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Schuurmans M, Saha A, Alves N, Vendittelli P, Yakar D, Sabroso-Lasa S, Xue N, Malats N, Huisman H, Hermans J, Litjens G. End-to-end prognostication in pancreatic cancer by multimodal deep learning: a retrospective, multicenter study. Eur Radiol 2025:10.1007/s00330-025-11694-y. [PMID: 40410330 DOI: 10.1007/s00330-025-11694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/26/2025] [Accepted: 04/21/2025] [Indexed: 05/25/2025]
Abstract
OBJECTIVES Pancreatic cancer treatment plans involving surgery and/or chemotherapy are highly dependent on disease stage. However, current staging systems are ineffective and poorly correlated with survival outcomes. We investigate how artificial intelligence (AI) can enhance prognostic accuracy in pancreatic cancer by integrating multiple data sources. MATERIALS AND METHODS Patients with histopathology and/or radiology/follow-up confirmed pancreatic ductal adenocarcinoma (PDAC) from a Dutch center (2004-2023) were included in the development cohort. Two additional PDAC cohorts from a Dutch and Spanish center were used for external validation. Prognostic models including clinical variables, contrast-enhanced CT images, and a combination of both were developed to predict high-risk short-term survival. All models were trained using five-fold cross-validation and assessed by the area under the time-dependent receiver operating characteristic curve (AUC). RESULTS The models were developed on 401 patients (203 females, 198 males, median survival (OS) = 347 days, IQR: 171-585), with 98 (24.4%) short-term survivors (OS < 230 days) and 303 (75.6%) long-term survivors. The external validation cohorts included 361 patients (165 females, 138 males, median OS = 404 days, IQR: 173-736), with 110 (30.5%) short-term survivors and 251 (69.5%) longer survivors. The best AUC for predicting short vs. long-term survival was achieved with the multi-modal model (AUC = 0.637 (95% CI: 0.500-0.774)) in the internal validation set. External validation showed AUCs of 0.571 (95% CI: 0.453-0.689) and 0.675 (95% CI: 0.593-0.757). CONCLUSION Multimodal AI can predict long vs. short-term survival in PDAC patients, showing potential as a prognostic tool in clinical decision-making. KEY POINTS Question Prognostic tools for pancreatic ductal adenocarcinoma (PDAC) remain limited, with TNM staging offering suboptimal accuracy in predicting patient survival outcomes. Findings The multimodal AI model demonstrated improved prognostic performance over TNM and unimodal models for predicting short- and long-term survival in PDAC patients. Clinical relevance Multimodal AI provides enhanced prognostic accuracy compared to current staging systems, potentially improving clinical decision-making and personalized management strategies for PDAC patients.
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Affiliation(s)
- Megan Schuurmans
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands.
| | - Anindo Saha
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natália Alves
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierpaolo Vendittelli
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Derya Yakar
- Department of Medical Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Sergio Sabroso-Lasa
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center, Madrid, Spain
| | - Nannan Xue
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center, Madrid, Spain
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center, Madrid, Spain
| | - Henkjan Huisman
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - John Hermans
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geert Litjens
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
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Li J, Li X, Chen Y, Wang Y, Wang B, Zhang X, Zhang N. Mesothelin expression prediction in pancreatic cancer based on multimodal stochastic configuration networks. Med Biol Eng Comput 2025; 63:1117-1129. [PMID: 39641869 DOI: 10.1007/s11517-024-03253-2] [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: 07/03/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
Predicting tumor biomarkers with high precision is essential for improving the diagnostic accuracy and developing more effective treatment strategies. This paper proposes a machine learning model that utilizes CT images and biopsy whole slide images (WSI) to classify mesothelin expression levels in pancreatic cancer. By combining multimodal learning and stochastic configuration networks, a radiopathomics mesothelin-prediction system named RPMSNet is developed. The system extracts radiomic and pathomic features from CT images and WSI, respectively, and sends them into stochastic configuration networks for the final prediction. Compared to traditional radiomics or pathomics, this system has the capability to capture more comprehensive image features, providing a multidimensional insight into tissue characteristics. The experiments and analyses demonstrate the accuracy and effectiveness of the system, with an area under the curve of 81.03%, an accuracy of 73.67%, a sensitivity of 71.54%, a precision of 76.78%, and a F1-score of 72.61%, surpassing both single-modality and dual-modality models. RPMSNet highlights its potential for early diagnosis and personalized treatment in precision medicine.
