术前代谢肿瘤体积与切除胰腺癌的早期全身转移相关：转录组全分析。
Preoperative Metabolic Tumor Volume Associated with Early Systemic Metastasis in Resected Pancreatic Cancer: A Transcriptome-Wide Analysis.
机构信息
Department of Systems Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
出版信息
Gut Liver. 2019 May 15;13(3):356-365. doi: 10.5009/gnl18242.
BACKGROUND/AIMS: F-fluorodeoxyglucose-positron emission tomography (F-FDG-PET) reflects biological aggressiveness and predicts prognoses in various tumors. Evaluating the oncologic significance of the preoperative metabolic phenotype might be necessary for planning the surgical strategy in resectable pancreatic cancers.
METHODS
From January 2010 to December 2015, a total of 93 patients with pathologic T3 (pT3) pancreatic cancer were included in this study. Clinicopathological parameters and PET parameters were evaluated, and transcriptome-wide analysis was performed to identify the oncologic impact and molecular landscape of the metabolic phenotype of resectable pancreatic cancers.
RESULTS
Preoperative metabolic tumor volume (MTV) was significantly higher in the pN1 group compared to the pN0 group (11.1±11.2 vs 6.5±7.8, p=0.031). Higher MTV values (MTV ≥4.5) were associated with multiple lymph node metastasis (p=0.003), and the lymph node ratio was also significantly higher in resected pT3 pancreatic cancer with MTV ≥4.5 compared to those with MTV <4.5 (0.12±0.13vs 0.05±0.08, p=0.001). Disease-specific survival of patientswith MTV <4.5 was better than that of patients withMTV ≥4.5 (mean, 28.8 months; 95% confidence interval[CI], 40.1 to 57.0 vs mean, 32.6 months; 95% CI, 25.5 to 39.7; p=0.026). Patients with MTV ≥4.5 who received postoperative adjuvant chemotherapy showed better survival outcomes than patients with MTV ≥4.5 who did not receive adjuvant treatment in resected pT3 pancreatic cancers (p<0.001). Transcriptome-wide analysis revealed that tumors with MTV ≥4.5 demonstrated significantly different expression of cancer-related genes reflecting aggressive tumor biology.
CONCLUSIONS
Resectable pancreatic cancer with high MTV is not only associated with lymph node metastasis but also early systemic metastasis. The molecular background of resectable pancreatic cancer with high MTV may be associated with aggressive biologic behavior, which might need to be considered when managing resectable pancreatic cancers. Further study is mandatory.
背景/目的：氟-18 氟代脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）反映了各种肿瘤的生物学侵袭性，并预测了预后。评估可切除胰腺癌术前代谢表型的肿瘤学意义，可能对规划手术策略是必要的。
方法
本研究纳入了 2010 年 1 月至 2015 年 12 月期间的 93 例病理 T3（pT3）胰腺癌患者。评估了临床病理参数和 PET 参数，并进行了转录组分析，以确定可切除胰腺癌代谢表型的肿瘤学影响和分子特征。
结果
与 pN0 组相比，pN1 组患者的术前代谢肿瘤体积（MTV）显著更高（11.1±11.2 比 6.5±7.8，p=0.031）。较高的 MTV 值（MTV≥4.5）与多个淋巴结转移相关（p=0.003），并且 MTV≥4.5 的可切除 pT3 胰腺癌的淋巴结比值也明显高于 MTV<4.5 的患者（0.12±0.13 比 0.05±0.08，p=0.001）。MTV<4.5 的患者的疾病特异性生存率优于 MTV≥4.5 的患者（平均 28.8 个月；95%置信区间[CI]，40.1 至 57.0 比平均 32.6 个月；95%CI，25.5 至 39.7；p=0.026）。在接受可切除 pT3 胰腺癌术后辅助化疗的 MTV≥4.5 患者中，与未接受辅助治疗的患者相比，生存结果更好（p<0.001）。转录组分析显示，MTV≥4.5 的肿瘤表现出与侵袭性肿瘤生物学相关的显著不同的癌症相关基因表达。
结论
高 MTV 的可切除胰腺癌不仅与淋巴结转移相关，而且与早期全身转移相关。高 MTV 的可切除胰腺癌的分子背景可能与侵袭性生物学行为相关，这在管理可切除胰腺癌时可能需要考虑。需要进一步研究。
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