Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Image Acquisition and Analysis
- 1.
- Creatine (Cr) with separately fitted CH2 (Cr_2, 3.09 ppm) and CH3 (Cr_1, 3.03 ppm) groups;
- 2.
- N-Acetylaspartate (NAA, 2.02 ppm);
- 3.
- Glutamate (Glu) and Glutamine (Gln) (2.05–2.50 ppm): Glx as a combined Glu/Gln after separately fitted with each amplitude;
- 4.
- Two lipid/macromolecule lines with separately fitted CH3 (Lipid_1, 0.9 ppm) and CH2 (Lipid_2, 1.5 ppm) groups.
2.3. Statistical Analysis
3. Results
3.1. Clinical Treatment and Follow-Up
3.2. Comparison of MRS Metabolites between Pancreatic Cancer and Normal Pancreatic Parenchyma
3.3. Correlation of MRS Metabolites in Pancreatic Cancer with Pathologic Grade and Clinical TNM Stage
3.4. Correlation of MRS Metabolites in Pancreatic Cancer with PET Parameters
3.5. Relationships between Clinical Parameters and MRS Metabolites with Survival Outcomes
3.6. Subgroup Analysis in Patients with and without Curative Surgery
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Parameter | Variable |
---|---|
Age (years) * | 62.7 ± 12.1 (34~81) |
Sex (Men/Women) * | |
Men | 36 (62) |
Women | 22 (38) |
Tumor size (cm) * | 3.3 ± 1.4 |
Tumor location † | |
Head | 33 (57) |
Neck | 7 (12) |
Body | 12 (21) |
Tail | 6 (10) |
Surgery method † (n = 19) | |
Whipple operation | 14 |
Distal pancreatectomy | 2 |
Exploratory laparotomy and biopsy | 1 |
Bypass and biopsy | 2 |
TNM staging † | |
I | 4 (7) |
II | 12 (21) |
III | 9 (16) |
IV | 33 (57) |
Histology grades † (n = 20) | |
Well-differentiated | 3 |
Moderately differentiated | 8 |
Poorly differentiated | 9 |
Metabolites | ppm | Normal Pancreas | Pancreatic Cancer | p Value |
---|---|---|---|---|
Cr_2 | 3.9 | 11.2 ± 19.9 | 7.7 ± 13.9 | 0.200 |
Cr_1 | 3.03 | 8.9 ± 15.8 | 4.5 ± 6.1 | 0.076 |
Glx | 2.05–2.5 | 137.9 ± 201.4 | 66 ± 72.3 | 0.005 * |
NAA | 2.02 | 78.9 ± 100.6 | 24.1 ± 41.7 | <0.001 * |
Lipid_2 | 1.3 | 3119.4 ± 7427.6 | 1015.2 ± 1190.7 | <0.001 * |
Lipid_1 | 0.9 | 886.3 ± 1218.7 | 181.4 ± 240.2 | <0.001 * |
Metabolites | Pathological Grades | T Stage | N Stage | M Stage | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Well- and Moderately (n = 11) | Poorly Differentiated (n = 9) | p Value | T1–3 (n = 26) | T4 (n = 32) | p Value | N0 (n = 14) | N1 (n = 44) | p Value | M0 (n = 25) | M1 (n = 33) | p Value | |
Cr_2 | 6 ± 5.7 | 6.3 ± 12.8 | 0.152 | 6.6 ± 9.2 | 8.2 ± 16.7 | 0.506 | 14.2 ± 22.4 | 5.3 ± 8.9 | 0.019 * | 5.6 ± 6.7 | 8.9 ± 17.3 | 0.85 |
Cr_1 | 5.3 ± 6.5 | 2.6 ± 3.4 | 0.370 | 4.7 ± 6.1 | 4 ± 6.1 | 0.681 | 4.7 ± 6.2 | 4.2 ± 6.1 | 0.581 | 4.4 ± 5.5 | 4.3 ± 6.6 | 0.395 |
Glx | 91.4 ± 87.5 | 46.6 ± 39.6 | 0.230 | 76.4 ± 75 | 57.5 ± 70.1 | 0.152 | 85.8 ± 83.4 | 59.7 ± 68.3 | 0.170 | 69.2 ± 70.5 | 63.6 ± 74.7 | 0.392 |
