2023年第2版《NCCN胰腺癌临床实践指南》更新解读

外科理论与实践››2024,Vol. 29››Issue (01): 10-13.doi:10.16139/j.1007-9610.2024.01.03

2023年第2版《NCCN胰腺癌临床实践指南》更新解读

陈佳浩, 姜翀弋()

复旦大学附属华东医院肝胆胰脾外科，上海 200040

收稿日期:2023-12-14出版日期:2024-01-25发布日期:2024-05-14
通讯作者:姜翀弋，E-mail：jiangzhongyi9@126.com
基金资助:
国家自然科学基金(82372968);上海市申康医院发展中心项目(SHDC2024CRI080);复旦大学医学工程联合基金(XM03231533)

Interpretation of 2023 2nd NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma

CHEN Jiahao, JIANG Chongyi()

Department of Hepato-Biliary-Pancreatic & Splenic Surgery, Huadong Hospital, Fudan University, Shanghai 200040, China

Received:2023-12-14Online:2024-01-25Published:2024-05-14

摘要/Abstract

摘要：

胰腺癌是预后极差的消化系统恶性肿瘤。美国国立综合癌症网络（National Comprehensive Cancer Network, NCCN）结合最新高质量循证医学证据不断更新推出胰腺癌的临床实践指南以指导胰腺癌的规范化诊疗。2023年5月4日与6月19日《NCCN胰腺癌临床实践指南》分别进行了两次更新。相较于2022年第2版，这两次更新主要集中于最新的免疫/靶向治疗进展、NALIRIFOX方案的引入以及体能状态中等病人治疗方案的补充。本文结合相关循证医学证据对最新《NCCN胰腺癌临床实践指南》的更新进行解读。

关键词:胰腺癌,美国国立癌症综合网络(NCCN),指南,解读

Abstract:

Pancreatic adenocarcinoma, a severe digestive malignancy, is characterized by its poor prognosis. The National Comprehensive Cancer Network (NCCN) persistently refines its guidelines, integrating cutting-edge evidence-based medical insights to standardize the diagnostic and therapeutic strategies of pancreatic adenocarcinoma. The NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma were updated twice on May 4 and June 19, 2023, respectively. Compared to the 2022 predecessor, these two updates placed a particular emphasis on immunotherapy/targeted therapy, the introduction of NALIRIFOX regimen, and supplementary treatment protocols for patients with intermediate performance status. This article provided an interpretation of the latest updates to the NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma, integrating relevant evidence-based medical findings.

Key words:Pancreatic adenocarcinoma,National Comprehensive Cancer Network(NCCN),Guideline,Interpretation

中图分类号:

R735.9

陈佳浩, 姜翀弋. 2023年第2版《NCCN胰腺癌临床实践指南》更新解读[J]. 外科理论与实践, 2024, 29(01): 10-13.

CHEN Jiahao, JIANG Chongyi. Interpretation of 2023 2nd NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 10-13.

