關(guān)于胰腺腺鱗癌的研究文獻(xiàn)綜述目錄TOC\o"1-3"\h\u12856關(guān)于胰腺腺鱗癌的研究文獻(xiàn)綜述 1216571胰腺腺鱗癌的病理特征 189712胰腺腺鱗癌的起源假說 2130283胰腺腺鱗癌的臨床表現(xiàn) 2322574胰腺腺鱗癌的術(shù)前診斷 2102735胰腺腺鱗癌的治療方案 3217706胰腺腺鱗癌的基因組學(xué)分析 41胰腺腺鱗癌的病理特征1907年Herxheimer首次描述腺鱗癌該種實(shí)體腫瘤，并將其命名為adenocancroid（腺樣體），之后有學(xué)者將這種包括柱狀腺癌和角蛋白類鱗狀細(xì)胞的腫瘤稱為混合鱗狀腺癌、粘液表皮樣癌和腺棘皮瘤ADDINEN.CITE<EndNote><Cite><Author>Madura</Author><Year>1999</Year><RecNum>603</RecNum><DisplayText><styleface="superscript">[28]</style></DisplayText><record><rec-number>603</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616584260">603</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Madura,J.A.</author><author>Jarman,B.T.</author><author>Doherty,M.G.</author><author>Yum,M.N.</author><author>Howard,T.J.</author></authors></contributors><auth-address>DepartmentofSurgery,IndianaUniversitySchoolofMedicine,Indianapolis46202-5125,USA.</auth-address><titles><title>Adenosquamouscarcinomaofthepancreas</title><secondary-title>ArchSurg</secondary-title><alt-title>Archivesofsurgery(Chicago,Ill.:1960)</alt-title></titles><periodical><full-title>ArchSurg</full-title><abbr-1>Archivesofsurgery(Chicago,Ill.:1960)</abbr-1></periodical><alt-periodical><full-title>ArchSurg</full-title><abbr-1>Archivesofsurgery(Chicago,Ill.:1960)</abbr-1></alt-periodical><pages>599-603</pages><volume>134</volume><number>6</number><edition>1999/06/15</edition><keywords><keyword>Carcinoma,Adenosquamous/*surgery</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>PancreaticNeoplasms/*surgery</keyword><keyword>RetrospectiveStudies</keyword></keywords><dates><year>1999</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0004-0010(Print) 0004-0010</isbn><accession-num>10367867</accession-num><urls></urls><electronic-resource-num>10.1001/archsurg.134.6.599</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[28]。組織學(xué)上，目前診斷胰腺腺鱗癌的指南定義為30%或更高比例的惡性鱗狀細(xì)胞癌成分與導(dǎo)管腺癌混合的胰腺腫瘤ADDINEN.CITEADDINEN.CITE.DATA[28,29]，胰腺腺鱗癌是較為罕見的胰腺癌亞型，較低生存率與其侵襲性行為相關(guān)。在其他器官系統(tǒng)中，如肺、食道、結(jié)腸、胃、唾液腺和女性生殖器官，這種混合腫瘤更常見ADDINEN.CITE<EndNote><Cite><Author>Borazanci</Author><Year>2015</Year><RecNum>605</RecNum><DisplayText><styleface="superscript">[30]</style></DisplayText><record><rec-number>605</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616584371">605</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Borazanci,E.</author><author>Millis,S.Z.</author><author>Korn,R.</author><author>Han,H.</author><author>Whatcott,C.J.</author><author>Gatalica,Z.</author><author>Barrett,M.T.</author><author>Cridebring,D.</author><author>VonHoff,D.D.</author></authors></contributors><auth-address>ErkutBorazanci,DanielDVonHoff,HonorHealthResearchInstitute,VirginiaG.PiperCancerCenter,Scottsdale,AZ85258,UnitedStates.