Abstract

Simple SummaryPancreatic cancer remains one of the most lethal tumor entities worldwide given its overall 5-year survival after diagnosis of 9%. Thus, further understanding of molecular changes to improve individual prognostic assessment as well as diagnostic and therapeutic advancement is crucial. The aim of this study was to investigate the feasibility of Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) to identify specific peptide signatures linked to established prognostic parameters of pancreatic cancer. In a patient cohort of 18 patients with exocrine pancreatic cancer after tumor resection, MALDI imaging analysis additional to histopathological assessment was performed. Applying this method to tissue sections of the tumors, we were able to identify discriminative peptide signatures corresponding to nine proteins for the prognostic histopathological features lymphatic vessel invasion, lymph node metastasis and angioinvasion. This demonstrates the technical feasibility of MALDI-MSI to identify peptide signatures with prognostic value through the workflows used in this study.Despite the overall poor prognosis of pancreatic cancer there is heterogeneity in clinical courses of tumors not assessed by conventional risk stratification. This yields the need of additional markers for proper assessment of prognosis and multimodal clinical management. We provide a proof of concept study evaluating the feasibility of Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) to identify specific peptide signatures linked to prognostic parameters of pancreatic cancer. On 18 patients with exocrine pancreatic cancer after tumor resection, MALDI imaging analysis was performed additional to histopathological assessment. Principal component analysis (PCA) was used to explore discrimination of peptide signatures of prognostic histopathological features and receiver operator characteristic (ROC) to identify which specific m/z values are the most discriminative between the prognostic subgroups of patients. Out of 557 aligned m/z values discriminate peptide signatures for the prognostic histopathological features lymphatic vessel invasion (pL, 16 m/z values, eight proteins), nodal metastasis (pN, two m/z values, one protein) and angioinvasion (pV, 4 m/z values, two proteins) were identified. These results yield proof of concept that MALDI-MSI of pancreatic cancer tissue is feasible to identify peptide signatures of prognostic relevance and can augment risk assessment.

Highlights

  • Pancreatic cancer was diagnosed in 458,918 patients worldwide in 2018

  • We evaluated the technical feasibility of Matrix-assisted laser desorption/ionization (MALDI)-mass spectrometry imaging (MSI) to identify the peptide signature and potential discriminative peptide signatures of formalin-fixed, paraffin-embedded (FFPE) tissue sections of pancreatic cancer tissue of surgical specimens

  • We evaluated the technical feasibility of MALDI-MSI to identify the peptide signa5 of 12 ture and potential discriminative peptide signatures of formalin-fixed, paraffin-embedded (FFPE) tissue sections of pancreatic cancer tissue of surgical specimens

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Summary

Introduction

Pancreatic cancer was diagnosed in 458,918 patients worldwide in 2018. Despite immense efforts to improve early detection and clinical management, the overall 5-year survival after diagnosis remains 9% [1]. At time of diagnosis the main proportion of patients has advanced stage disease, leaving only 15–20% qualified for potentially curative, resective surgery [2]. There is, heterogeneity in clinical courses of tumors even within the same stage [4]. This indicates a pressing need to further augment clinical and histopathological staging in categorizing tumor malignancy, behavior and prognosis by additional prognostic markers for proper risk stratification and, clinical management of exocrine pancreatic cancer. In cases of resectable disease certain subgroups of patients need to be identified that are likely to benefit from neoadjuvant therapy due to aggressive tumor biology or occult metastatic disease. In unresectable disease the further prognostic characterization contributes to the decision of the aggressiveness and toxicity of treatment

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