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Zhang X, Detering L, Heo GS, Sultan D, Luehmann H, Li L, Somani V, Lesser J, Tao J, Kang LI, Li A, Lahad D, Rho S, Ruzinova MB, DeNardo DG, Dehdashti F, Lim KH, Liu Y. Chemokine Receptor 2 Targeted PET/CT Imaging Distant Metastases in Pancreatic Ductal Adenocarcinoma. ACS Pharmacol Transl Sci 2024; 7:285-293. [PMID: 38230294 PMCID: PMC10789124 DOI: 10.1021/acsptsci.3c00303] [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: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/18/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and treatment-refractory malignancies. The lack of an effective screening tool results in the majority of patients being diagnosed at late stages, which underscores the urgent need to develop more sensitive and specific imaging modalities, particularly in detecting occult metastases, to aid clinical decision-making. The tumor microenvironment of PDAC is heavily infiltrated with myeloid-derived suppressor cells (MDSCs) that express C-C chemokine receptor type 2 (CCR2). These CCR2-expressing MDSCs accumulate at a very early stage of metastasis and greatly outnumber PDAC cells, making CCR2 a promising target for detecting early, small metastatic lesions that have scant PDAC cells. Herein, we evaluated a CCR2 targeting PET tracer (68Ga-DOTA-ECL1i) for PET imaging on PDAC metastasis in two mouse models. Positron emission tomography/computed tomography (PET/CT) imaging of 68Ga-DOTA-ECL1i was performed in a hemisplenic injection metastasis model (KI) and a genetically engineered orthotopic PDAC model (KPC), which were compared with 18F-FDG PET concurrently. Autoradiography, hematoxylin and eosin (H&E), and CCR2 immunohistochemical staining were performed to characterize the metastatic lesions. PET/CT images visualized the PDAC metastases in the liver/lung of KI mice and in the liver of KPC mice. Quantitative uptake analysis revealed increased metastasis uptake during disease progression in both models. In comparison, 18F-FDG PET failed to detect any metastases during the time course studies. H&E staining showed metastases in the liver and lung of KI mice, within which immunostaining clearly demonstrated the overexpression of CCR2 as well as CCR2+ cell infiltration into the normal liver. H&E staining, CCR2 staining, and autoradiography also confirmed the expression of CCR2 and the uptake of 68Ga-DOTA-ECL1i in the metastatic foci in KPC mice. Using our novel CCR2 targeted radiotracer 68Ga-DOTA-ECL1i and PET/CT, we demonstrated the sensitive and specific detection of CCR2 in the early PDAC metastases in two mouse models, indicating its potential in future clinical translation.
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Affiliation(s)
- Xiaohui Zhang
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Lisa Detering
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Gyu Seong Heo
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Deborah Sultan
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Hannah Luehmann
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Lin Li
- Division
of Oncology, Department of Medicine, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - Vikas Somani
- Division
of Oncology, Department of Medicine, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - Josie Lesser
- Department
of Anthropology, Washington University in
St. Louis, St. Louis, Missouri 63110, United States
| | - Joan Tao
- Department
of Medicine, University of Missouri, Columbia, Missouri 65211, United States
| | - Liang-I. Kang
- Department
of Pathology and Immunology, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - Alexandria Li
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Divangana Lahad
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Shinji Rho
- Department
of Medicine, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Marianna B. Ruzinova
- Department
of Pathology and Immunology, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - David G. DeNardo
- Division
of Oncology, Department of Medicine, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
- Department
of Pathology and Immunology, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - Farrokh Dehdashti
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
| | - Kian-Huat Lim
- Division
of Oncology, Department of Medicine, Washington
University in St. Louis, St. Louis, Missouri 63110, United States
| | - Yongjian Liu
- Department
of Radiology, Washington University in St.
Louis, St. Louis, Missouri 63110, United States
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Kong Q, Teng F, Li H, Chen Z. Radical resection benefits patients suffering pancreatic ductal adenocarcinoma with liver oligometastases. Ann Surg Treat Res 2024; 106:51-60. [PMID: 38205094 PMCID: PMC10774701 DOI: 10.4174/astr.2024.106.1.51] [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: 08/11/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose Whether patients suffering liver oligometastases from pancreatic ductal adenocarcinoma (LOPDA) should undergo surgical treatment remains controversial. Methods PubMed and Embase databases were systematically reviewed until 2023 June. Survival data were collected from the Kaplan-Meier curves. Safety and survival were evaluated using primary outcomes such as 1-year, 3-year, and 5-year survival rates, and 30-day mortality and morbidity. A subgroup meta-analysis was conducted to compare survival rates post-synchronous resection and resection post-neoadjuvant chemotherapy in LOPDA. Results Our analysis of 15 studies involving 1,818 patients (surgical group, 648 and nonsurgical group, 1,170) indicates that radical hepatectomy for LOPDA notably improved 1-year (odds ratio [OR], 3.24; 95% confidence interval [CI], 2.45-4.28; P < 0.001), 3-year (OR, 5.74; 95% CI, 3.36-8.90; P < 0.001), and 5-year (OR, 4.89; 95% CI, 2.56-9.35; P < 0.001) overall survival (OS) rates. A separate analysis of 6 studies with 750 patients demonstrated the safety of LOPDA surgery, with no increase in postoperative complications (P = 0.26 for overall morbidity and P = 0.99 for mortality) compared to the patients with no metastatic disease from the pancreatic ductal adenocarcinoma (NMPDA) group. The NMPDA group showed superior 1-year and 3-year OS rates, but not 5-year OS rates compared to the LOPDA group. Conclusion Surgical treatment apparently offers a survival advantage to LOPDA by comparing with nonsurgical groups in 1-, 3-, and 5-year OS rates. Radical resection for LOPDA is a safe treatment without more postoperative complications than NMPDA.
