Treatment of pancreatic cancer is multimodal and surgery is an essential part,mandatory for curative potential.Also chemotherapy is essential,and serious postoperative complications or rapid disease progression may pr...Treatment of pancreatic cancer is multimodal and surgery is an essential part,mandatory for curative potential.Also chemotherapy is essential,and serious postoperative complications or rapid disease progression may preclude completion of multimodal treatment.The sequence of treatment interventions has therefore become an important concern,and numerous ongoing randomized controlled trials compare clinical outcome after upfront surgery and neoadjuvant treatment with subsequent resection.In previous years,borderline resectable and locally advanced pancreatic cancer was most often considered unresectable.More effective chemotherapy together with the latest improvements in surgical expertise has resulted in extended operations,pushing the borders of resectability.Multivisceral resections with or without resection of major mesen-teric vessels are now performed in numerous patients,resulting in better outcome,recorded as overall survival and/or patient reported outcome.But postoperative morbidity increases concurrently,and clinical benefit must be carefully evaluated against risk of potential harm,associated with new comprehensive multimodal treatment sequences.Even though cost/utility analyses are deficient,extended surgery has resulted in signifi-cantly longer and better life for many patients with no other treatment alternative.Improved selection of patients to surgery and/or chemotherapy will in the near future be possible,based on better tumor biology insight.Clinically available biomarkers enabling personalized treatment are forthcoming,but these options are still limited.The importance of surgical resection for each patient’s prognosis is presently increasing,justifying sustained expansion of the surgical treatment modality.展开更多
AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was ev...AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes(PROs) of the HRQo L questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor(TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests:(1) Ankylosing Spondylitis Disease Activity ScoreC-Reactive Protein(ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index(BASDAI), Bath Ankylosing Spondylitis Functional Index(BASFI) and Bath Ankylosing Spondylitis Metrology Index(BASMI) for articular activity;(2) Inflammatory Bowel Disease Questionnaire(IBDQ), Crohn's Disease Activity Index(CDAI) and partial Mayo(p Mayo) score for gastrointestinal symptoms and activity; and(3) Health Assessment Questionnaire(HAQ), Patient Global Assessment(PGA) and Short Form-36 health survey(SF-36) questionnaires for PROs of the HRQo L.RESULTS Integrated evaluation and management of the patients affected by ES, carried out simultaneously by a gastroenterologist and a rheumatologist, allowed clinicians to choose the optimal therapeutic strategy. In a cohort of 30 ES patients affected by active articular and gastrointestinal disease, or axial active articular inflammation, Ada led to fast and sustained improvement of both articular and gastrointestinal disease activities. In fact, all the clinimetric evaluation tests exploring articular or gastrointestinal activity, as well as all the HRQo L scores, showed a significant improvement having been achieved at the earliest(6-mo) assessment. This important clinical improvement was maintained at the 12-mo follow-up. Importantly, global and gastrointestinal quality of life significantly correlated with articular disease activity, providing evidence to support that the integrated evaluation is the best option to manage patients with ES.CONCLUSION Ada treatment, upon multidisciplinary(gastrorheumatologic) evaluation, significantly improves both articular and gastrointestinal inflammation, thereby improving the HRQo L in patients affected by ES.展开更多
文摘Treatment of pancreatic cancer is multimodal and surgery is an essential part,mandatory for curative potential.Also chemotherapy is essential,and serious postoperative complications or rapid disease progression may preclude completion of multimodal treatment.The sequence of treatment interventions has therefore become an important concern,and numerous ongoing randomized controlled trials compare clinical outcome after upfront surgery and neoadjuvant treatment with subsequent resection.In previous years,borderline resectable and locally advanced pancreatic cancer was most often considered unresectable.More effective chemotherapy together with the latest improvements in surgical expertise has resulted in extended operations,pushing the borders of resectability.Multivisceral resections with or without resection of major mesen-teric vessels are now performed in numerous patients,resulting in better outcome,recorded as overall survival and/or patient reported outcome.But postoperative morbidity increases concurrently,and clinical benefit must be carefully evaluated against risk of potential harm,associated with new comprehensive multimodal treatment sequences.Even though cost/utility analyses are deficient,extended surgery has resulted in signifi-cantly longer and better life for many patients with no other treatment alternative.Improved selection of patients to surgery and/or chemotherapy will in the near future be possible,based on better tumor biology insight.Clinically available biomarkers enabling personalized treatment are forthcoming,but these options are still limited.The importance of surgical resection for each patient’s prognosis is presently increasing,justifying sustained expansion of the surgical treatment modality.
文摘AIM To report adalimumab(Ada) efficacy on articulargastrointestinal disease and health-related quality of life(HRQo L) in patients with enteropathic spondyloarthritis(ES).METHODS A cohort of 52 patients with ES was evaluated in the departments of gastroenterology and internal medicine. At baseline, all patients underwent assessment by an integrated gastro-rheumatologic evaluation of articular and gastrointestinal activity, as well patient reported outcomes(PROs) of the HRQo L questionnaires. After this integrated evaluation and following a specific working flowchart, the Ada anti-tumor necrosis factor(TNF)-inhibitor was assigned to a cohort of 30 patients and its clinical efficacy was evaluated at baseline and after 6-mo and 12-mo treatment by the following tests:(1) Ankylosing Spondylitis Disease Activity ScoreC-Reactive Protein(ASDAS-CRP); Bath Ankylosing Spondylitis Disease Activity Index(BASDAI), Bath Ankylosing Spondylitis Functional Index(BASFI) and Bath Ankylosing Spondylitis Metrology Index(BASMI) for articular activity;(2) Inflammatory Bowel Disease Questionnaire(IBDQ), Crohn's Disease Activity Index(CDAI) and partial Mayo(p Mayo) score for gastrointestinal symptoms and activity; and(3) Health Assessment Questionnaire(HAQ), Patient Global Assessment(PGA) and Short Form-36 health survey(SF-36) questionnaires for PROs of the HRQo L.RESULTS Integrated evaluation and management of the patients affected by ES, carried out simultaneously by a gastroenterologist and a rheumatologist, allowed clinicians to choose the optimal therapeutic strategy. In a cohort of 30 ES patients affected by active articular and gastrointestinal disease, or axial active articular inflammation, Ada led to fast and sustained improvement of both articular and gastrointestinal disease activities. In fact, all the clinimetric evaluation tests exploring articular or gastrointestinal activity, as well as all the HRQo L scores, showed a significant improvement having been achieved at the earliest(6-mo) assessment. This important clinical improvement was maintained at the 12-mo follow-up. Importantly, global and gastrointestinal quality of life significantly correlated with articular disease activity, providing evidence to support that the integrated evaluation is the best option to manage patients with ES.CONCLUSION Ada treatment, upon multidisciplinary(gastrorheumatologic) evaluation, significantly improves both articular and gastrointestinal inflammation, thereby improving the HRQo L in patients affected by ES.
