1
|
Ba Q, Wang X, Lu Y. Establishment of a prognostic model for pancreatic cancer based on mitochondrial metabolism related genes. Discov Oncol 2024; 15:376. [PMID: 39196457 PMCID: PMC11358576 DOI: 10.1007/s12672-024-01255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 08/20/2024] [Indexed: 08/29/2024] Open
Abstract
AIM Pancreatic ductal adenocarcinoma (PAAD) is recognized as an exceptionally aggressive cancer that both highly lethal and unfavorable prognosis. The mitochondrial metabolism pathway is intimately involved in oncogenesis and tumor progression, however, much remains unknown in this area. In this study, the bioinformatic tools have been used to construct a prognostic model with mitochondrial metabolism-related genes (MMRGs) to evaluate the survival, immune status, mutation profile, and drug sensitivity of PAAD patients. METHOD Univariate Cox regression and LASSO regression were used to screen the differentially expressed genes (DEGs), and multivariate Cox regression was used to develop the risk model. Kaplan-Meier estimator was employed to identify MMRGs signatures associated with overall survival (OS). ROC curves were utilized to evaluate the model's performance. Maftools, immunedeconv and CIBERSORT R packages were applied to analyze the gene mutation profiles and immune status. The corresponding sensitivity to pharmaceutical agents was assessed using oncoPredict R packages. RESULTS A prognostic model with five MMRGs was developed, which defined the patients as high-risk showed lower survival rates. There was good consistency among individuals categorized as high-risk, showing elevated rates of genetic alterations, particularly in the TP53 and KRAS genes. Furthermore, these patients exhibited increased levels of immunosuppression, characterized by an increased presence of macrophages, neutrophils, Th2 cells, and regulatory T cells. Additionally, high-risk patients showed increased sensitivity to Sabutoclax and Venetoclax. CONCLUSION By utilizing a gene signature associated with mitochondrial metabolism, a prognostic model has been established which could be a highly efficient method for predicting the outcomes of PAAD patients.
Collapse
Affiliation(s)
- Qinwen Ba
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Wang
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Yanjun Lu
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
2
|
Chang S, Liu Y, Liang Y, Man Q, Li H, Guo Y, Zhao T. Biological risk based on preoperative serum CA19-9 and histological grade predicts prognosis and improves accuracy of classification in patients with pancreatic ductal adenocarcinoma. Cancer Rep (Hoboken) 2023; 6:e1911. [PMID: 37827990 PMCID: PMC10728503 DOI: 10.1002/cnr2.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Carbohydrate antigen (CA) 19-9 and histological grade can serve as indicators of the biological characteristics of pancreatic ductal adenocarcinoma (PDAC). AIMS The aim of this study was to investigate the combined impact of preoperative CA19-9 levels and histological grade on prognosis and classification accuracy in PDAC patients. METHODS AND RESULTS A retrospective cohort study was conducted on 612 patients with PDAC who underwent curative pancreatectomy, and a biological risk model based on preoperative CA19-9 levels and histology grade was established. The prognostic importance of the biological risk model was evaluated, and its validity was confirmed through a validation cohort of 218 patients. The survival of patients with PDAC was independently associated with preoperative CA19-9 levels and histology grade, indicating a biological risk. This biological risk was incorporated into the eighth edition of the TNM staging system, leading to the development of a modified TNM (mTNM) staging system. Receiver operating characteristic (ROC) curves demonstrated that the mTNM staging system had a significantly larger area under the curve (AUC) than the TNM staging system. The discriminatory capacity of the mTNM staging system was further validated in an independent cohort. CONCLUSION Biological risk based on preoperative CA19-9 and histological grade could predict the survival of patients with PDAC. The incorporation of biological risk into the TNM staging system has the potential to enhance the accuracy of patient classification in PDAC, predicting patient survival and enabling the development of individualized treatment plans.
Collapse
Affiliation(s)
- Shaofei Chang
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
- Department of GastroenteropancreasShanxi Provincial People's HospitalTaiyuanChina
| | - Yaohua Liu
- Graduate SchoolShanxi Medical UniversityJinzhongChina
- Department of UltrasoundThe Second People's Hospital of Shanxi ProvinceTaiyuanChina
| | - Yuexiang Liang
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
| | - Quan Man
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
| | - Haorui Li
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
| | - Yu Guo
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
| | - Tiansuo Zhao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and TherapyTianjin's Clinical Research Center For CancerTianjinChina
| |
Collapse
|
3
|
Liang Y, Cui J, Ding F, Zou Y, Guo H, Man Q, Chang S, Gao S, Hao J. A new staging system for postoperative prognostication in pancreatic ductal adenocarcinoma. iScience 2023; 26:107589. [PMID: 37664604 PMCID: PMC10469961 DOI: 10.1016/j.isci.2023.107589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 07/09/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
The current TNM staging system for pancreatic ductal adenocarcinoma (PDAC) has revised the definitions of T and N categories as well as stage groups. However, studies validating these modifications have yielded inconsistent results. The existing TNM staging system in prognostic prediction remains unsatisfactory. The prognosis of PDAC is closely associated with pathological and biological factors. Herein, we propose a new staging system incorporating distant metastasis, postoperative serum levels of CA19-9 and CEA, tumor size, lymph node metastasis, lymphovascular involvement, and perineural invasion to enhance the accuracy of prognosis assessment. The proposed staging system exhibited a strong correlation with both overall survival and recurrence-free survival, effectively stratifying survival into five distinct tiers. Additionally, it had favorable discrimination and calibration. Thus, the proposed staging system demonstrates superior prognostic performance compared to the TNM staging system, and can serve as a valuable complementary tool to address the limitations of TNM staging in prognostication.