参考文献19

[1]	OZONO Y, KAWAKAMI H, UCHIYAMA N, et al. Current status and issues in genomic analysis using EUS-FNA/FNB specimens in hepatobiliary-pancreatic cancers[J].J Gastroenterol,2023,58(11):1081-1093. doi:10.1007/s00535-023-02037-zpmid:37698719
[2]	ASOKKUMAR R, YUNG KA C, LOH T, et al. Comparison of tissue and molecular yield between fine-needle biopsy (FNB) and fine-needle aspiration (FNA): a rando-mized study[J].Endosc Int Open,2019,7(8):E955-E963.
[3]	KANDEL P, NASSAR A, GOMEZ V, et al. Comparison of endoscopic ultrasound-guided fine-needle biopsyversusfine-needle aspiration for genomic profiling and DNA yield in pancreatic cancer: a randomized crossover trial[J].Endoscopy,2021,53(4):376-382.
[4]	NCCN Clinical Practice Guidelines in Oncology.Pancreatic adenocarcinoma (version 2.2023)[EB/OL].(2023-06-19)[2023-12-05]. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455.
[5]	GKOLFAKIS P, CRINÒ S F, TZIATZIOS G, et al. Comparative diagnostic performance of end-cutting fine-needle biopsy needles for EUS tissue sampling of solid pancreatic masses: a network meta-analysis[J].Gastrointest Endosc,2022,95(6):1067-1077.
[6]	COSTA B, VALE N. Dostarlimab: a review[J].Biomo-lecules,2022,12(8):1031.
[7]	CERCEK A, LUMISH M, SINOPOLI J, et al. PD-1 bloc-kade in mismatch repair-deficient, locally advanced rectal cancer[J].N Engl J Med,2022,386(25):2363-2376.
[8]	CHEN I M, JOHANSEN J S, THEILE S, et al. Rando-mized phase Ⅱ study of nivolumab with or without ipili-mumab combined with stereotactic body radiotherapy for refractory metastatic pancreatic cancer (CheckPAC)[J].J Clin Oncol,2022,40(27):3180-3189.
[9]	STRICKLER J H, SATAKE H, GEORGE T J, et al. Sotorasib inKRASp.G12C-mutated advanced pancreatic cancer[J].N Engl J Med,2023,388(1):33-43.
[10]	BEKAII-SAAB T S, YAEGER R, SPIRA A I, et al. Adagrasib in advanced solid tumors harboring aKRAS^G12Cmutation[J].J Clin Oncol,2023,41(25):4097-4106.
[11]	RAHMAN F A U, ALI S, SAIF M W. Update on the role of nanoliposomal irinotecan in the treatment of metastatic pancreatic cancer[J].Therap Adv Gastroenterol,2017,10(7):563-572. doi:10.1177/1756283X17705328pmid:28804517
[12]	NCCN Clinical Practice Guidelines in Oncology.Pancreatic adenocarcinoma (version 2.2022)[EB/OL].(2022-12-06)[2023-12-05]. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1455.
[13]	WAINBERG Z A, MELISI D, MACARULLA T, et al. NALIRIFOXversusnab-paclitaxel and gemcitabine in treatment-naive patients with metastatic pancreatic ductal adenocarcinoma (NAPOLI 3): a randomised, open-label, phase 3 trial[J].Lancet,2023,402(10409):1272-1281.
[14]	WAINBERG Z A, BEKAII-SAAB T, BOLAND P M, et al. First-line liposomal irinotecan with oxaliplatin, 5-fluorouracil and leucovorin (NALIRIFOX) in pancreatic ductal adenocarcinoma: a phase Ⅰ/Ⅱ study[J].Eur J Cancer,2021,151:14-24.
[15]	WANG-GILLAM A, LI C P, BODOKY G, et al. Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (NAPOLI-1): a global, randomised, open-label, phase 3 trial[J].Lancet,2016,387(10018):545-557.
[16]	GHAZI R, ABIMANSOUR J P, MAHMOUD T, et al. Uncoveredversusfully covered self-expandable metal stents for the management of distal malignant biliary obstruction[J].Gastrointest Endosc,2023,98(4):577-584.
[17]	ALMADI M A, BARKUN A, MARTEL M. Plasticvs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses[J].Am J Gastroenterol,2017,112(2):260-273.
[18]	LI T T, SONG S L, XIAO L N, et al. Efficacy of fully co-vered self-expandable metal stents for the management of pancreatic duct strictures in chronic pancreatitis: a systematic review and meta-analysis[J].J Gastroenterol Hepatol,2020,35(7):1099-1106.
[19]	SOFI A A, KHAN M A, AHMAD S, et al. Comparison of clinical outcomes of multiple plastic stents and covered metal stent in refractory pancreatic ductal strictures in chronic pancreatitis- a systematic review and meta-analysis[J].Pancreatology,2021,21(5):854-861. doi:10.1016/j.pan.2021.03.017pmid:33941467