NAA | 22.0 ± 21.9 | 15.1 ± 15.7 | 0.603 | 32.1 ± 55.8 | 17.1 ± 19.6 | 0.359 | 27.4 ± 28 | 22.7 ± 43.8 | 0.271 | 16.9 ± 15.6 | 29 ± 51.5 | 0.519 |
Lipid_2 | 1337.6 ± 1278.2 | 1044.9 ± 1205.1 | 0.456 | 1139.3 ± 1246.1 | 860.4 ± 1128.6 | 0.101 | 1410.8 ± 1444 | 850.1 ± 1067.2 | 0.122 | 1088.9 ± 1192.3 | 907 ± 1183.6 | 0.282 |
Lipid_1 | 197.2 ± 274.9 | 289.6 ± 264.8 | 0.503 | 222.3 ± 274.4 | 138.4 ± 200 | 0.038 * | 248.4 ± 253.7 | 153 ± 230.7 | 0.084 | 192.6 ± 213.6 | 163.5 ± 257 | 0.094 |
PFS | OS | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariable | Multivariable | Univariable | Multivariable | ||||||||||
Parameters | Cutoff | HR | 95% CI | p Value | HR | 95% CI | p Value | HR | 95% CI | p Value | HR | 95% CI | p Value |
Age (y/o) | 64.5 | 1.001 | 0.574–1.748 | 0.996 | 1.025 | 0.588–1.787 | 0.935 | ||||||
Sex (Women vs. men) | 1.222 | 0.691–2.162 | 0.490 | 0.731 | 0.411–1.301 | 0.287 | |||||||
Size (cm) | 3.1 | 0.712 | 0.408–1.243 | 0.232 | 0.965 | 0.554–1.683 | 0.821 | ||||||
TNM stage (4 vs. ≦ 3) | 2.096 | 1.164–3.774 | 0.014 * | 2.084 | 1.11–3.92 | 0.023 | 1.858 | 1.038–3.326 | 0.037 * | ||||
MRS metabolites | |||||||||||||
Cr_2 | 10.26/12.02 | 0.32 | 0.115–0.895 | 0.022 * | 0.299 | 0.10–0.86 | 0.025 | 0.309 | 0.096–1.001 | 0.039 * | |||
Cr_1 | 1.89/1.89 | 0.466 | 0.256–0.846 | 0.01 * | 0.313 | 0.17–0.576 | <0.0001 * | 0.342 | 0.185–0.632 | <0.0001 | |||
Glx | 45.36/39.86 | 0.472 | 0.261–0.854 | 0.011 * | 0.449 | 0.254–0.794 | 0.0048 * | ||||||
NAA | 30.62/30.62 | 0.519 | 0.22–1.222 | 0.13 | 0.437 | 0.185–1.029 | 0.052 | ||||||
Lipid_2 | 1720/835.7 | 0.496 | 0.22–1.117 | 0.084 | 0.489 | 0.27–0.887 | 0.016 * | ||||||
Lipid_1 | 149.25/133.35 | 0.452 | 0.24–0.851 | 0.012 * | 0.575 | 0.295–1.117 | 0.102 | 0.478 | 0.261–0.873 | 0.014 * | 0.556 | 0.302–1.023 | 0.059 |
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Chang, C.-K.; Shih, T.T.-F.; Tien, Y.-W.; Chang, M.-C.; Chang, Y.-T.; Yang, S.-H.; Cheng, M.-F.; Chen, B.-B. Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome. Diagnostics 2021, 11, 1541. https://doi.org/10.3390/diagnostics11091541
Chang C-K, Shih TT-F, Tien Y-W, Chang M-C, Chang Y-T, Yang S-H, Cheng M-F, Chen B-B. Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome. Diagnostics. 2021; 11(9):1541. https://doi.org/10.3390/diagnostics11091541
Chicago/Turabian StyleChang, Chih-Kai, Tiffany Ting-Fang Shih, Yu-Wen Tien, Ming-Chu Chang, Yu-Ting Chang, Shih-Hung Yang, Mei-Fang Cheng, and Bang-Bin Chen. 2021. "Metabolic Alterations in Pancreatic Cancer Detected by In Vivo 1H-MR Spectroscopy: Correlation with Normal Pancreas, PET Metabolic Activity, Clinical Stages, and Survival Outcome" Diagnostics 11, no. 9: 1541. https://doi.org/10.3390/diagnostics11091541