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Biomedicines
Special Issues
Diagnosis, Pathogenesis and Treatment of Pancreatic Ductal Adenocarcinoma
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Diagnosis, Pathogenesis and Treatment of Pancreatic Ductal Adenocarcinoma

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Cancer Biology and Oncology".

Deadline for manuscript submissions: 30 April 2025 | Viewed by 3700

Special Issue Editors

Dr. Teresa Perra

E-Mail Website
Guest Editor
Department of Medicine, Surgery and Pharmacy, Unit of General Surgery, University of Sassari, 07100 Sassari, Italy
Interests: pancreatic cancer; pancreatic ductal adenocarcinoma; pancreatic surgery; hepatobiliary surgery; colorectal surgery; surgical oncology
Special Issues, Collections and Topics in MDPI journals
Prof. Alberto Porcu

E-Mail Website
Guest Editor
Department of Medicine, Surgery and Pharmacy, Unit of General Surgery, University of Sassari, 07100 Sassari, Italy
Interests: pancreatic cancer; pancreatic ductal adenocarcinoma; pancreatic surgery; hepatobiliary surgery; cholangiocarcinoma; hepatocellular carcinoma; liver metastases; colorectal surgery; surgical oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pancreatic ductal adenocarcinoma (PDAC) is the most common form of pancreatic cancer, originating from the epithelial cells of the main pancreatic duct.

The pathogenesis of PDAC is not fully understood, but includes various risk factors such as genetic predisposition, chronic pancreatitis, smoking, obesity, and diabetes. Genetic mutations play a significant role in the development of PDAC, with KRAS, TP53, and CDKN2A among the most commonly altered genes.

Treatment for PDAC depends on the stage of the cancer and the patient's overall health status. Early stage disease may be treated with surgical resection, while later stages or metastatic PDAC might require chemotherapy, radiation therapy, or targeted therapy. Novel treatment approaches, such as immunotherapy and personalized medicine, are being explored in order to improve patient outcomes.

This Special Issue aims to provide an overview of the advancements in preclinical and clinical practices in the field of the treatment of PDAC. We invite authors to submit original research and review articles focusing on this important topic.

Dr. Teresa Perra
Prof. Dr. Alberto Porcu
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Biomedicines is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic cancer
  • pancreatic ductal adenocarcinoma
  • treatment
  • management
  • complications
  • vascular reconstruction
  • neoadjuvant therapy

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Published Papers (3 papers)

