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Objectives: Nab -paclitaxel and gemcitabine (GnP) or FOLFIRINOX (a combination of leucovorin, fluorouracil, irinotecan, and oxaliplatin [FFX]) is currently recognized as the standard first-line regimen for unresectable pancreatic ductal adenocarcinoma (PDAC). Class III β-tubulin (TUBB3) has the potential to predict resistance to taxane in various tumors; therefore, this study aimed to clarify whether TUBB3 is a predictive marker for GnP response., Methods: We retrospectively reviewed 113 patients with PDAC who received GnP or FFX as first-line chemotherapy and examined immunohistochemically the TUBB3 expression in specimens obtained by endoscopic ultrasound-guided fine-needle aspiration., Results: High TUBB3 expression was associated with a significantly lower disease control rate ( P = 0.017) and shorter progression-free survival (PFS) ( P = 0.019), and multivariate analysis revealed that TUBB3 expression was an independent variable for PFS in the GnP first-line group ( P = 0.045). In addition, in the FFX first-line group, TUBB3 expression was not correlated with PFS or overall survival (OS). In all 113 patients, TUBB3 expression was not also associated with OS., Conclusions: Class III β-tubulin might be a predictive factor for the response of GnP, but not a prognostic factor for OS, helping the selection of an optimized first-line chemotherapy regimen for unresectable PDAC., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The objective of this study was to evaluate the International Consensus Diagnostic Criteria (ICDC) for type 1 autoimmune pancreatitis (AIP) in comparison with the Japanese criteria 2011 (JPS2011)., Methods: We retrospectively investigated the usefulness of ICDC in comparison with JPS2011 in 64 patients with AIP and 90 patients with pancreatic cancer., Results: The sensitivity and specificity of ICDC for AIP were 98.4% (63/64) and 100% (90/90), respectively. The sensitivities and specificities of ductal imaging, serology, other organ involvement, and pancreatic histology were 74.1%, 89.1%, 53.1%, and 26.1% and 94.7%, 94.5%, 100%, and 100%, respectively. On the other hand, the sensitivities and specificities of JPS2011 for AIP were 84.4% (54/64) and 100% (90/90), respectively. The condition of all the 10 patients who were deniable or possible under the JPS2011 could be diagnosed as definitive AIP under the ICDC. The sensitivities and specificities of Japanese criteria 2006, Asian Diagnostic Criteria, and HISORt criteria were 80.6%, 84.4%, and 92.2% and 95.8%, 87.8%, and 100%, respectively., Conclusions: The sensitivity and specificity of ICDC are higher than those of previous criteria. The JPS2011 is easy to handle for general practice, and specificity is very high. However, the sensitivity of JPS2011 is lower than that of ICDC, and improvement of sensitivity is to be hoped in the future.

Objectives: The aim of the study was to clarify the problems of the Japanese criteria for autoimmune pancreatitis (AIP) in comparison with the other criteria., Methods: We retrospectively investigated the clinical, imaging, serological, and histopathogic features, together with other organ involvement and response to steroid, in 50 patients with AIP diagnosed on the basis of the Japanese, Korean, HISORt, and Asian criteria. Thirty-five patients with pancreatic cancer were enrolled as a control group., Results: Forty (80%) of 50 patients received a diagnosis of AIP on the basis of the Japanese criteria. Imaging findings and serological parameters fulfilled the Japanese criteria in 40 (80%) and 50 (100%) of the patients. Pathological findings fulfilled the Japanese criteria in 6 (43%) of 14 patients. All of the 10 patients who did not have a diagnosis of AIP did not fulfill the imaging criteria. Serological parameters fulfilled the Japanese criteria in 8 (23%) of 35 patients with pancreatic cancer. The sensitivities of the Japanese, Korean, HISORt, and Asian criteria for AIP were 80%, 86%, 92%, and 82%, respectively. The specificities of those 4 criteria were 89%, 89%, 97%, and 89%, respectively., Conclusions: The low sensitivity of imaging criteria and low specificity of serological criteria were the problems in the Japanese criteria.

Objectives: To clarify the frequency and clinical significance of extrapancreatic lesions in autoimmune pancreatitis (AIP)., Methods: The frequency and clinical characteristics of extrapancreatic lesions during the clinical course of AIP were investigated retrospectively in 64 patients with AIP. The predictive factors for relapse of AIP at clinical onset were also examined., Results: Extrapancreatic lesions occurred in 95% (61/64) during the clinical course of AIP. The frequencies of sclerosing cholangitis, sclerosing sialadenitis, retroperitoneal fibrosis, and mediastinal or hilar lymphadenopathy were 84% (54/64), 23% (15/64), 16% (10/64), and 77% (27/35), respectively. Patients with sclerosing sialadenitis or extrapancreatic bile duct sclerosing cholangitis had a significantly higher serum immunoglobulin G concentration than those without (P = 0.005 and P = 0.016, respectively). Univariate analysis revealed that sclerosing sialadenitis (P = 0.005), diffuse pancreatic ductal changes (P = 0.028), and a high serum immunoglobulin G concentration (P = 0.030) at clinical onset of AIP were significant predictive factors for relapse. Multivariate analysis revealed that diffuse pancreatic ductal changes (P = 0.005) and sclerosing sialadenitis (P = 0.012) were significant independent predictive factors for relapse of AIP., Conclusions: The frequency of extrapancreatic lesions with AIP during the clinical course was high. The presence of sclerosing sialadenitis at clinical onset is a significant predictive factor for relapse of AIP.