AccScience Publishing / GTM / Online First / DOI: 10.36922/gtm.2893
CASE REPORT

Pancreatoduodenectomy for pancreatic adenocarcinoma in a patient with systemic lupus erythematosus who underwent renal transplantation: A case report

Ran Wei1 Dailei Qin1 Zehui Yao1 Xiaojun Lin1* Bokang Cui1*
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1 State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guandong, China
Global Translational Medicine 2024, 3(3), 2893 https://doi.org/10.36922/gtm.2893
Submitted: 5 February 2024 | Accepted: 22 May 2024 | Published: 4 September 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

The incidence of pancreatic cancer is elevated in patients with systemic lupus erythematosus (SLE), particularly those who have undergone renal transplantation. However, the feasibility of performing a pancreaticoduodenectomy (PD) for this specific patient group remains uncertain. Here, we present a case of a 44-year-old male with SLE and a history of renal transplantation who was newly diagnosed with pancreatic cancer. The patient successfully underwent PD combined with resection and reconstruction of the superior mesenteric vein and had an uneventful post-operative course. In silico analysis revealed higher ratios of naïve B cells, CD8+ T cells, CD4+ memory-activated T cells, and monocytes in the tumor tissue of this patient compared to most patients in The Cancer Genome Atlas and PACA-AU datasets (exceeding the mean + standard error value for each cell type). In addition, the patient exhibited higher proportions of naïve B cells, memory B cells, CD4+ memory-activated T cells, regulatory T cells, resting natural killer cells, and activated dendritic cells in the lymph nodes compared to patients in the GSE103787 dataset (exceeding the mean + standard error value for each cell type). Furthermore, expression levels of cytotoxic marker genes (granzyme B and perforin 1) were higher in both the tumor tissue and lymph nodes compared to public datasets (exceeding the mean + standard error value). In conclusion, this case demonstrates that a patient with SLE and renal transplantation can tolerate PD. In addition, it provides the first description of this patient group’s unique anti-tumor immune microenvironment through in silico analysis.

Keywords
Case report
Pancreatic cancer
Systemic lupus erythematosus
Renal transplantation
Immune microenvironment
Funding
The present study was supported by the National Natural Science Foundation of China (82103570).
Conflict of interest
The authors declare that they have no conflict of interest.
References
  1. Durcan L, O’Dwyer T, Petri M. Management strategies and future directions for systemic lupus erythematosus in adults. Lancet. 2019;393(10188):2332-2343. doi: 10.1016/s0140-6736(19)30237-5

 

  1. Tallbacka KR, Pettersson T, Pukkala E. Increased incidence of cancer in systemic lupus erythematosus: A Finnish cohort study with more than 25 years of follow-up. Scand J Rheumatol. 2018;47(6):461-464. doi: 10.1080/03009742.2017.1384054

 

  1. Westermann R, Zobbe K, Cordtz R, Haugaard JH, Dreyer L. Increased cancer risk in patients with cutaneous lupus erythematosus and systemic lupus erythematosus compared with the general population: A Danish nationwide cohort study. Lupus. 2021;30(5):752-761. doi: 10.1177/0961203321990106

 

  1. Seo MS, Yeo J, Hwang IC, Shim JY. Risk of pancreatic cancer in patients with systemic lupus erythematosus: A meta-analysis. Clin Rheumatol. 2019;38(11):3109-3116. doi: 10.1007/s10067-019-04660-9

 

  1. Huang SP, Guisinger A, Averell C, Bell CF, Rubin B. Clinical and economic burden of systemic lupus erythematosus in the years preceding end-stage kidney disease diagnosis: A retrospective observational study. Rheumatol Ther. 2023;10:551-562. doi: 10.1007/s40744-023-00532-6

 

  1. Au EH, Chapman JR, Craig JC, et al. Overall and site-specific cancer mortality in patients on dialysis and after kidney transplant. J Am Soc Nephrol. 2019;30(3):471-480. doi: 10.1681/asn.2018090906

 