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Affiliation(s)
- Junjie Li
- College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Xuanle Li
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518071, China
- Department of Radiology, Medical Imaging Research Institute, Huaihe Hospital of Henan University, Kaifeng, 475000, China
| | - Yingge Chen
- College of Sciences, Northeastern University, Shenyang, 110819, China
| | - Yunling Wang
- Department of Radiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Binjie Wang
- Department of Radiology, Medical Imaging Research Institute, Huaihe Hospital of Henan University, Kaifeng, 475000, China.
| | - Xuefeng Zhang
- College of Sciences, Northeastern University, Shenyang, 110819, China.
| | - Na Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518071, China.
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Bisgaard ALH, Brink C, Schytte T, Bahij R, Weisz Ejlsmark M, Bernchou U, Bertelsen AS, Pfeiffer P, Mahmood F. Prediction of overall survival in patients with locally advanced pancreatic cancer using longitudinal diffusion-weighted MRI. Front Oncol 2024; 14:1401464. [PMID: 39091912 PMCID: PMC11291378 DOI: 10.3389/fonc.2024.1401464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Background and purpose Biomarkers for prediction of outcome in patients with pancreatic cancer are wanted in order to personalize the treatment. This study investigated the value of longitudinal diffusion-weighted magnetic resonance imaging (DWI) for prediction of overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiotherapy (SBRT). Materials and methods The study included 45 patients with LAPC who received 5 fractions of 10 Gy on a 1.5T MRI-Linac. DWI was acquired prior to irradiation at each fraction. The analysis included baseline values and time-trends of the apparent diffusion coefficient (ADC) and DWI parameters obtained using a decomposition method. A multivariable Cox proportional hazards model for OS was made using best-subset selection, using cross-validation based on Bootstrap. Results The median OS from the first day of SBRT was 15.5 months (95% CI: 13.2-20.6), and the median potential follow-up time was 19.8 months. The best-performing multivariable model for OS included two decomposition-based DWI parameters: one baseline and one time-trend parameter. The C-Harrell index describing the model's discriminating power was 0.754. High baseline ADC values were associated with reduced OS, whereas no association between the ADC time-trend and OS was observed. Conclusion Decomposition-based DWI parameters indicated value in the prediction of OS in LAPC. A DWI time-trend parameter was included in the best-performing model, indicating a potential benefit of acquiring longitudinal DWI during the SBRT course. These findings support both baseline and longitudinal DWI as candidate prognostic biomarkers, which may become tools for personalization of the treatment of patients with LAPC.
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Affiliation(s)
- Anne L. H. Bisgaard
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tine Schytte
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Rana Bahij
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Mathilde Weisz Ejlsmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Uffe Bernchou
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders S. Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Agarwal H, Bynum RC, Saleh N, Harris D, MacCuaig WM, Kim V, Sanderson EJ, Dennahy IS, Singh R, Behkam B, Gomez-Gutierrez JG, Jain A, Edil BH, McNally LR. Theranostic nanoparticles for detection and treatment of pancreatic cancer. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2024; 16:e1983. [PMID: 39140128 PMCID: PMC11328968 DOI: 10.1002/wnan.1983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/21/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most recalcitrant cancers due to its late diagnosis, poor therapeutic response, and highly heterogeneous microenvironment. Nanotechnology has the potential to overcome some of the challenges to improve diagnostics and tumor-specific drug delivery but they have not been plausibly viable in clinical settings. The review focuses on active targeting strategies to enhance pancreatic tumor-specific uptake for nanoparticles. Additionally, this review highlights using actively targeted liposomes, micelles, gold nanoparticles, silica nanoparticles, and iron oxide nanoparticles to improve pancreatic tumor targeting. Active targeting of nanoparticles toward either differentially expressed receptors or PDAC tumor microenvironment (TME) using peptides, antibodies, small molecules, polysaccharides, and hormones has been presented. We focus on microenvironment-based hallmarks of PDAC and the potential for actively targeted nanoparticles to overcome the challenges presented in PDAC. It describes the use of nanoparticles as contrast agents for improved diagnosis and the delivery of chemotherapeutic agents that target various aspects within the TME of PDAC. Additionally, we review emerging nano-contrast agents detected using imaging-based technologies and the role of nanoparticles in energy-based treatments of PDAC. This article is categorized under: Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Diagnostic Tools > In Vivo Nanodiagnostics and Imaging.