Collapse
Affiliation(s)
- Yuexiang Liang
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
- Department of Gastrointestinal Oncology Surgery, Center of Cancer Prevention and Therapy, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Jingli Cui
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
- Department of General Surgery, Weifang People’s Hospital, Weifang 261044, China
| | - Fanghui Ding
- Department of General Surgery, the First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Yiping Zou
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
| | - Hanhan Guo
- Department of Gastrointestinal Oncology Surgery, Center of Cancer Prevention and Therapy, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, China
| | - Quan Man
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
| | - Shaofei Chang
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
- Department of Gastrointestinal Pancreatic Surgery, Shanxi Provincial People’s Hospital, Taiyuan 030012, China
| | - Song Gao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
| | - Jihui Hao
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center For Cancer, Tianjin 30060, China
| |
Collapse
|
4
|
Zhu L, Shen S, Wang H, Zhang G, Yin X, Shi X, Gao S, Han J, Ren Y, Wang J, Jiang H, Guo S, Jin G. A neoadjuvant therapy compatible prognostic staging for resected pancreatic ductal adenocarcinoma. BMC Cancer 2023; 23:790. [PMID: 37612635 PMCID: PMC10463422 DOI: 10.1186/s12885-023-11181-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To improve prediction, the AJCC staging system was revised to be consistent with upfront surgery (UFS) and neoadjuvant therapy (NAT) for PDAC. BACKGROUND The AJCC staging system was designed for patients who have had UFS for PDAC, and it has limited predictive power for patients receiving NAT. METHODS We examined 146 PDAC patients who had resection after NAT and 1771 who had UFS at Changhai Hospital between 2012 and 2021. The clinicopathological factors were identified using Cox proportional regression analysis, and the Neoadjuvant Therapy Compatible Prognostic (NATCP) staging was developed based on these variables. Validation was carried out in the prospective NAT cohort and the SEER database. The staging approach was compared to the AJCC staging system regarding predictive accuracy. RESULTS The NAT cohort's multivariate analysis showed that tumor differentiation and the number of positive lymph nodes independently predicted OS. The NATCP staging simplified the AJCC stages, added tumor differentiation, and restaged the disease based on the Kaplan-Meier curve survival differences. The median OS for NATCP stages IA, IB, II, and III was 31.7 months, 25.0 months, and 15.8 months in the NAT cohort and 30.1 months, 22.8 months, 18.3 months, and 14.1 months in the UFS cohort. Compared to the AJCC staging method, the NATCP staging system performed better and was verified in the validation cohort. CONCLUSIONS Regardless of the use of NAT, NATCP staging demonstrated greater predictive abilities than the existing AJCC staging approach for resected PDAC and may facilitate clinical decision-making based on accurate prediction of patients' OS.
Collapse
Affiliation(s)
- Lingyu Zhu
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Shuo Shen
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Huan Wang
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Guoxiao Zhang
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Xiaoyi Yin
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Xiaohan Shi
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Suizhi Gao
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Jiawei Han
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Yiwei Ren
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Jian Wang
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Hui Jiang
- Department of Pathology, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China.
| | - Shiwei Guo
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China.
| | - Gang Jin
- Department of Pancreatic Hepatobiliary Surgery, Changhai Hospital, Naval Medical University, NO. 168 Changhai Road, Yangpu District, Shanghai, China.
