italy
| | - Marco Dal Molin
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Irene Esposito
- Department of Pathology, Heinrich Heine University and University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Ralph Hruban
- Department of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology University of Verona, Verona, Italy
| | - Laura Maggino
- Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy
| | - Hanno Matthaei
- Department of Surgery, University Hospital of Bonn, Bonn, Germany
| | - Giovanni Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology University of Verona, Verona, Italy
| | - Laura D Wood
- Department of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, Section of Pathology University of Verona, Verona, Italy
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Valente R, Crippa S, Arnelo U, Vanella G, Zerboni G, Zarantonello L, Fogliati A, Arcidiacono PG, Vujasinovic M, Lohr JM, Falconi M, Capurso G, Del Chiaro M. The use of ace inhibitors influences the risk of progression of BD-IPMNs under follow-up. Pancreatology 2022; 22:516-524. [PMID: 35431111 DOI: 10.1016/j.pan.2022.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemoprevention's ability to slow down or prevent the progression of BD-IPMNs is extremely appealing. Aspirin (ASA), Ace Inhibitors/Angiotensin Receptor Blockers (ACEIs/ARBs) and Statins (STATs) are frequently prescribed drugs with a possible beneficial effect on different cancer types. Their effect on IPMNs is largely unknown. AIM To evaluate the association between the use of ASA, ACEIs/ARBs and STATs and the risk of progression of BD-IPMNs in follow-up. MATERIALS AND METHODS multicenter, retrospective cohort study on patients with presumed BD-IPMNs without relative or absolute indication for surgery. Pharmacological exposures and risk factors were collected. We identified clinically relevant progression (occurrence of radiological absolute or relative indication for surgery) and any progression (occurrence of clinically relevant progression OR any dimension increase OR the occurrence of new cysts). RESULTS Overall 594 patients were included. ACEIs were associated with a lower occurrence of any progression (HR = 0.70; 95% CI 0.49-0.98, p = 0.04) and clinically relevant progression, HR = 0.42 (95% CI 0.20-0.88; p = 0.02). No significant effect was shown for factors associated with the occurrence of pancreas cancer such as smoking, alcohol consumption and 1st degree family history of pancreas cancer. Among pharmacological exposures, no convincing effect was shown for the chronic use of ASA, ARB and STAT. CONCLUSIONS ACEIs might have an effect in slowing the progression of BD-IPMNs. ASA, STAT and ARBs show no convincing effect on the progression of BD-IPMNs. Further, prospective, and long-term multicenter studies are needed to verify such association and to define the potential underlying mechanisms.
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Affiliation(s)
- Roberto Valente
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden; Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA
| | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Urban Arnelo
- Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulia Zerboni
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Alessandro Fogliati
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Miroslav Vujasinovic
- Department for Upper Abdominal Diseases, Karolinska University Hospital and Department of Medicine Huddinge, Karolinska Institute, Sweden
| | | | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy
| | - Gabriele Capurso
- Pancreatobiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, IRCCS, Milan, Italy; Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Marco Del Chiaro
- Department of Surgical Oncology, Anschutz Medical Campus, University of Colorado, Denver, USA
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5
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Can aspirin use reduce the risk of pancreatic cancer: an updated systematic review and meta-analysis. JOURNAL OF PANCREATOLOGY 2020. [DOI: 10.1097/jp9.0000000000000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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6
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Takedomi H, Tsuruoka N, Takamori A, Miyahara K, Yamanouchi K, Shimamura T, Fujimoto Y, Noda T, Matsunaga T, Takara Y, Shimada F, Hidaka H, Endo H, Anzai K, Fujimoto K. Correlation of Barrett's esophagus with colorectal polyps in Japanese patients: A retrospective chart review. J Gastroenterol Hepatol 2019; 34:1160-1165. [PMID: 30667560 DOI: 10.1111/jgh.14610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Barrett's esophagus and colorectal polyps have several overlapping risk factors. Whereas several reports in Western countries have indicated a close relationship between Barrett's esophagus and colorectal polyps, the relationship between these two diseases remains unclear in Japan. This study was performed to determine whether the prevalence of Barrett's esophagus is related to that of colorectal polyps in Japanese patients. METHODS The present retrospective chart review included 1582 Japanese patients who underwent both total colonoscopy and esophagogastroduodenoscopy from January 2010 to December 2016. The data on colorectal polyps and Barrett's esophagus were obtained from the endoscopic findings. The medical record of each patient was checked for age, sex, body mass index, smoking, alcohol drinking, use of acid suppression agents, and comorbidities including a history of diabetes, ischemic heart disease, gastroesophageal reflux disease, hiatal hernia, and Helicobacter pylori infection. RESULTS Colorectal polyps were detected in 789 of the 1582 patients (49.9%). Barrett's esophagus was detected in 233 patients (14.7%), and most cases of Barrett's esophagus (n = 229) were classified as short-segment Barrett's esophagus. Colorectal polyps were more frequent in patients with than without Barrett's esophagus (odds ratio, 1.79; 95% confidence interval, 1.31-2.46; P < 0.001). In addition to Barrett's esophagus, the data indicated that old age, male sex, obesity, smoking, alcohol drinking, diabetes mellitus, and ischemic heart disease were independent risk factors for colorectal polyps. CONCLUSIONS The present study revealed the correlation between the prevalence of Barrett's esophagus and colorectal polyps in Japanese patients.
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Affiliation(s)
- Hironobu Takedomi
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.,Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.,Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Ayako Takamori
- Clinical Research Center, Saga Medical School, Saga, Japan
| | - Koichi Miyahara
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Kohei Yamanouchi
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Takuya Shimamura
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Yo Fujimoto
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takahiro Noda
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan
| | - Takuya Matsunaga
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Yoshimichi Takara
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Furitsu Shimada
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan.,Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Hidenori Hidaka
- Department of Internal Medicine, Karatsu Red Cross Hospital, Saga, Japan.,Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan
| | - Hiroyoshi Endo
- Department of Internal Medicine, Saiseikai Karatsu Hospital, Saga, Japan
| | - Keizo Anzai
- Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
| | - Kazuma Fujimoto
- Departments of Internal Medicine and Clinical Research Center, Saga Medical School, Saga, Japan
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Abstract
Expression of prostaglandin biosynthetic pathway enzymes in mucinous pancreatic cysts is unknown. Cyclooxygenase-2 (COX-2) inhibition is a potential cancer chemoprevention strategy for these lesions. We evaluated the expression of COX-2, cytosolic phospholipase A2 (cPLA2), and protein kinase B (AKT) in the epithelium of pancreatic cysts and correlated enzyme expression with aspirin (ASA) use and cyst fluid prostaglandin E2 (PGE2) concentration.
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Affiliation(s)
- Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
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9
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Risch HA. Aspirin and Pancreatic Cancer-Response. Cancer Epidemiol Biomarkers Prev 2017; 26:979. [PMID: 28506963 DOI: 10.1158/1055-9965.epi-17-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
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