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Affiliation(s)
- Happy Agarwal
- Stephenson Cancer Center, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Ryan C Bynum
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Nada Saleh
- Stephenson Cancer Center, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Danielle Harris
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - William M MacCuaig
- Stephenson Cancer Center, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Vung Kim
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Emma J Sanderson
- Stephenson Cancer Center, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Isabel S Dennahy
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Rohit Singh
- Stephenson Cancer Center, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Bahareh Behkam
- Department of Mechanical Engineering, Virginia Tech University, Blacksburg, Virginia, USA
| | | | - Ajay Jain
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Barish H Edil
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
| | - Lacey R McNally
- Department of Surgery, University of Oklahoma Health Science, Oklahoma City, Oklahoma, USA
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Liberda-Matyja D, Koziol-Bohatkiewicz P, Wrobel TP. Pancreatic intraepithelial neoplasia detection and duct pathology grading using FT-IR imaging and machine learning. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 309:123756. [PMID: 38154304 DOI: 10.1016/j.saa.2023.123756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 12/08/2023] [Indexed: 12/30/2023]
Abstract
Pancreatic intraepithelial neoplasia (PanIN) is manifested by noninvasive lesions in the epithelium of smaller pancreatic ducts. Generally, cancer development risk from low-grade PanIN is minor, whereas, invasive pancreatic ductal adenocarcinoma (PDAC) development is highly related to high-grade PanINs. Therefore, in the case of high-grade PanIN detection, additional surgical resection may be recommended. However, even the low-grade PanINs can indicate possible progression to PDAC. The definition of PanIN is constantly changing and there is a need for new tools to better characterize and understand its behavior. We have recently developed a comprehensive pancreatic cancer classification model with biopsies collected from over 600 biopsies from 250 patients. Here, we take the next step and employ Infrared (IR) spectroscopy to build the first classification model for PanINs detection. Furthermore, we created a Partial Least Squares Regression (PLSR) model to characterize ducts from benign to cancerous. This model was then used to predict and grade PanINs accordingly to their malignancy level.
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Affiliation(s)
- Danuta Liberda-Matyja
- Jagiellonian University, Doctoral School of Exact and Natural Sciences, Prof. St. Łojasiewicza 11, PL30348 Cracow, Poland; Solaris National Synchrotron Radiation Centre, Jagiellonian University, Czerwone Maki 98, 30-392 Krakow, Poland
| | - Paulina Koziol-Bohatkiewicz
- Solaris National Synchrotron Radiation Centre, Jagiellonian University, Czerwone Maki 98, 30-392 Krakow, Poland; Faculty of Physics, Astronomy and Applied Computer Science, Jagiellonian University, Lojasiewicza 11, 30-348 Krakow, Poland
| | - Tomasz P Wrobel
- Solaris National Synchrotron Radiation Centre, Jagiellonian University, Czerwone Maki 98, 30-392 Krakow, Poland.
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Ciesielka J, Jakimów K, Tekiela N, Peisert L, Kwaśniewska A, Kata D, Chudek J. Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL. J Clin Med 2024; 13:1263. [PMID: 38592088 PMCID: PMC10932348 DOI: 10.3390/jcm13051263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. METHODS The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. RESULTS A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. CONCLUSIONS Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.
