胰腺恶性肿瘤中＞90%的病例为胰腺导管腺癌pancreatic ductal carcinoma）[1]，它是消化系统预后最差的恶性肿瘤之一。近60~70%的胰腺癌在头颈部或沟突部，发生在胰体部为5~10%，胰尾癌为10~15%[2]。显微镜下肿瘤包绕的间质大部分由成纤维细胞、炎症细胞以及细胞外基质组成[3]。肿瘤细胞与间质细胞之间有一个复杂的相互作用，导致信号通路（如TGF-b/SMAD，HGF/Met ，基质金属蛋白酶，肿瘤细胞Hedgehog信号通路，Wnt）通过自动分泌和旁分泌机制激活并，建立动态的微环境，促进肿瘤生长和侵润[4]。所以胰腺癌有局部侵犯和远处转移的倾向，在切除标本中常发现周围神经，血管和淋巴结被侵入。在切除的病例中淋巴结转移在50~75%[5~7]。
甚至在治愈性切除后，实际生存仅有10%~20%。在所有胰腺癌治疗的手段中，外科是能够达到完全治愈的手段。胰腺癌很容易扩散到邻近组织和远处转移。这种癌症典型地侵犯胰腺后神经组织，十二指肠，门静脉和肠系膜上静脉，以及局部淋巴结。 1. Cubilla, A. L. & Fitzgerald, P J. Tumors of the exocrine pancreas. in Atlas of Tumor Pathology (Eds Hartmann, W. H. & Sobin, H.), 2nd series, fascicle 19 (Armed Forces Institute of Pathology, Washington, 1984). 2. Solcia, E., Capella, C. & Kloppel, G. Tumors of the exocrine pancreas. in Tumors of the Pancreas (Eds Rosai, J. & Sobin, L. H.) 145 (Armed Forces Institute of Pathology, Washington, 1997). 3. Chu, G. C., Kimmelman, A. C., Hezel, A. F & DePinho, R. A. Stromal biology of pancreatic cancer. J. Cell. Biochem. 101, 887—907 (2007). 4. Mahadevan, D. & Von Hoff, D. D. Tumor—stroma interactions in pancreatic ductal adenocarcinoma. Mol. Cancer Ther. 6, 1186—1197 (2007). 5. Winter, J. M. et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J. Gastrointest. Surg. 10, 1199—1211 (2006).
6. Sohn, T. A. et al. Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J. Gastrointest. Surg. 4, 567—579 (2000). 7. Yeo, C. J. et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann. Surg. 221, 721—731 (1995). |