</auth-address><titles><title>Adenosquamouscarcinomaofthepancreas:Molecularcharacterizationof23patientsalongwithaliteraturereview</title><secondary-title>WorldJGastrointestOncol</secondary-title><alt-title>Worldjournalofgastrointestinaloncology</alt-title></titles><periodical><full-title>WorldJGastrointestOncol</full-title><abbr-1>Worldjournalofgastrointestinaloncology</abbr-1></periodical><alt-periodical><full-title>WorldJGastrointestOncol</full-title><abbr-1>Worldjournalofgastrointestinaloncology</abbr-1></alt-periodical><pages>132-40</pages><volume>7</volume><number>9</number><edition>2015/09/18</edition><keywords><keyword>Adenosquamouscarcinomaofthepancreas</keyword><keyword>Molecularprofiling</keyword><keyword>Review</keyword></keywords><dates><year>2015</year><pub-dates><date>Sep15</date></pub-dates></dates><isbn>1948-5204(Print)</isbn><accession-num>26380056</accession-num><urls></urls><custom2>PMC4569590</custom2><electronic-resource-num>10.4251/wjgo.v7.i9.132</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[30]。胰腺腺鱗癌的病理包括典型的鱗狀細(xì)胞癌成分，其特征是有輪狀上皮、角質(zhì)角蛋白或珍珠狀上皮ADDINEN.CITEADDINEN.CITE.DATA[31]。兩個(gè)胰腺腺鱗癌病例報(bào)道中發(fā)現(xiàn)鱗狀細(xì)胞癌成分位于腫瘤周圍，而腺癌成分位于中心ADDINEN.CITEADDINEN.CITE.DATA[32,33]。胰腺腺鱗癌患者腫瘤細(xì)胞壞死多見，腫瘤分級高。BrodyJr和JamaliM分別報(bào)道了透明細(xì)胞和橫紋肌樣成分的存在ADDINEN.CITEADDINEN.CITE.DATA[34,35]。AlwaheebS等ADDINEN.CITE<EndNote><Cite><Author>Alwaheeb</Author><Year>2005</Year><RecNum>611</RecNum><DisplayText><styleface="superscript">[36]</style></DisplayText><record><rec-number>611</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616584653">611</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Alwaheeb,S.</author><author>Chetty,R.</author></authors></contributors><auth-address>DepartmentofPathology,UniversityHealthNetwork/TorontoMedicalLaboratories,UniversityofToronto,Toronto,Ontario,Canada.</auth-address><titles><title>Adenosquamouscarcinomaofthepancreaswithanacantholyticpatterntogetherwithosteoclast-likeandpleomorphicgiantcells</title><secondary-title>JClinPathol</secondary-title><alt-title>Journalofclinicalpathology</alt-title></titles><periodical><full-title>JClinPathol</full-title><abbr-1>Journalofclinicalpathology</abbr-1></periodical><alt-periodical><full-title>JClinPathol</full-title><abbr-1>Journalofclinicalpathology</abbr-1></alt-periodical><pages>987-90</pages><volume>58</volume><number>9</number><edition>2005/08/30</edition><keywords><keyword>Acantholysis/pathology</keyword><keyword>Carcinoma,Adenosquamous/*pathology</keyword><keyword>GiantCells/*pathology</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>Osteoclasts/*pathology</keyword><keyword>PancreaticNeoplasms/*pathology</keyword></keywords><dates><year>2005</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0021-9746(Print) 0021-9746</isbn><accession-num>16126885</accession-num><urls></urls><custom2>PMC1770836</custom2><electronic-resource-num>10.1136/jcp.2004.025221</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[36]2005年報(bào)道了一例胰腺腺鱗癌鱗癌間質(zhì)成分中破骨細(xì)胞和多形性巨細(xì)胞，同時(shí)注意到鱗狀細(xì)胞癌成分中存在棘皮分解。O‘ConnorJK等ADDINEN.CITEADDINEN.CITE.DATA[37]的研究結(jié)果發(fā)現(xiàn)，胰腺腺鱗癌的生長速度是胰腺癌的兩倍。圖2-2典型胰腺腺鱗癌顯微鏡下圖像（放大20倍）2胰腺腺鱗癌的起源假說目前推測胰腺腺鱗癌起源的假說主要有三種理論，分別為分化理論、碰撞理論以及鱗狀化生理論。