BackgroundCancer‐associated wasting, termed cancer cachexia, has a profound effect on the morbidity and mortality of cancer patients but remains difficult to recognize and diagnose. While increases in circulating levels of a number of inflammatory cytokines have been associated with cancer cachexia, these associations were generally made in patients with advanced disease and thus may be associated with disease progression rather than directly with the cachexia syndrome. Thus, we sought to assess potential biomarkers of cancer‐induced cachexia in patients with earlier stages of disease.MethodsA custom multiplex array was used to measure circulating levels of 25 soluble factors from 70 pancreatic cancer patients undergoing attempted tumour resections. A high‐sensitivity multiplex was used for increased sensitivity for nine cytokines.ResultsResectable pancreatic cancer patients with cachexia had low levels of canonical pro‐inflammatory cytokines including interleukin‐6 (IL‐6), interleukin‐1β (IL‐1β), interferon‐γ (IFN‐γ), and tumour necrosis factor (TNF). Even in our more sensitive analysis, these cytokines were not associated with cancer cachexia. Of the 25 circulating factors tested, only monocyte chemoattractant protein‐1 (MCP‐1) was increased in treatment‐naïve cachectic patients compared with weight stable patients and identified as a potential biomarker for cancer cachexia. Although circulating levels of leptin and granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) were found to be decreased in the same cohort of treatment‐naïve cachectic patients, these factors were closely associated with body mass index, limiting their utility as cancer cachexia biomarkers.ConclusionsUnlike in advanced disease, it is possible that cachexia in patients with resectable pancreatic cancer is not associated with high levels of classical markers of systemic inflammation. However, cachectic, treatment‐naïve patients have higher levels of MCP‐1, suggesting that MCP‐1 may be useful as a biomarker of cancer cachexia.

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RezumatColangiocarcinomul perihilar este cel mai des întâlnit tip de cancer al căilor biliare, asociat cu o mortalitate ridicată din cauza întârzierii prezentării la medic. Pentru stabilirea diagnosticului şi planificarea preoperatorie este nevoie de modalităţi imagistice cu secţiuni transversale de înaltă rezoluţie. Deşi rezecţia chirurgicală cu margini de rezecţie negative dă speranţa vindecării, doar un mic procent al pacienţilor pot beneficia de intervenţie chirurgicală la momentul diagnosticului. Embolizarea venei porte şi decompresia căilor biliare au prioritate în cazul unor pacienţi, înainte de intervenţia chirurgicală. Transplantul hepatic combinat cu tratamentul neoadjuvant a avut rezultate foarte bune la pacienţi selectaţi cu afecţiuni inoperabile, cu o rată de supravieţuire de 5 ani fără recidivă. Gemcitabina plus cisplatin constituie tratamentul chimioterapeutic de bază la pacienţii cu colangiocarcinom perihilar metastatic inoperabil. Progresele recente în înţelegerea patogenezei moleculare a colangiocarcinomului au generat un interes ridicat în identificarea de tratamente inovatoare care au ca obiectiv căi moleculare cu rol cheie. În cele de faţă, prezentăm o trecere în revistă a principiilor actuale de management al pacienţilor cu colangiocarcinom perihilar.