Pancreatic movement focuses on the latest developments in the field of pancreatic cancer, Professor Bai Li's in-depth comments

*It is only for medical professionals to read for reference.
How far are pancreatic cancer patients from early diagnosis? Pancreatic cancer (PC) is known as the “king of cancer” and is the third leading cause of cancer-related death in the world.
Most PC patients are diagnosed as advanced patients and have lost treatment opportunities
.

Improving the early diagnosis rate of PC, and then optimizing the treatment of patients with advanced PC is the current clinical difficulty
.

In this regard, we specially invited Professor Bai Li from the Chinese People's Liberation Army General Hospital to comment on the latest developments in the diagnosis of two pancreatic cancers in 2021
.

In 2021, what new developments will PC usher in in terms of diagnosis? Progress 1: Small RNA (tsRNA) derived from tRNA is abnormally regulated in PC, suggesting that tsRNA may play an important role in the occurrence of PC New biomarkers for survival assessment
.

This study proved that serum tRF-Pro-AGG-004 and tRF-Leu-CAG-002 are promising new biomarkers that can be used for early diagnosis of PC
.

In situ hybridization (ISH) scores of tRF-Pro-AGG-004 and tRF-LeuCAG-002 in tumor tissues can be used as biomarkers to predict the survival time of patients after surgery (Figure 1)
.

The study revealed the existence form, source and biological function of circulating tsRNAs in serum, and provided new ideas for the diagnosis and treatment of PC
.

At the same time, the study suggests that tsRNAs can also exist stably in the circulatory system, and their abundance is much higher than that of miRNA
.

However, the diagnostic value and biological functions of circulating tsRNAs in PC are still unclear [1]
.

Figure 1.
ISH score based on tRF-Pro-AGG-004 and tRF-Leu-CAG-002, and Kaplan-Meier total of two cohorts of PC patients who combined tRF-Pro-AGG-004 and tRF-Leu-CAG-002 Survival curve progression 2: When using endoscopic ultrasound-guided fine-needle tissue biopsy (EUS-FNB) to diagnose PC, on-site rapid evaluation (ROSE) should not be routinely recommended.
This study is an international, multicenter, random, non-inferiority The study explored the difference in diagnostic accuracy between EUS-FNB combined with ROSE vs.
EUS-FNB alone
.

The study included 800 patients from 8 countries and 14 centers, among which 771 patients were analyzed.
The patients were allocated to the EUS-FNB combined ROSE group (385 cases) and EUS-FNB single use according to a 1:1 ratio.
Group (386 cases)
.

The primary end point of the study is diagnostic accuracy, and the secondary end points are safety, organization core acquisition rate, specimen quality and sampling procedure time [2]
.

The results of the study showed that the diagnostic accuracy of the EUS-FNB combined with ROSE group vs.
the EUS-FNB single-use group was similar: 96.
4% vs.
97.
4% (P=0.
396) (Table 1), the non-inferiority of the EUS-FNB single-use group The effectiveness is confirmed, and the absolute risk difference is 1.
0%
.

The safety and sample quality of the two groups are similar.
The acquisition rate of the tissue core of the EUS-FNB combined ROSE group vs.
EUS-FNB single use group is 70.
7% vs.
78.
0% (P = 0.
021), and the average sampling time is: 17.
9±8.
8 vs.
11.
7±6.
0 min (P<0.
0001) [2]
.

Table 1.
EUS-FNBþROSE and EUS-FNB alone evaluate the diagnostic methods of solid pancreatic lesions (SPLs).
New biomarkers are expected to be used for early diagnosis of PC, but further exploration of tRNA-derived small RNA (tsRNA) is a new type of regulation Sexual small non-coding RNAs are involved in a variety of physiological and pathological processes
.

tsRNA is usually 18-40 nucleotides in length and can be divided into three different categories, including: small RNA derived from precursor tRNA, which is characterized by a poly U residue at the 3'end (3'U tRF); mature TRNA-derived fragment (tRF); tRNA half molecule (tRH)
.

At the same time, exosomes are also related to tsRNA.
Exosomes are membrane-bound carriers with a diameter of 30-100nm.
They are secreted by most cell types and exist in various types of body fluids, including plasma, serum, and urine.
Fluid and saliva
.

Among them, microRNA, circular RNA (circRNA) and long non-coding RNA have shown great potential as diagnostic or prognostic biomarkers [3,4]
.

As for tsRNA, as early as 2019, West China Hospital of Sichuan University reported that tsRNA derived from exosomal tRNA can be used as a tumor diagnostic biomarker
.

In the study of West China University of Medical Sciences, researchers used small RNA-seq technology to analyze exosomal tsRNA from cell culture media and plasma, and found that tsRNA was present in exosomes
.