根據(jù)分化理論，胰腺腺鱗癌腺癌和鱗癌的成分是從同一胰腺干細(xì)胞分化而來的ADDINEN.CITEADDINEN.CITE.DATA[33,37,38]，這一理論在最近的分子學(xué)發(fā)現(xiàn)中得到證據(jù)支持，YuanFangADDINEN.CITEADDINEN.CITE.DATA[39]等人2017年發(fā)現(xiàn)胰腺腺鱗癌中腺癌組分和鱗癌組分具有相似的基因組學(xué)改變。鱗狀化生理論ADDINEN.CITEADDINEN.CITE.DATA[38,40]認(rèn)為鱗狀化生是由慢性胰腺炎引起的導(dǎo)管炎癥或腺瘤性腫瘤的阻塞引起的，最終引起胰腺腺鱗癌，BoeckerW等ADDINEN.CITEADDINEN.CITE.DATA[41]2020年發(fā)現(xiàn)胰腺腺鱗癌的鱗癌成分來源于預(yù)先存在的胰腺導(dǎo)管腺癌細(xì)胞中，該證據(jù)支持鱗狀化生假說。碰撞理論ADDINEN.CITEADDINEN.CITE.DATA[28,38,42]認(rèn)為兩個(gè)組織學(xué)上不同的腫瘤獨(dú)立地在胰腺中產(chǎn)生，結(jié)合在一起形成胰腺腺鱗癌，Simone等ADDINEN.CITE<EndNote><Cite><Author>Simone</Author><Year>2013</Year><RecNum>623</RecNum><DisplayText><styleface="superscript">[1]</style></DisplayText><record><rec-number>623</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616585190">623</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Simone,C.G.</author><author>ZuluagaToro,T.</author><author>Chan,E.</author><author>Feely,M.M.</author><author>Trevino,J.G.</author><author>George,T.J.,Jr.</author></authors></contributors><auth-address>DivisionofHematologyandOncologyDepartmentofMedicine.</auth-address><titles><title>Characteristicsandoutcomesofadenosquamouscarcinomaofthepancreas</title><secondary-title>GastrointestCancerRes</secondary-title><alt-title>Gastrointestinalcancerresearch:GCR</alt-title></titles><periodical><full-title>GastrointestCancerRes</full-title><abbr-1>Gastrointestinalcancerresearch:GCR</abbr-1></periodical><alt-periodical><full-title>GastrointestCancerRes</full-title><abbr-1>Gastrointestinalcancerresearch:GCR</abbr-1></alt-periodical><pages>75-9</pages><volume>6</volume><number>3</number><edition>2013/08/13</edition><dates><year>2013</year><pub-dates><date>May</date></pub-dates></dates><isbn>1934-7820(Print) 1934-7820</isbn><accession-num>23936547</accession-num><urls></urls><custom2>PMC3737509</custom2><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[1]提出慢性胰腺炎背景下發(fā)生的胰腺導(dǎo)管上皮鱗狀化生與胰腺腺鱗癌的發(fā)生有關(guān)，然而大多數(shù)學(xué)者并不贊同碰撞理論假說。3胰腺腺鱗癌的臨床表現(xiàn)與胰腺癌相比，胰腺腺鱗癌具有更強(qiáng)的侵襲性特征，低分化、神經(jīng)浸潤比例更高、更多的陽性淋巴結(jié)數(shù)目ADDINEN.CITEADDINEN.CITE.DATA[31]。胰腺腺鱗癌患者與胰腺導(dǎo)管腺癌的臨床表現(xiàn)類似，無特異性臨床表現(xiàn)，主要癥狀以腹痛、體重減輕、背痛、惡心、嘔吐、厭食、黃疸為最常見ADDINEN.CITEADDINEN.CITE.DATA[38]，既往有病例報(bào)道ADDINEN.CITEADDINEN.CITE.DATA[29,32]過臨床并發(fā)癥有深靜脈血栓形成、糖尿病和肺栓塞。惡性腫瘤相關(guān)的高鈣血癥更多的是與頭部，頸部，肺和食管鱗狀細(xì)胞癌相關(guān)，而在胰腺腺鱗癌患者中并不多見。KobayashiNADDINEN.CITEADDINEN.CITE.DATA[43]和InoueTADDINEN.CITEADDINEN.CITE.DATA[44]分別報(bào)道一例胰腺腺鱗癌患者因甲狀旁腺激素相關(guān)蛋白(PTH-RP)分泌引起的體液性高鈣血癥，盡管采用雙膦酸鹽治療，高鈣血癥仍持續(xù)存在，其中InoueT等人通過免疫組化進(jìn)一步證實(shí)PTH-RP定位于腺鱗癌細(xì)胞。4胰腺腺鱗癌的術(shù)前診斷準(zhǔn)確的進(jìn)行胰腺腺鱗癌術(shù)前診斷是具有挑戰(zhàn)性。目前胰腺腺鱗癌的常規(guī)影像學(xué)診斷手段為超聲、CT、MRI，其中CT檢查在胰腺腺鱗癌診斷中最為常用。有學(xué)者ADDINEN.CITE<EndNote><Cite><Author>Lozano</Author><Year>1998</Year><RecNum>630</RecNum><DisplayText><styleface="superscript">[45]</style></DisplayText><record><rec-number>630</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616585690">630</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Lozano,M.D.