Pancreatic cancer in 2021: What you need to know to win

Table 1 Genetic syndromes predisposing to pancreatic cancer (the frequency of mutated genes among patients with pancreatic ductal adenocarcinoma is indicated in brackets)

Genetic syndrome	Mutated genes
Hereditary breast/ovarian cancer syndrome[36,37]	BRCA1 (0.7%), BRCA2 (1.4%), PALB2 (1%)
Familial atypical multiple mole melanoma syndrome[38]	CDKN2A (0.7%)
Peutz-Jeghers syndrome[39]	STK11
Familial adenomatous polyposis	APC (0.4%)
Lynch syndrome[40]	MLH1, MSH2 (0.4%), PMS2 (0.3%)
Hereditary pancreatitis[41]	PRSS1, SPINK1
Ataxia telangectasia[42]	ATM (1.4%)
Li-Fraumeni syndrome[42]	P53 (0.4%)

Table 2 Resectability criteria

Resectability status		Resectable	Borderline resectable	Locally advanced
Arterial involvement	Celiac artery	None	≤ 180°; > 180°, without involvement of aorta o GDA (body/tail)	>180° (head/uncinate); Solid tumor contact with CA and aorta
	SMA common hepatic artery	None	≤ 180°; Solit tumor contact without extension into CA or hepatic artery biforcation	> 180°
Venous involvement (portal vein/smv)		None; ≤ 180° contact without contour irregularity	> 180°; ≤ 180° with contour irregularity or thrombosis, with reconstructible PV/SMV; Solid tumor contact with IVC	Unreconstractible PV/SMV due to tumor involvement or occlusion

CA: Celiac artery; GDA: Gastroduodenal artery; IVC: Inferior vena cava; PV: Portal vein; SMA: Superior mesenteric artery; SMV: Superior mesenteric vein.

Table 3 Resectability criteria and societies

Vessel involvement	NCCN 2019	MDACC	ACTO	AHPBA/SSAT/SSO
CA abutment (≤ 180°)	Borderline	Borderline	Borderline	Unresectable
CA encasement (> 180°)	Borderline (body/tail); locally advanced (head/uncinate)	Unresectable	Unresectable	Unresectable
SMA abutment (< 180°); SMA encasement (> 180°); CHA abutment or encasement	Borderline; Locally advanced; Borderline	Borderline; Unresectable; Borderline	Borderline; Unresectable; Borderline	Borderline; Unresectable; Borderline
PV/SMV encasement (> 180°) or abutment (≤ 180°) with contour abnormality	Borderline	Borderline	Borderline	Borderline

ACTO: Alliance for Clinical Trials in Oncology; AHPBA: American Hepato-Pancreato-Biliary Association; CA: Celiac artery; CHA: Common hepatic artery; MDACC: The University of Texas MD Anderson Cancer Center; NCCN: National Comprehensive Cancer Network; PV: Portal vein; SMA: Superior mesenteric artery; SMV: Superior mesenteric vein; SSAT: Society for Surgery of the Alimentary Tract; SSO: Society for Surgical Oncology.

Table 4 Phase of trial and level of evidence of trial about chemotherapy for resectable and borderline resectable pancreatic ductal adenocarcinoma

Ref.	Phase of trial	Level of evidence
Neoptolemos et al[185]	III	II
Oettle et al[186]	III	I
Neoptolemos et al[187]	III	I
Neoptolemos et al[188]	III	I
Conroy et al[189]	III	I
You et al[195]	III	II
van Roessel et al[198]	IV	II
Versteijne et al[202]	III	II
Ghaneh et al[205]	II	II
Sohal et al[207]	IV	II
Labori et al[209]	III	II
Schwarz et al[210]	II	I
Ettrich et al[211]	II	II
Motoi et al[212]	III	II
UMIN-CTR Clinical Trial[215] (UMIN000026858)	III	II

Table 5 Phase and level of evidence of trials about immunotherapy for pancreatic ductal adenocarcinoma

Ref.	Phase of trial	Level of evidence
Royal et al[245]	II	II
Brahmer et al[246]	I	I
O'Reilly et al[247]	II	II
Tumeh et al[248]	II	III
Le et al[250]	II	II
Le et al[251]	II	II
Wainberg et al[252]	I	II
Weiss et al[253]	Ib/II	II
National Institute of Public Health[254] (JapicCTI-184230,ONO-4538)	II	II
Wang-Gillam et al[255]	II	II
Le et al[257]	IIb	I
Asahara et al[258]	I/II	II
Suzuki et al[259]	II	III
Miyazawa et al[260]	II	II
Wedén et al[261]	IV	III
Toubaji et al[262]	I	III
Abou-Alfa et al[263]	I/II	III
Cohn et al[264]	I	III
Katsuda et al[265]	III	I
Katsuda et al[266]	I/II	II
Beatty et al[270]	I	III
Le et al[271]	Ib	II
Chung et al[272]	I	III
Wang-Gillam et al[273]	I	III
Reiss et al[274]	II	III
Desai et al[275]	Ib/II	Ongoing trial
Chang et al[278]	I	III
Noonan et al[279]	II	II
Mahalingam et al[280]	Ib	III