期刊
JOURNAL OF CLINICAL INVESTIGATION
卷 124, 期 4, 页码 1525-1536出版社
AMER SOC CLINICAL INVESTIGATION INC
DOI: 10.1172/JCI73455
关键词
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资金
- Lustgarten Foundation [989161]
- Methodist Hospital Research Institute
- Ernest Cockrell Jr. Distinguished Endowed Chair
- NIH's Physical Sciences Oncology Centers (PS-OCs) [U54CA143837]
- NIH's Center for Transport Oncophysics
- Department of Defense [W81XWH-09-1-0212]
- NIH [U54CA151668, U54CA149196]
- NSF [DMS-1263742]
- Anne Eastland Spears Fellowship for GI Cancer Research
- NCI/NIH [KCA088084]
- Ruby Hansen Surface Professorship in Molecular Modeling of Cancer
- Direct For Mathematical & Physical Scien
- Division Of Mathematical Sciences [1263742] Funding Source: National Science Foundation
Background. The therapeutic resistance of pancreatic ductal adenocarcinoma (PDAC) is partly ascribed to ineffective delivery of chemotherapy to cancer cells. We hypothesized that physical properties at vascular, extracellular, and cellular scales influence delivery of and response to gemcitabine-based therapy. Methods. We developed a method to measure mass transport properties during routine contrast-enhanced CT scans of individual human PDAC tumors. Additionally, we evaluated gemcitabine infusion during PDAC resection in 12 patients, measuring gemcitabine incorporation into tumor DNA and correlating its uptake with human equilibrative nucleoside transporter (hENT1) levels, stromal reaction, and CT-derived mass transport properties. We also studied associations between CT-derived transport properties and clinical outcomes in patients who received preoperative gemcitabine-based chemoradiotherapy for resectable PDAC. Results. Transport modeling of 176 CT scans illustrated striking differences in transport properties between normal pancreas and tumor, with a wide array of enhancement profiles. Reflecting the interpatient differences in contrast enhancement, resected tumors exhibited dramatic differences in gemcitabine DNA incorporation, despite similar intravascular pharmacokinetics. Gemcitabine incorporation into tumor DNA was inversely related to CT-derived transport parameters and PDAC stromal score, after accounting for hENT1 levels. Moreover, stromal score directly correlated with CT-derived parameters. Among 110 patients who received preoperative gemcitabine-based chemoradiotherapy, CT-derived parameters correlated with pathological response and survival. Conclusion. Gemcitabine incorporation into tumor DNA is highly variable and correlates with multiscale transport properties that can be derived from routine CT scans. Furthermore, pretherapy CT-derived properties correlate with clinically relevant endpoints.
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