We identified 2 useful predictive factors for malignancy in branch duct type IPMN; a mural nodule size >5 mm and a CEA level in the pancreatic juice obtained by preoperative ERP >30 ng/mL.

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The invasion process is a crucial step for pancreatic ductal adenocarcinoma (PDAC); however, the genes related to invasion remain unclear. To identify specific genes for the invasion process, we compared microarray data for infiltrating cancer and PanIN-3, which were harvested from an individual PDAC patient by microdissection. Furthermore, immunohistochemical, coimmunoprecipitation and invasion analyses were performed to confirm the biologic significance of molecules identified by expression profile. In the present study, we focused on MUC16 and mesothelin among 87 genes that were significantly upregulated in infiltrating components compared to PanIN-3 in all PDAC patients, because MUC16 was the most differently expressed between two regions, and mesothelin was reported as the receptor for MUC16. Immunohistochemical analysis revealed that MUC16 and mesothelin were expressed simultaneously only in infiltrating components and increased at the invasion front, and binding of MUC16 and mesothelin was found in PDAC by immunoprecipitation assay. The downregulation of MUC16 by shRNA and the blockage of MUC16 binding to mesothelin by antibody inhibited both invasion and migration of pancreatic cancer cell line. MUC16 high/ mesothelin high expression was an independent prognostic factor for poor survival in PDAC patients. In conclusion, we identified two specific genes, MUC16 and mesothelin, associated with the invasion process in patients with PDAC. (Cancer Sci 2012; 103: 739-746) F or most patients with pancreatic ductal adenocarcinoma (PDAC), the diagnosis is made at an advanced stage;(1) the survival rate for these patients is dismal because PDAC has a propensity for early local invasion and vascular dissemination.(2) The genetic and biochemical determinants of the process of invasion and metastasis in PDAC are still largely unknown.Pancreatic ductal adenocarcinoma appears to arise from histologically well-defined precursor lesions in the ducts of the pancreas, called pancreatic intraepithelial neoplasms (PanIN). (3,4) PanIN are graded based on their degree of architectural and nuclear atypia and are categorized into a four-tier classification, including PanIN-1A, 1B, 2 and 3.(5) PanIN-3 lesions demonstrate widespread loss of nuclear polarity, nuclear atypia and frequent mitoses, and whereas cancerous cells break through the basement membrane, they evolve into infiltrating adenocarcinoma. The invasion process is the crucial step in PDAC because cancer cells that invade the vasculature, or lymphatic or neural vessels, can progress further to metastasis only after obtaining infiltrating status. In the present study, we identified specific molecular markers associated with invasion in PDAC, which might be useful not only as early diagnostic markers but also as new therapeutic targets for patients with PDAC.

This single-center comparative randomized superiority study compared biliary stenting using fully covered selfexpandable metal stents (FCSEMS) and biliary stenting using plastic stents (PS) in preoperative biliary drainage of patients with borderline resectable pancreatic cancer (BRPC) who are planned to undergo a single regimen of neo-adjuvant chemotherapy (NAC).Methods: Twenty-two patients with BRPC who required preoperative biliary drainage before NAC (Gemcitabine plus Nabpaclitaxel) were randomly assigned 1:1 to the FCSEMS or PS group. The primary endpoint was the rate of stent dysfunction until surgery or tumor progression. Secondary endpoints were stent patency, number of re-interventions, adverse events of endoscopic retrograde biliary drainage (EBD), operation time, volume of intraoperative bleeding, postoperative hospitalization, postoperative adverse events and medical costs.Results: Eleven patients in each of the groups reached the primary endpoint. The FCSEMS group showed a significantly lower rate of stent dysfunction (18.2% vs. 72.8%, P = 0.015), longer stent patency (P = 0.02), and lower number of reinterventions for stent dysfunction (0.27 AE 0.65 vs. 1.27 AE 1.1, P = 0.001) than the PS group. The adverse events of EBD, operation time, volume of intraoperative bleeding, postoperative hospitalization, postoperative adverse events and medical costs did not significantly differ between the two groups.Conclusions: In patients with BRPC for preoperative biliary drainage, stent dysfunction occurred less frequently with FCSEMSs than with PSs. In addition, FCSEMS and PS provided similar preoperative management of BRPC in terms of the safety of surgery and medical costs. (UMIN ID000030473).

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