</author><author>Panizo,A.</author><author>Sola,I.J.</author><author>Pardo-Mindán,F.J.</author></authors></contributors><auth-address>DepartmentofPathology,UniversityofNavarra,Pamplona,Spain.mdlozano@cun.unav.es</auth-address><titles><title>FNACguidedbycomputedtomographyinthediagnosisofprimarypancreaticadenosquamouscarcinoma.Areportofthreecases</title><secondary-title>ActaCytol</secondary-title><alt-title>Actacytologica</alt-title></titles><periodical><full-title>ActaCytol</full-title><abbr-1>Actacytologica</abbr-1></periodical><alt-periodical><full-title>ActaCytol</full-title><abbr-1>Actacytologica</abbr-1></alt-periodical><pages>1451-4</pages><volume>42</volume><number>6</number><edition>1998/12/16</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Biopsy,Needle</keyword><keyword>Carcinoma,Adenosquamous/*diagnosticimaging/*pathology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>PancreaticNeoplasms/*diagnosticimaging/*pathology</keyword><keyword>Tomography,X-RayComputed</keyword></keywords><dates><year>1998</year><pub-dates><date>Nov-Dec</date></pub-dates></dates><isbn>0001-5547(Print) 0001-5547</isbn><accession-num>9850660</accession-num><urls></urls><electronic-resource-num>10.1159/000332185</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[45]在胰腺腺鱗癌中采用細(xì)針抽吸細(xì)胞學(xué)(FNAC)檢查明確病理類型，但目前并不建議使用，原因是可能引起腹膜播種惡性腫瘤細(xì)胞。在約翰·霍普金斯大學(xué)和埃默里大學(xué)的回顧性研究中發(fā)現(xiàn)，三分之二（67%）患者最初被診斷為胰腺癌，在手術(shù)切除后最終確診為PASC。病理學(xué)家有可能忽略或者錯(cuò)誤分類了胰腺FNAC標(biāo)本中的鱗狀細(xì)胞成分，這不僅導(dǎo)致PASC報(bào)告缺失，而且完全可能漏診該種惡性腫瘤。在既往的胰腺腺鱗癌文獻(xiàn)報(bào)道中，CT影像學(xué)特征包括瘤體邊緣強(qiáng)化、邊界不清以及腫瘤中央壞死等特點(diǎn)。NabaeTADDINEN.CITEADDINEN.CITE.DATA[46]1998年發(fā)現(xiàn)兩例胰腺腺鱗癌患者均存在腫瘤浸潤性中心壞死，這一特征似乎有助于胰腺腺鱗癌的診斷。ImaokaH等ADDINEN.CITEADDINEN.CITE.DATA[47]對23例胰腺腺鱗癌和46例胰腺實(shí)體腫瘤（以胰腺導(dǎo)管腺癌為主）進(jìn)行的2：1匹配的病例對照研究，對超聲造影和超聲內(nèi)鏡的圖像進(jìn)行評價(jià)，研究結(jié)果表明瘤體周圍邊緣環(huán)形增強(qiáng)是胰腺腺鱗癌最有用的預(yù)測因子，在胰腺腺鱗癌的檢測和分期中，觀察邊緣環(huán)形增強(qiáng)可以提示胰腺腺鱗癌患者不良的預(yù)后，同時(shí)可能幫助鑒別診斷PDAC和PASC。KujiI等ADDINEN.CITEADDINEN.CITE.DATA[48]發(fā)現(xiàn)鎵(Ga-67)在腫瘤內(nèi)強(qiáng)而均勻的攝取，這被認(rèn)為是由于在鱗狀細(xì)胞癌組分中的積聚所致，提示Ga-67檸檬酸鹽顯像可用于胰腺腺鱗癌的診斷。胰腺腺鱗癌可以選擇性地吸收鎵-67(Ga-67)，可以通過核掃描可視化檢測該腫瘤類型。5胰腺腺鱗癌的治療方案目前的胰腺腺鱗癌沒有標(biāo)準(zhǔn)的治療方案，由于該種胰腺腫瘤組織學(xué)類型的罕見性，導(dǎo)致提供的證據(jù)非常有限，大多為個(gè)案報(bào)道，難以實(shí)施循證醫(yī)學(xué)。胰腺腺鱗癌外科治療以手術(shù)為主，手術(shù)切除是唯一治愈的機(jī)會，同時(shí)是否手術(shù)切除也是胰腺腺鱗癌患者生存最強(qiáng)的預(yù)測因子。Katz等ADDINEN.CITEADDINEN.CITE.DATA[49]分析了2000-2007年加州癌癥登記處95例胰腺腺鱗癌患者的臨床參數(shù)，結(jié)果表明接受腫瘤切除的患者中位生存期為12個(gè)月(95%CI，8-52)，而未手術(shù)治療的患者僅為5個(gè)月(95%CI，1-12)，生存曲線顯示手術(shù)治療能顯著改善胰腺腺鱗癌患者的預(yù)后。同樣地，在BoydCAADDINEN.CITE<EndNote><Cite><Author>Boyd</Author><Year>2012</Year><RecNum>635</RecNum><DisplayText><styleface="superscript">[4]</style></DisplayText><record><rec-number>635</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616585920">635</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Boyd,C.A.</author><author>Benarroch-Gampel,J.</author><author>Sheffield,K.M.