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Affiliation(s)
- Jakub Ciesielka
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Krzysztof Jakimów
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Natalia Tekiela
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Laura Peisert
- Student’s Research Group, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland; (K.J.); (N.T.); (L.P.)
| | - Anna Kwaśniewska
- Department of Radiology, The Mielecki Hospital, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Dariusz Kata
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
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Terasawa H, Matsumoto K, Tanaka T, Tomoda T, Ogawa T, Ishihara Y, Kikuchi T, Obata T, Oda T, Matsumi A, Miyamoto K, Morimoto K, Fujii Y, Yamazaki T, Uchida D, Horiguchi S, Tsutsumi K, Kato H, Otsuka M. Cysts or necrotic components in pancreatic ductal adenocarcinoma is associated with the risk of EUS-FNA/B complications including needle tract seeding. Pancreatology 2023; 23:988-995. [PMID: 37951728 DOI: 10.1016/j.pan.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND EUS-FNA/B for pancreatic ductal adenocarcinoma (PDAC) is generally considered to be safe; however, while the incidence is low, there are occurrences of complications. Among these complications, there are serious ones like needle tract seeding (NTS), and it is not known than which types of tumors have the risks of EUS-FNA/B complications. This study aimed to evaluate the risk of EUS-FNA/B complications in patients with PDAC, focusing on morphological features. METHODS Overall, 442 patients who underwent EUS-FNA/B for solid pancreatic masses between January 2018 and May 2022 in four institutions were retrospectively surveyed. Finally, 361 patients histopathologically diagnosed with PDAC were analyzed. Among these patients, 79 tumors with cysts or necrotic components were compared with 282 tumors without cysts or necrotic components. The incidence and risk of EUS-FNA/B complications including NTS were evaluated. RESULTS There were 9 (2.4 %) of total EUS-FNA/B complications and 3 (0.8 %) of NTS. The incidence of total complication rate and NTS in tumors with cysts or necrotic components were significantly higher than in those without cysts or necrotic components (total complication 6.3 % vs. 1.4 %, p = 0.026, NTS 3.7 % vs. 0 %, p = 0.01). The transgastric route of puncture (OR: 93.3, 95 % CI: 3.81-2284.23) and the existence of cysts or necrotic components (OR: 7.3, 95 % CI: 1.47-36.19) were risk factors for EUS-FNA/B complications identified by the multivariate analysis. CONCLUSIONS We should pay attention to the risks of EUS-FNA/B complications, including NTS, when the tumor has cysts or necrotic components.
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Affiliation(s)
- Hiroyuki Terasawa
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan.
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Takeshi Tomoda
- Department of Gastroenterology, Okayama City Hospital, Okayama, Okayama, Japan
| | - Taiji Ogawa
- Department of Gastroenterology, Tsuyama Chuo Byoin, Tsuyama, Okayama, Japan
| | - Yuki Ishihara
- Department of Gastroenterology, National Hospital Organisation Iwakuni Medical Center, Iwakuni, Yamaguchi, Japan
| | - Tatsuya Kikuchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Taisuke Obata
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Takashi Oda
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kazuya Miyamoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Kosaku Morimoto
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Yuki Fujii
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Daisuke Uchida
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Okayama, Japan
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Natu J, Nagaraju GP. Gemcitabine effects on tumor microenvironment of pancreatic ductal adenocarcinoma: Special focus on resistance mechanisms and metronomic therapies. Cancer Lett 2023; 573:216382. [PMID: 37666293 DOI: 10.1016/j.canlet.2023.216382] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is considered one of the deadliest malignancies, with dismal survival rates and extremely prevalent chemoresistance. Gemcitabine is one of the primary treatments used in treating PDACs, but its benefits are limited due to chemoresistance, which could be attributed to interactions between the tumor microenvironment (TME) and intracellular processes. In preclinical models, certain schedules of administration of gemcitabine modulate the TME in a manner that does not promote resistance. Metronomic therapy constitutes a promising strategy to overcome some barriers associated with current PDAC treatments. This review will focus on gemcitabine's mechanism in treating PDAC, combination therapies, gemcitabine's interactions with the TME, and gemcitabine in metronomic therapies.