  1. Coghill AE, Johnson LG, Berg D, Resler AJ, Leca N, Madeleine MM. Immunosuppressive medications and squamous cell skin carcinoma: Nested case-control study within the Skin Cancer after Organ Transplant (SCOT) cohort. Am J Transplant. 2016;16(2):565-573. doi: 10.1111/ajt.13596

 

  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660

 

  1. Scarlett CJ, Salisbury EL, Biankin AV, Kench J. Precursor lesions in pancreatic cancer: Morphological and molecular pathology. Pathology. 2011;43(3):183-200. doi: 10.1097/PAT.0b013e3283445e3a

 

  1. Cancer Genome Atlas Research Network. Integrated genomic characterization of pancreatic ductal adenocarcinoma. Cancer Cell. 2017;32(2):185-203.e13. doi: 10.1016/j.ccell.2017.07.007

 

  1. Rausch V, Krieg A, Camps J, et al. Array comparative genomic hybridization of 18 pancreatic ductal adenocarcinomas and their autologous metastases. BMC Res Notes. 2017;10:560. doi: 10.1186/s13104-017-2886-0

 

  1. Newman AM, Steen CB, Liu CL, et al. Determining cell type abundance and expression from bulk tissues with digital cytometry. Nat Biotechnol. 2019;37(7):773-782. doi: 10.1038/s41587-019-0114-2

 

  1. Newman AM, Liu CL, Green MR, et al. Robust enumeration of cell subsets from tissue expression profiles. Nat Methods. 2015;12(5):453-457. doi: 10.1038/nmeth.3337

 

  1. Wei R, Zhu WW, Yu GY, et al. S100 calcium-binding protein A9 from tumor-associated macrophage enhances cancer stem cell-like properties of hepatocellular carcinoma. Int J Cancer. 2021;148(5):1233-1244. doi: 10.1002/ijc.33371

 

  1. Serenari M, Ercolani G, Cucchetti A, et al. The impact of extent of pancreatic and venous resection on survival for patients with pancreatic cancer. Hepatobiliary Pancreat Dis Int. 2019;18(4):389-394. doi: 10.1016/j.hbpd.2019.06.004

 

  1. Fromentin M, Mullaert J, Gille B, et al. Extended antibiotic prophylaxis after pancreatoduodenectomy reduces postoperative abdominal infection in high-risk patients: Results from a retrospective cohort study. Surgery. 2022;172(1):205-211. doi: 10.1016/j.surg.2021.12.028

 

  1. Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of cancer recurrence in patients with immune-mediated diseases with use of immunosuppressive therapies: An updated systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024;22(3):499-512.e6. doi: 10.1016/j.cgh.2023.07.027

 

  1. Schalck A, Sakellariou-Thompson D, Forget MA, et al. Single-Cell sequencing reveals trajectory of tumor-infiltrating lymphocyte states in pancreatic cancer. Cancer Discov. 2022;12(10):2330-2349. doi: 10.1158/2159-8290.Cd-21-1248

 

  1. Weigelin B, Friedl P. T cell-mediated additive cytotoxicity - Death by multiple bullets. Trends Cancer. 2022;8(12):980-987. doi: 10.1016/j.trecan.2022.07.007

 

  1. Voskoboinik I, Whisstock J, Trapani JA. Perforin and granzymes: Function, dysfunction and human pathology. Nat Rev Immunol. 2015;15(6):388-400. doi: 10.1038/nri3839

 

  1. Cao Y, He H, Li R, et al. Latency-associated peptide identifies immunoevasive subtype gastric cancer with poor prognosis and inferior chemotherapeutic responsiveness. Ann Surg. 2022;275(1):e163-e173. doi: 10.1097/sla.0000000000003833

 

  1. Sun H, Huang Q, Huang M, et al. Human CD96 correlates to natural killer cell exhaustion and predicts the prognosis of human hepatocellular carcinoma. Hepatology. 2019;70(1):168-183. doi: 10.1002/hep.30347
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Global Translational Medicine, Electronic ISSN: 2811-0021 Print ISSN: 3060-8600, Published by AccScience Publishing