</author><author>Cooksley,C.D.</author><author>Riall,T.S.</author></authors></contributors><auth-address>DepartmentofSurgery,TheUniversityofTexasMedicalBranch,Galveston,TX77555-0541,USA.</auth-address><titles><title>415patientswithadenosquamouscarcinomaofthepancreas:apopulation-basedanalysisofprognosisandsurvival</title><secondary-title>JSurgRes</secondary-title><alt-title>TheJournalofsurgicalresearch</alt-title></titles><periodical><full-title>JSurgRes</full-title><abbr-1>TheJournalofsurgicalresearch</abbr-1></periodical><alt-periodical><full-title>JSurgRes</full-title><abbr-1>TheJournalofsurgicalresearch</abbr-1></alt-periodical><pages>12-9</pages><volume>174</volume><number>1</number><edition>2011/08/06</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Carcinoma,Adenosquamous/*mortality/pathology/surgery</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>NeoplasmStaging</keyword><keyword>PancreaticNeoplasms/*mortality/pathology/surgery</keyword><keyword>Prognosis</keyword><keyword>SurvivalRate</keyword></keywords><dates><year>2012</year><pub-dates><date>May1</date></pub-dates></dates><isbn>0022-4804(Print) 0022-4804</isbn><accession-num>21816433</accession-num><urls></urls><custom2>PMC3210865</custom2><custom6>NIHMS304835</custom6><electronic-resource-num>10.1016/j.jss.2011.06.015</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[4]等人的研究中，手術(shù)切除對腺鱗癌患者預(yù)后的影響最大，未手術(shù)治療的腺鱗癌患者死亡的幾率是手術(shù)患者的2.35倍（HR2.35，95%CI1.47-3.76）。目前國內(nèi)外沒有標(biāo)準(zhǔn)的胰腺腺鱗癌放化療方案。TanakaADDINEN.CITEADDINEN.CITE.DATA[50]等人的研究表明用干擾素-α、腫瘤壞死因子-α和5-氟尿嘧啶聯(lián)合應(yīng)用的新輔助化療可以縮小無法切除的胰腺腺鱗癌患者的腫瘤體積。OkabayashiTADDINEN.CITE<EndNote><Cite><Author>Okabayashi</Author><Year>2008</Year><RecNum>637</RecNum><DisplayText><styleface="superscript">[51]</style></DisplayText><record><rec-number>637</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616586026">637</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Okabayashi,T.</author><author>Hanazaki,K.</author></authors></contributors><titles><title>Surgicaloutcomeofadenosquamouscarcinomaofthepancreas</title><secondary-title>WorldJGastroenterol</secondary-title><alt-title>Worldjournalofgastroenterology</alt-title></titles><periodical><full-title>WorldJGastroenterol</full-title><abbr-1>Worldjournalofgastroenterology</abbr-1></periodical><alt-periodical><full-title>WorldJGastroenterol</full-title><abbr-1>Worldjournalofgastroenterology</abbr-1></alt-periodical><pages>6765-70</pages><volume>14</volume><number>44</number><edition>2008/12/06</edition><keywords><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Carcinoma,Adenosquamous/mortality/pathology/*surgery</keyword><keyword>Chemotherapy,Adjuvant</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>*Pancreatectomy</keyword><keyword>PancreaticNeoplasms/mortality/pathology/*surgery</keyword><keyword>Radiotherapy,Adjuvant</keyword><keyword>SurvivalAnalysis</keyword><keyword>TimeFactors</keyword><keyword>TreatmentOutcome</keyword></keywords><dates><year>2008</year><pub-dates><date>Nov28</date></pub-dates></dates><isbn>1007-9327(Print) 1007-9327</isbn><accession-num>19058301</accession-num><urls></urls><custom2>PMC2773870</custom2><electronic-resource-num>10.3748/wjg.14.6765</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[51]報(bào)道了7例接受放療的胰腺腺鱗癌患者，其2年生存率為20%，中位生存期為13個(gè)月；39例患者中僅8名患者接受了輔助化療，這表明術(shù)后輔助化療通常不適用于胰腺腺鱗癌患者，輔助化療組幾乎全部接受了以5-氟尿嘧啶為基礎(chǔ)的方案治療。