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Research

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15 pages, 799 KiB  
Article
Correlation Between Systemic Inflammation, Gut Microbiome Dysbiosis and Postoperative Complications After the Modified Whipple Procedure
by Gelu Mihai Breaza, Florin Emil Hut, Octavian Cretu, Simona-Alina Abu-Awwad, Ahmed Abu-Awwad, Laurențiu Vasile Sima, Radu Gheorghe Dan, Cristina Ana-Maria Dan, Raluca Maria Closca and Flavia Zara
Biomedicines 2025, 13(1), 104; https://doi.org/10.3390/biomedicines13010104 - 5 Jan 2025
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Abstract
(1) Background: The modified Whipple procedure, or pylorus-preserving pancreaticoduodenectomy, is a complex surgical intervention used to treat pancreatic head tumors. While preserving digestive function, it is associated with significant perioperative risks. This study explores the clinical, immunological, and microbiome-related factors influencing postoperative complications, [...] Read more.
(1) Background: The modified Whipple procedure, or pylorus-preserving pancreaticoduodenectomy, is a complex surgical intervention used to treat pancreatic head tumors. While preserving digestive function, it is associated with significant perioperative risks. This study explores the clinical, immunological, and microbiome-related factors influencing postoperative complications, focusing on the interplay between patient comorbidities, systemic inflammation, and gut dysbiosis. (2) Methods: A retrospective analysis was conducted on 123 patients undergoing the modified Whipple procedure for pancreatic head tumors. Patients were categorized into two groups based on the occurrence of significant postoperative complications (Group A: with complications; Group B: without complications). Data on demographics, comorbidities, inflammatory markers (CRP, IL-6, procalcitonin), and gut microbiome composition were collected. Microbial diversity was evaluated using the Shannon Index, and logistic regression was performed to identify independent predictors of complications. (3) Results: Patients in Group A had a significantly higher prevalence of diabetes mellitus (43.1% vs. 20.8%; p = 0.02) and cardiovascular disease (35.3% vs. 13.9%; p = 0.01). Elevated inflammatory markers (CRP ≥ 40 mg/L, IL-6 ≥ 30 pg/mL, procalcitonin ≥ 0.5 ng/mL) were strongly associated with higher complication rates. Microbiome analysis indicated dysbiosis in Group A, with reduced Lactobacillus and Bifidobacterium levels, increased Enterobacteriaceae abundance, and a lower Shannon Index (<2). Patients exhibiting both dysbiosis and elevated inflammation had the highest complication rate (60%). Multivariate analysis identified diabetes, elevated IL-6, and dysbiosis as independent predictors of adverse outcomes. (4) Conclusions: Postoperative complications after the modified Whipple procedure are influenced by systemic inflammation and gut dysbiosis. A systematic preoperative assessment of microbiome health and inflammatory markers enables accurate risk stratification and personalized interventions, potentially reducing the incidence of complications and improving overall surgical outcomes. Full article
(This article belongs to the Special Issue Diagnosis, Pathogenesis and Treatment of Pancreatic Ductal Adenocarcinoma)
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20 pages, 4520 KiB  
Article
Novel Predictive Strategy Using CA19-9 and Fecal Elastase Levels to Make Treatment Decisions for Resectable Pancreatic Cancer: A Retrospective Study
by Hyung Sun Kim, Woojin Kim, Won-Gun Yun, Hye-Sol Jung, Youngmin Han, Mirang Lee, Wooil Kwon, Jin-Young Jang and Joon Seong Park
Biomedicines 2025, 13(1), 62; https://doi.org/10.3390/biomedicines13010062 - 30 Dec 2024
Viewed by 514
Abstract
Background: Carbohydrate antigen 19-9 (CA19-9) is used as a marker to predict recurrence and survival of patients with pancreatic ductal adenocarcinoma (PDAC). Recently, fecal elastase-1 (FE-1) has been shown to correlate with prognosis in patients with PDAC. Method: A total of [...] Read more.
Background: Carbohydrate antigen 19-9 (CA19-9) is used as a marker to predict recurrence and survival of patients with pancreatic ductal adenocarcinoma (PDAC). Recently, fecal elastase-1 (FE-1) has been shown to correlate with prognosis in patients with PDAC. Method: A total of 536 patients who underwent curative intent surgery between 2010 and 2019 were included in the study. The cutoff points of preoperative CA19-9 and FE-1 levels were extracted from the Youden index and previous studies. Cox proportional hazard models were used to investigate the association between preoperative tumor marker levels and survival after surgery. Results: Patients with CA19-9 ≥ 385 had more advanced T-/N-stages and lower survival rates compared to those with CA19-9 < 385. Multivariate Cox analyses demonstrated that combining preoperative tumor markers was associated with worse 3-year overall survival (both CA19-9 and FE-1 low, HR = 1.41, p = 0.044; both high, HR = 1.44, p = 0.047; CA19-9 high and FE-1 low, HR = 2.00, p < 0.001; and p for trend < 0.001). The same trend was confirmed in the analysis with recurrence-free survival. Conclusions: This study presents a new predictive strategy using combined CA19-9 and FE-1 levels to determine the treatment for resectable pancreatic cancer. Full article
(This article belongs to the Special Issue Diagnosis, Pathogenesis and Treatment of Pancreatic Ductal Adenocarcinoma)
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Review

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26 pages, 4817 KiB  
Review
The Road Ahead in Pancreatic Cancer: Emerging Trends and Therapeutic Prospects
by Chris T. P. Do, Jack Y. Prochnau, Angel Dominguez, Pei Wang and Manjeet K. Rao
Biomedicines 2024, 12(9), 1979; https://doi.org/10.3390/biomedicines12091979 - 2 Sep 2024
Cited by 2 | Viewed by 1958
Abstract
This review explores the challenges and emerging trends in pancreatic cancer therapy. In particular, we focus on the tumor microenvironment and the potential of immunotherapy for pancreatic cancer. Pancreatic ductal adenocarcinoma, characterized by its dense stromal architecture, presents unique challenges for effective treatment. [...] Read more.
This review explores the challenges and emerging trends in pancreatic cancer therapy. In particular, we focus on the tumor microenvironment and the potential of immunotherapy for pancreatic cancer. Pancreatic ductal adenocarcinoma, characterized by its dense stromal architecture, presents unique challenges for effective treatment. Recent advancements have emphasized the role of the tumor microenvironment in therapeutic resistance and disease progression. We discuss novel strategies targeting the desmoplastic barrier and immunosuppressive cells to enhance immune cell infiltration and activation. Recent clinical trials, particularly those involving novel immunotherapeutic agents and tumor vaccines, are examined to understand their efficacy and limitations. Our analysis reveals that combining immunotherapy with chemotherapy, radiation therapy, or drugs targeting epigenetic processes shows promise, improving overall survival rates and response to treatment. For instance, trials utilizing checkpoint inhibitors in combination with standard chemotherapies have extended disease-free survival by up to 6 months compared to chemotherapy alone. Importantly, vaccines targeting specific tumor neoantigens have shown the potential to increase patient survival. However, these approaches also face significant challenges, including overcoming the immunosuppressive tumor microenvironment and enhancing the delivery and efficacy of therapeutic agents. By providing an overview of both the promising results and the obstacles encountered, this review aims to highlight ongoing efforts to refine immunotherapy approaches for better patient outcomes. Full article
(This article belongs to the Special Issue Diagnosis, Pathogenesis and Treatment of Pancreatic Ductal Adenocarcinoma)
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