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Affiliation(s)
- Jay Natu
- Department of Hematology and Oncology, Heersink School of Medicine, University of Alabama, Birmingham, AL, 35233, USA
| | - Ganji Purnachandra Nagaraju
- Department of Hematology and Oncology, Heersink School of Medicine, University of Alabama, Birmingham, AL, 35233, USA.
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Yang F, Wei H, Li X, Yu X, Zhao Y, Li L, Li Y, Xie L, Wang S, Lin M. Pretreatment synthetic magnetic resonance imaging predicts disease progression in nonmetastatic nasopharyngeal carcinoma after intensity modulation radiation therapy. Insights Imaging 2023; 14:59. [PMID: 37016104 PMCID: PMC10073373 DOI: 10.1186/s13244-023-01411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND To investigate the potential of synthetic MRI (SyMRI) in the prognostic assessment of patients with nonmetastatic nasopharyngeal carcinoma (NPC), and the predictive value when combined with diffusion-weighted imaging (DWI) as well as clinical factors. METHODS Fifty-three NPC patients who underwent SyMRI were prospectively included. 10th Percentile, Mean, Kurtosis, and Skewness of T1, T2, and PD maps and ADC value were obtained from the primary tumor. Cox regression analysis was used for analyzing the association between SyMRI and DWI parameters and progression-free survival (PFS), and then age, sex, staging, and treatment as confounding factors were also included. C-index was obtained by bootstrap. Moreover, significant parameters were used to construct models in predicting 3-year disease progression. ROC curves and leave-one-out cross-validation were used to evaluate the performance and stability. RESULTS Disease progression occurred in 16 (30.2%) patients at a follow-up of 39.6 (3.5, 48.2) months. T1_Kurtosis, T1_Skewness, T2_10th, PD_Mean, and ADC were correlated with PFS, and T1_Kurtosis (HR: 1.093) and ADC (HR: 1.009) were independent predictors of PFS. The C-index of SyMRI and SyMRI + DWI + Clinic models was 0.687 and 0.779. Moreover, the SyMRI + DWI + Clinic model predicted 3-year disease progression better than DWI or Clinic model (p ≤ 0.008). Interestingly, there was no significant difference between the SyMRI model (AUC: 0.748) and SyMRI + DWI + Clinic model (AUC: 0.846, p = 0.092). CONCLUSION SyMRI combined with histogram analysis could predict disease progression in NPC patients, and SyMRI + DWI + Clinic model further improved the predictive performance.
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Affiliation(s)
- Fan Yang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Haoran Wei
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaolu Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaoduo Yu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yanfeng Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yujie Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lizhi Xie
- MR Research China, GE Healthcare, Beijing, China
| | - Sicong Wang
- MR Research China, GE Healthcare, Beijing, China
| | - Meng Lin
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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10
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De Robertis R, Tomaiuolo L, Pasquazzo F, Geraci L, Malleo G, Salvia R, D’Onofrio M. Correlation between ADC Histogram-Derived Metrics and the Time to Metastases in Resectable Pancreatic Adenocarcinoma. Cancers (Basel) 2022; 14:6050. [PMID: 36551536 PMCID: PMC9775993 DOI: 10.3390/cancers14246050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Background: A non-invasive method to improve the prognostic stratification would be clinically beneficial in patients with resectable pancreatic adenocarcinoma (PDAC). The aim of this study was to correlate conventional magnetic resonance (MR) features and the metrics derived from the histogram analysis of apparent diffusion coefficient (ADC) maps, with the risk and the time to metastases (TTM) after surgery in patients with PDAC. Methods: pre-operative MR examinations of 120 patients were retrospectively analyzed. Patients were grouped according to the presence (M+) or absence (M−) of metastases during follow-up. Conventional MR features and histogram-derived metrics were compared between M+ and M− patients using the Fisher’s or Mann−Whitney tests; receiver operating characteristic (ROC) curves were constructed for the features that showed a significant difference between groups. A Cox regression analysis was performed to identify the features with a significant effect on the TTM, and Kaplan−Meier curves were constructed for significant features. Results: 68.3% patients developed metastases over a mean follow-up time of 29 months (range, 3−54 months). ADC skewness and kurtosis were significantly higher in M+ than in M− patients (p < 0.001). Skewness had a significant effect on the risk of metastases (hazard ratio—HR = 5.22, p < 0.001). Patients with an ADC skewness ≥0.23 had a significantly shorter TTM than those with a skewness <0.22 (11.7 vs. 30.8 months, p < 0.001). Conclusions: pre-operative histogram analysis of ADC maps provides parameters correlated to the metastatic potential of PDAC. Higher ADC skewness seems to be associated with a significantly shorter TTM in patients with resectable PDAC.