In order to explore the potential value of tsRNA in tumor diagnosis, the researchers compared the plasma exosomal tsRNA levels between liver cancer patients and healthy volunteers, revealing a significant increase in plasma exosomes in liver cancer patients, proving plasma exocytosis Somatic tsRNA is a new type of tumor diagnostic biomarker
.

This study reveals that tsRNA has great potential as a new type of "liquid biopsy" biomarker for tumor diagnosis.
It not only expands the types of non-coding RNA in exosomes, but also shows that tsRNA biomarkers have important value in tumor diagnosis
.

Finally, Professor Bai Li concluded: “Good tumor markers must meet the following conditions at the same time, that is, high sensitivity, strong specificity, simple detection methods, easy operation and promotion, and economic popularization
.

Despite the current research results It shows that non-coding RNA represented by tsRNA has a brighter application prospect in the diagnosis of pancreatic cancer, but it is still a long way from being widely used in clinical practice
.

"Should EUS-FNB technology be combined with other methods? application? The answer is mixed.
Based on the bright prospects of biomarkers in PC, Professor Bai Li also expressed a positive view on the diagnostic strategy of EUS-FNB combined with tumor biomarkers: "The two can be effectively combined, but at the same time, it must be clear that the two differences between
.

"" It is undeniable that contains tsRNA including tumor markers for early warning, monitoring and treatment of PC predict recurrence and metastasis have a certain significance, but also pathological irreplaceable
.

Although tumor markers The appearance may be earlier than imaging, but any tumor markers, including conventional and newly developed molecular markers, are auxiliary diagnostics
.

At present, the gold indicator of tumor diagnosis is still pathology, even if the value of cytological diagnosis is higher than tumor markers matter
.

endoscopic ultrasound-guided fine needle aspiration biopsy or pathology of superiority crowd type of tumor, the degree of malignancy, targets and immunotherapy treatments screened's more than measuring tumor markers
.

"Professor Bai Li stressed
.

The road is long and long, and the treatment of PC patients still needs to be constantly sought.
"At present, the first-line treatment of PC is AG (gemcitabine + albumin paclitaxel) and FOLFIRNOX (oxaliplatin, 5-fluorouracil, irinotecan and leucovorin).
the main program
.

after FOLFIRNOX after dose reform program, in terms of security and the AG program is not very different, the degree of similarity benefit
.

in contrast, AS (albumin-paclitaxel plus for Gio) program due to a lack of large-scale clinical trials ⅲ The data has not yet been widely used
.

" "But the second-line treatment for PC is confusing, and there is currently no standard treatment
.

Irinotecan liposome + 5-fluorouracil + leucovorin is the only second-line treatment for PC with evidence from large-scale clinical studies.
Program
.

" "In the past ten years, with the continuous maturity of treatment concepts, the continuous advancement of molecular biology detection technology, the continuous research and development of therapeutic drugs, the treatment of tumors has undergone earth-shaking changes, and more and more tumor patients have achieved long-term Survival
.

I believe that with our continuous in-depth exploration of pancreatic cancer, one day, a huge breakthrough in the field of pancreatic cancer will surely be achieved!" Professor Bai Li is full of expectations
.

Expert Profile Professor Bai Li, Chief Physician, Professor, Ph.
D.
, Doctoral Supervisor, Department of Oncology, PLA General Hospital, Chairman, Gastrointestinal Tumor Precise Treatment Committee, Beijing Society for Cancer Prevention and Treatment, Director, Clinical Oncology Committee of China Anti-Cancer Association (CSCO) Director, Chinese Medical Association Oncology Branch Pancreatic Cancer Professional Committee Standing Committee CSCO Gastric Cancer Professional Committee Standing Committee Chinese Medical Doctor Association Surgeon Branch MDT Committee Standing Committee Anti-Cancer Association Colorectal Cancer Committee Standing Committee Reference [1]Jin F, Yang L, Wang W, et al.
A novel class of tsRNA signatures as biomarkers for diagnosis and prognosis of pancreatic cancer.
Mol Cancer.
2021;20(1):95.
[2]Crinò SF, Di Mitri R, Nguyen NQ, et al.
Endoscopic ultrasound–guided fine-needle biopsy with or without rapid on-site evaluation for diagnosis of solid pancreatic lesions: a randomized controlled non-inferiority trial.
Gastroenterology.
Published online June[3] Huang Shangxiao, Huang Jianfeng, Huang Changjie.
Research progress of microRNA in pancreatic cancer[J].
Chinese clinicians Journal,2020,48(7):781-783.
[4]He Risheng,Xu Yi,Cui Yunfu.
Circular RNA and its research progress in pancreatic cancer[J].
Abdominal Surgery,2021,34(2) :154-158.
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