Departments of Pediatrics and Cell and Developmental Biology, Children's Cancer and Blood Foundation Laboratories, Drukier Institute for Children's Health, Meyer Cancer Center Weill Cornell Medicine, New York, NY, USA.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Nat Med. 2024 Aug;30(8):2170-2180. doi: 10.1038/s41591-024-03075-7. Epub 2024 Jun 28.
Metastasis occurs frequently after resection of pancreatic cancer (PaC). In this study, we hypothesized that multi-parametric analysis of pre-metastatic liver biopsies would classify patients according to their metastatic risk, timing and organ site. Liver biopsies obtained during pancreatectomy from 49 patients with localized PaC and 19 control patients with non-cancerous pancreatic lesions were analyzed, combining metabolomic, tissue and single-cell transcriptomics and multiplex imaging approaches. Patients were followed prospectively (median 3 years) and classified into four recurrence groups; early (<6 months after resection) or late (>6 months after resection) liver metastasis (LiM); extrahepatic metastasis (EHM); and disease-free survivors (no evidence of disease (NED)). Overall, PaC livers exhibited signs of augmented inflammation compared to controls. Enrichment of neutrophil extracellular traps (NETs), Ki-67 upregulation and decreased liver creatine significantly distinguished those with future metastasis from NED. Patients with future LiM were characterized by scant T cell lobular infiltration, less steatosis and higher levels of citrullinated H3 compared to patients who developed EHM, who had overexpression of interferon target genes (MX1 and NR1D1) and an increase of CD11B natural killer (NK) cells. Upregulation of sortilin-1 and prominent NETs, together with the lack of T cells and a reduction in CD11B NK cells, differentiated patients with early-onset LiM from those with late-onset LiM. Liver profiles of NED closely resembled those of controls. Using the above parameters, a machine-learning-based model was developed that successfully predicted the metastatic outcome at the time of surgery with 78% accuracy. Therefore, multi-parametric profiling of liver biopsies at the time of PaC diagnosis may determine metastatic risk and organotropism and guide clinical stratification for optimal treatment selection.
胰腺癌(PaC)切除术后常发生转移。本研究假设,对转移性肝活检进行多参数分析,可根据转移风险、时间和器官部位对患者进行分类。对 49 例局部 PaC 患者和 19 例非癌性胰腺病变对照患者行胰腺切除术时获得的肝活检进行了分析,结合代谢组学、组织和单细胞转录组学以及多重成像方法。对患者进行了前瞻性随访(中位时间 3 年),并将其分为四个复发组:早期(切除后<6 个月)或晚期(切除后>6 个月)肝转移(LiM);肝外转移(EHM);无疾病幸存者(无疾病证据(NED))。总体而言,与对照组相比,PaC 肝脏显示出炎症增强的迹象。中性粒细胞胞外陷阱(NETs)、Ki-67 上调和肝肌酸减少显著区分了未来发生转移的患者和 NED。与发生 EHM 的患者相比,未来发生 LiM 的患者具有特征性的肝小叶浸润性 T 细胞稀少、脂肪变性少和组蛋白 H3 瓜氨酸化水平较高。与发生 EHM 的患者相比,干扰素靶基因(MX1 和 NR1D1)过度表达和 CD11B 自然杀伤(NK)细胞增加的患者,其干扰素靶基因(MX1 和 NR1D1)过度表达和 CD11B 自然杀伤(NK)细胞增加。与发生 LiM 晚期的患者相比,早发性 LiM 患者的分选素-1上调和突出的 NETs,以及缺乏 T 细胞和减少 CD11B NK 细胞,区分了早发性 LiM 和晚发性 LiM。NED 的肝谱与对照组非常相似。使用上述参数,开发了一种基于机器学习的模型,该模型在手术时以 78%的准确率成功预测了转移结果。因此,在 PaC 诊断时对肝活检进行多参数分析,可能可以确定转移风险和器官趋向性,并指导临床分层,以选择最佳治疗方案。