Pancreatic ductal adenocarcinoma (PDAC) is a lethal neoplasm because of difficulties in early detection. This delay is caused by lack of non-invasive screening, or tests for early diagnosis, in addition to rapid disease progression with non-specific symptoms. Most patients present with unresectable disease, and outcomes are consequently poor. Furthermore, advances in surgical techniques, perioperative management and oncological treatments have made limited impact on overall survival. This is true even despite our improved understanding of PDAC genetic/transcriptional landscapes, molecular subtypes, intra-/inter-tumoural heterogeneity and innovative therapeutics. As early diagnosis is vital for prolonging survival, there is an urgent need for reliable, highly sensitive and specific biomarkers. Blood-based biomarkers are an ideal choice due to their relatively low cost, minimal invasiveness and accessibility for repeated sampling. However, these biomarkers should also be able to stage the disease, as well as provide prognostic/predictive information to guide clinical decisions, especially since selection and timing of therapeutic modalities can be critical.1 Extracellular vesicles (EVs; exosomes, microvesicles and apoptotic bodies) are lipid bilayer structures found in biofluids that contain cell-derived bioactive molecules, including nucleic acids.2 EVs have recently emerged as critical mediators of communication between tumour cells and also the surrounding microenvironment.3 EVs can transmit information to recipient cells by acting at cell surface, releasing their cargo through membrane fusion, or may be internalised via endocytosis.4 Importantly, transferred EV components are functional and influence the phenotype of recipient cells,5 6 including …

中文翻译：

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使用血浆细胞外囊泡 RNA 谱诊断胰腺导管腺癌

由于早期发现困难，胰腺导管腺癌 (PDAC) 是一种致命的肿瘤。这种延迟是由于缺乏非侵入性筛查或早期诊断测试以及非特异性症状的快速疾病进展造成的。大多数患者出现无法切除的疾病，因此结果很差。此外，外科技术、围手术期管理和肿瘤治疗的进步对总生存率的影响有限。尽管我们对 PDAC 遗传/转录景观、分子亚型、肿瘤内/肿瘤间异质性和创新疗法的理解有所提高，但事实确实如此。由于早期诊断对于延长生存期至关重要，因此迫切需要可靠、高度敏感和特异的生物标志物。基于血液的生物标志物是一种理想的选择，因为它们成本相对较低、侵入性最小且易于重复采样。然而，这些生物标志物也应该能够对疾病进行分期，并提供预后/预测信息来指导临床决策，特别是因为治疗方式的选择和时机可能至关重要。 1 细胞外囊泡（EV；外泌体、微囊泡和凋亡小体） ) 是在含有细胞衍生的生物活性分子（包括核酸）的生物流体中发现的脂质双层结构。2 EVs 最近已成为肿瘤细胞与周围微环境之间通讯的关键介质。 3 EVs 可以通过作用于受体细胞来传递信息细胞表面，通过膜融合释放其货物，或者可能通过内吞作用被内化。