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Affiliation(s)
- Qingyan Kong
- Division of Hepatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Teng
- Division of Hepatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Li
- Division of Hepatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zheyu Chen
- Division of Hepatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Altmayer S, Armelin LM, Pereira JS, Carvalho LV, Tse J, Balthazar P, Francisco MZ, Watte G, Hochhegger B. MRI with DWI improves detection of liver metastasis and selection of surgical candidates with pancreatic cancer: a systematic review and meta-analysis. Eur Radiol 2024; 34:106-114. [PMID: 37566274 DOI: 10.1007/s00330-023-10069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis to evaluate if magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) adds value compared to contrast-enhanced computed tomography (CECT) alone in the preoperative evaluation of pancreatic cancer. METHODS MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through October 2022. Studies met eligibility criteria if they evaluated the per-patient diagnostic performance of MRI with DWI in the preoperative evaluation of newly diagnosed pancreatic cancer compared to CECT. Our primary outcome was the number needed to treat (NNT) to prevent one futile surgery using MRI with DWI, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis (i.e., surgical intervention in metastatic disease missed by CECT). The secondary outcomes were to determine the diagnostic performance and the NNT of MRI with DWI to change management in pancreatic cancer. RESULTS Nine studies met the inclusion criteria with a total of 1121 patients, of whom 172 had liver metastasis (15.3%). The proportion of futile surgeries reduced by MRI with DWI was 6.0% (95% CI, 3.0-11.6%), yielding an NNT of 16.6. The proportion of cases that MRI with DWI changed management was 18.1% (95% CI, 9.9-30.7), corresponding to an NNT of 5.5. The per-patient sensitivity and specificity of MRI were 92.4% (95% CI, 87.4-95.6%) and 97.3% (95% CI, 96.0-98.1). CONCLUSION MRI with DWI may prevent futile surgeries in pancreatic cancer by improving the detection of occult liver metastasis on preoperative CECT with an NNT of 16.6. CLINICAL RELEVANCE STATEMENT MRI with DWI complements the standard preoperative CECT evaluation for liver metastasis in pancreatic cancer, improving the selection of surgical candidates and preventing unnecessary surgeries. KEY POINTS • The NNT of MRI with DWI to prevent potential futile surgeries due to occult liver metastasis on CECT, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis, in patients with pancreatic cancer was 16.6. • The higher performance of MRI with DWI to detect liver metastasis occult on CECT can be attributed to an increased detection of subcentimeter liver metastasis.
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Affiliation(s)
- Stephan Altmayer
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
| | - Larissa Maria Armelin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, 190 Prof Alfredo Balena Ave, Belo Horizonte, Brazil
| | | | - Lis Vitoria Carvalho
- Faculdade de Medicina, Universidade de São Paulo, 455 Dr Arnaldo Ave, São Paulo, Brazil
| | - Justin Tse
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA
| | | | - Martina Zaguini Francisco
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Guilherme Watte
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, USA
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Auer TA. Diffusion-weighted imaging for the detection of liver metastases in the preoperative evaluation of pancreatic cancer - are we really at the end of the road? Eur Radiol 2024; 34:103-105. [PMID: 37603127 PMCID: PMC10791716 DOI: 10.1007/s00330-023-10159-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Timo A Auer
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Campus Virchow (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics. Int J Mol Sci 2022; 23:ijms23031339. [PMID: 35163262 PMCID: PMC8835851 DOI: 10.3390/ijms23031339] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 02/08/2023] Open
Abstract
Humans are exposed to a complex mix of man-made electric and magnetic fields (MFs) at many different frequencies, at home and at work. Epidemiological studies indicate that there is a positive relationship between residential/domestic and occupational exposure to extremely low frequency electromagnetic fields and some types of cancer, although some other studies indicate no relationship. In this review, after an introduction on the MF definition and a description of natural/anthropogenic sources, the epidemiology of residential/domestic and occupational exposure to MFs and cancer is reviewed, with reference to leukemia, brain, and breast cancer. The in vivo and in vitro effects of MFs on cancer are reviewed considering both human and animal cells, with particular reference to the involvement of reactive oxygen species (ROS). MF application on cancer diagnostic and therapy (theranostic) are also reviewed by describing the use of different magnetic resonance imaging (MRI) applications for the detection of several cancers. Finally, the use of magnetic nanoparticles is described in terms of treatment of cancer by nanomedical applications for the precise delivery of anticancer drugs, nanosurgery by magnetomechanic methods, and selective killing of cancer cells by magnetic hyperthermia. The supplementary tables provide quantitative data and methodologies in epidemiological and cell biology studies. Although scientists do not generally agree that there is a cause-effect relationship between exposure to MF and cancer, MFs might not be the direct cause of cancer but may contribute to produce ROS and generate oxidative stress, which could trigger or enhance the expression of oncogenes.
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