術(shù)后化療組2年生存率為16.7%，顯著高于未化療組的2年生存率的9.2%，但二者差異無統(tǒng)計(jì)學(xué)意義（P=0.364）。在YuanFang等ADDINEN.CITE<EndNote><Cite><Author>Fang</Author><Year>2019</Year><RecNum>638</RecNum><DisplayText><styleface="superscript">[3]</style></DisplayText><record><rec-number>638</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616586060">638</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Fang,Y.</author><author>Pu,N.</author><author>Zhang,L.</author><author>Wu,W.</author><author>Lou,W.</author></authors></contributors><auth-address>DepartmentofPancreaticSurgery,ZhongshanHospital,FudanUniversity,Shanghai200032,China.</auth-address><titles><title>Chemoradiotherapyisassociatedwithimprovedsurvivalforresectedpancreaticadenosquamouscarcinoma:aretrospectivecohortstudyfromtheSEERdatabase</title><secondary-title>AnnTranslMed</secondary-title><alt-title>Annalsoftranslationalmedicine</alt-title></titles><periodical><full-title>AnnTranslMed</full-title><abbr-1>Annalsoftranslationalmedicine</abbr-1></periodical><alt-periodical><full-title>AnnTranslMed</full-title><abbr-1>Annalsoftranslationalmedicine</abbr-1></alt-periodical><pages>522</pages><volume>7</volume><number>20</number><edition>2019/12/07</edition><keywords><keyword>Pancreaticadenosquamouscarcinoma(PASC)</keyword><keyword>adjuvanttreatment</keyword><keyword>chemoradiotherapy</keyword></keywords><dates><year>2019</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>2305-5839(Print) 2305-5839</isbn><accession-num>31807504</accession-num><urls></urls><custom2>PMC6861782</custom2><electronic-resource-num>10.21037/atm.2019.10.12</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>[3]人對159例僅原發(fā)于胰腺腺鱗癌患者研究中，術(shù)后放療聯(lián)合化療的中位生存時(shí)間，與無放化療組相比，從8個(gè)月延長至23個(gè)月；同時(shí)在TNM分期亞組分析中，接受放化療的PASC患者的OS明顯高于Ⅰ、Ⅱ、Ⅳ期未接受化療或放療的患者，所有這些結(jié)果均表明，化學(xué)放射治療在PASC治療中有其潛在的優(yōu)勢。對于晚期不可切除或轉(zhuǎn)移性胰腺腺鱗癌，目前的化療方案類似于胰腺導(dǎo)管腺癌，吉西他濱可以單獨(dú)使用，也可以與5-FU、卡培他濱、鉑劑或厄洛替尼等藥物聯(lián)合使用。WildAT等ADDINEN.CITEADDINEN.CITE.DATA[52]在62例胰腺腺鱗癌手術(shù)患者的研究發(fā)現(xiàn)在吉西他濱或5-氟尿嘧啶輔助化療中加入順鉑或奧沙利鉑，與未接受鉑類藥物的患者相比，其中位生存期明顯延長，結(jié)果表明可切除的胰腺腺鱗癌輔助方案中加入鉑類藥物可能會提高這些患者的生存率，這需要大樣本、多中心、前瞻性研究來證實(shí)。6胰腺腺鱗癌的基因組學(xué)分析由于胰腺腺鱗癌的罕見性，胰腺腺鱗癌文獻(xiàn)回顧中，很少有基因組測序及分子特征的分析。BorazanciEADDINEN.CITE<EndNote><Cite><Author>Borazanci</Author><Year>2015</Year><RecNum>640</RecNum><DisplayText><styleface="superscript">[30]</style></DisplayText><record><rec-number>640</rec-number><foreign-keys><keyapp="EN"db-id="p0rwrp05g0x5toerpv7xwfd4sf25wd0dfta5"timestamp="1616586126">640</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Boraza