| |
Collapse
|
5
|
Miao Y, Cai B, Lu Z. Technical options in surgery for artery-involving pancreatic cancer: Invasion depth matters. Surg Open Sci 2023; 12:55-61. [PMID: 36936450 PMCID: PMC10020102 DOI: 10.1016/j.sopen.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/18/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Background The artery involvement explains the majority of primary unresectability of non-metastatic pancreatic cancer patients and both arterial resection and artery-sparing dissection techniques are utilized in curative-intent pancreatectomies for artery-involving pancreatic cancer (ai-PC) patients. Methods This narrative review summarized the history of resectability evaluation for ai-PC and attempted to interpret its current pitfalls that led to the divergence of resectability prediction and surgical exploration, with a focus on the rationale and the surgical outcomes of the sub-adventitial divestment technique. Results The circumferential involvement of artery by tumor currently defined the resectability of ai-PC but insufficient to preclude laparotomy with curative intent. The reasons behind could be: 1. The radiographic involvement of tumor to arterial circumference was not necessarily resulted in histopathological artery wall invasion; 2. the developed surgical techniques facilitated radical resection, better perioperative safety as well as oncological benefit. The feasibility of periadventitial dissection, sub-adventitial divestment and other artery-sparing techniques for ai-PC depended on the tumor invasion depth to the artery, i.e., whether the external elastic lamina (EEL) was invaded demonstrating a hallmark plane for sub-adventitial dissections. These techniques were reported to be complicated with preferable surgical outcomes comparing to arterial resection combined pancreatectomies, while the arterial resection combined pancreatectomies were considered performed in patients with more advanced disease. Conclusions Adequate preoperative imaging modalities with which to evaluate the tumor invasion depth to the artery are to be developed. Survival benefits after these techniques remain to be proven, with more and higher-level clinical evidence needed. Key message The current resectability evaluation criteria, which were based on radiographic circumferential involvement of the artery by tumor, was insufficient to preclude curative-intent pancreatectomies for artery-involving pancreatic cancer patients. With oncological benefit to be further proven, periarterial dissection and arterial resection have different but overlapping indications, and predicting the tumor invasion depth in major arteries was critical for surgical planning.
Collapse
Affiliation(s)
- Yi Miao
- Pancreas Center, First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
- Pancreas Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, PR China
| | - Baobao Cai
- Pancreas Center, First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| | - Zipeng Lu
- Pancreas Center, First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
6
|
Mantke R, Schneider C, Weylandt K, Gretschel S, Marusch F, Kube R, Loew A, Jaehn P, Holmberg C, Hunger R. [Epidemiology and surgical treatment of pancreatic cancer in the State of Brandenburg : Analysis of 5418 cases]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:788-801. [PMID: 34994806 DOI: 10.1007/s00104-021-01561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pancreatic cancer is the second most frequent cause of death among all forms of cancer in Germany with more than 19,000 deaths per year. The evaluation of the nationwide clinical cancer register aims to depict the reality of treatment and to improve the quality of treatment in the future by targeted analyses. METHOD The data from the clinical cancer register of Brandenburg-Berlin for the diagnosis years 2001-2017 were analyzed with respect to the treatment of pancreatic cancer. Data from patients resident in the State of Brandenburg were evaluated with respect to epidemiological and therapeutic parameters. RESULTS A total of 5418 patients with pancreatic cancer were documented in the register from 2001 to 2017 and 49.6% of the patients were diagnosed as having the Union for International Cancer Control (UICC) stage IV. A pancreas resection was carried out in 26.4% of the cases. In cases of cancer of the head of the pancreas the most frequent procedure was a pylorus-preserving resection with 51.8% and a pancreatectomy was carried out in 9.4%. The R0 resection rate of all pancreatic cancers in the period from 2014 to 2017 was 61.9%. After R0 resection the 5‑year survival was 19%. Relevant multivariate survival factors were age, UICC stage and the residual (R) tumor classification. The case numbers per hospital had no influence on the absolute survival of patients operated on in the State of Brandenburg. CONCLUSION The treatment reality in the State of Brandenburg for patients with pancreatic cancer corresponds to the results of international publications with respect to the key performance indicators investigated. A qualitative internationally comparable treatment of these patients is also possible in nonmetropolitan regions.
Collapse
Affiliation(s)
- R Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland.
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Deutschland.
| | - C Schneider
- Registerstelle Neuruppin, Neuruppin, Klinisches Krebsregister für Brandenburg und Berlin gGmbH, Ruppiner Kliniken GmbH, Haus R, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
| | - K Weylandt
- Med. Klinik B / Schwerpunkt Gastroenterologie, Ruppiner Kliniken GmbH, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
| | - S Gretschel
- Klinik für Allgemein‑, Viszeral‑, Gefäß und Thoraxchirurgie, Ruppiner Kliniken GmbH, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
| | - F Marusch
- Klinik für Allgemein- und Viszeralchirurgie, Ernst von Bergmann Klinikum Potsdam, Charlottenstraße 72, 14467, Potsdam, Deutschland
| | - R Kube
- Chirurgische Klinik, Carl-Thiem-Klinikum Cottbus, Thiemstraße 111, 03048, Cottbus, Deutschland
| | - A Loew
- Med. Klinik B / Schwerpunkt Gastroenterologie, Ruppiner Kliniken GmbH, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Fehrbelliner Str. 38, 16816, Neuruppin, Deutschland
| | - P Jaehn
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Deutschland
- Institut für Sozialmedizin und Epidemiologie, Medizinische Hochschule Brandenburg, Hochstr. 15, 14770, Brandenburg, Deutschland
| | - C Holmberg
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Deutschland
- Institut für Sozialmedizin und Epidemiologie, Medizinische Hochschule Brandenburg, Hochstr. 15, 14770, Brandenburg, Deutschland
| | - R Hunger
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg, Medizinische Fakultät, Medizinische Hochschule Brandenburg, Hochstr. 29, 14770, Brandenburg an der Havel, Deutschland
| |
Collapse
|