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Affiliation(s)
- Riccardo De Robertis
- Department of Radiology, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Luisa Tomaiuolo
- Department of Radiology, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Francesca Pasquazzo
- Department of Radiology, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Luca Geraci
- Department of Radiology, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Giuseppe Malleo
- Department of Pancreatic Surgery, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Roberto Salvia
- Department of Pancreatic Surgery, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
| | - Mirko D’Onofrio
- Department of Radiology, Ospedale G.B. Rossi, University of Verona, 37134 Verona, Italy
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11
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Huang H, Sun J, Li Z, Zhang X, Li Z, Zhu H, Yu X. Impact of the tumor immune microenvironment on the outcome of pancreatic cancer: a retrospective study based on clinical pathological analysis. Gland Surg 2022; 11:472-482. [PMID: 35284302 PMCID: PMC8899427 DOI: 10.21037/gs-22-45] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/16/2022] [Indexed: 07/07/2024]
Abstract
BACKGROUND The cancerous microenvironment, characterized by the infiltration of CD4+ and CD8+ T cells, play a critical role in regulating the progression of cancer and treating efficiency of immunotherapy. However, the distribution of these cells and their associated cytokines in the tumor microenvironment of pancreatic cancer (PC) are not yet fully understood. Our study aims to analyze the contents of CD4+IL-17+ and CD8+ T cells in PC and their relationship with the clinicopathological features and survival outcomes of patients. METHODS PC tissues and adjacent tissues were retrospectively collected from 40 patients in our hospital. The expression of CD4, IL-17, and CD8 in histological samples was measured by immunohistochemistry. The correlation between CD4, IL-17, and CD8 expression and clinical characteristics was analyzed using Kaplan-Meier survival analysis. The risk factors affecting the outcome of PC were examined by the Cox proportional hazards model, then a nomogram predicting the survival of PC using these risk factors was established. RESULTS The content of CD4+IL-17+ T cells in PC tissues was significantly higher than that in adjacent normal tissues, while the number of CD8+ T cells was significantly lower than that in adjacent normal tissues (P<0.01). CD4+ T cells in PC tissues was significantly associated with TNM stage and lymph node metastasis (P<0.05). IL-17 and CD8 were significantly associated with histological grade, TNM stage, local infiltration, and lymph node metastasis (P<0.05). The median survival times (MSTs) of CD4 positive and negative patients were 13.2 and 21.4 months, respectively. The MSTs of IL-17 positive and negative patients were 10.4 and 24.8 months, respectively. The MSTs were 21.9 and 11.8 months for CD8 positive and negative patients, respectively (P<0.05). The Cox regression model demonstrated that TNM staging, lymph node metastasis, and CD4+IL-17+ and CD8+ T cells affected PC prognosis (P<0.05). The nomogram showed that the survival probability was reduced in patients with TNM stage III to IV, lymph node metastasis, high CD4+IL-17+ level, and low CD8+ expression. CONCLUSIONS CD4+IL-17+ and CD8+ T cells in PC tissues are associated with TNM staging, lymph node metastasis, and MST, and can be used as new prognostic indicators for PC.
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Affiliation(s)
- Hui Huang
- Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jichun Sun
- Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhiqiang Li
- Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xianlin Zhang
- Department of General Surgery, Affiliated Renhe Hospital of China, Three Gorges University, Yichang, China
| | - Zheng Li
- Department of General Surgery, Affiliated Renhe Hospital of China, Three Gorges University, Yichang, China
| | - Hongwei Zhu
- Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Yu
- Department of Hepatopancreatobiliary Surgery, The Third Xiangya Hospital, Central South University, Changsha, China
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