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Global Translational Medicine SLE patient underwent PD

therapy with tacrolimus (2 mg BID) and mycophenolate the patient experienced nausea, vomiting, weight loss,
mofetil (750 mg BID) was resumed on post-operative neutropenia, and thrombocytopenia. After two cycles of
day 3. The post-operative course was uneventful, and the AG chemotherapy, a CT scan showed stable disease, with
patient was discharged after the 12 post-operative day the liver metastasis reduced to 16 mm × 15 mm. The last
th
(Tables 1 and 2). Post-operative pathology confirmed follow-up was in April 2024, during which the patient was
pancreatic adenocarcinoma with three positive lymph still receiving AG chemotherapy.
nodes (pT2N1). Next-generation sequencing of the For the silico analysis conducted to evaluate changes
primary tumor identified five somatic mutations (TP53 in the immune microenvironment, we first obtained
c.711G>A, KRAS c.35G>T, ALK c.903G>T, SMAD4 transcriptomic data of tumor tissues from pancreatic
c.296G>T, and NCOA3 c3820_3828delCAGCAGCAA). cancer patients in the PACA-AU dataset (The International
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The tumor mutation burden was low (4.8/megabase), and Cancer Genome Consortium, https://dcc.icgc.org/) and
microsatellite instability was not detected. The patient The Cancer Genome Atlas (TCGA) dataset (downloaded
10
achieved a complete tumor resection with a negative margin through UCSC Xena browser, https://xenabrowser.net/
(R0). Considering his history of renal transplantation, datapages/). Expression data from the gene expression
the patient was deemed unlikely to tolerate the modified omnibus (GEO) database (GSE103787 ) was used to
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FOLFIRINOX regimen. Therefore, adjuvant chemotherapy compare the immune cell infiltration ratios in lymph nodes.
with tegafur was initiated after a 1-month follow-up. By To gain a more comprehensive view of the patient’s tumor
April 2023, serum levels of CA19-9 and CEA had decreased microenvironment, we applied the CIBERSORT algorithm
to normal (6.73 U/mL and 3.85 ng/mL, respectively).
However, in January 2024, a CT scan revealed a single (https://cibersort.stanford.edu) to extract immune cell
liver metastasis measuring 20 mm×17 mm. Consequently, abundance data from bulk RNA sequencing results of tumor
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the chemotherapy regimen was adjusted to nab-paclitaxel tissue and lymph nodes. This analysis utilized our RNA-seq
plus gemcitabine (AG). During AG chemotherapy, gene expression normalized values and transcriptomic data
from public databases (TCGA, PACA-AU, and GEO) as
input. Our analysis revealed that the profile of infiltrated
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Table 1. Laboratory data
immune cells in this patient’s tumor tissue closely
Parameter Pre- Post-surgery Post-surgery Units resembled those found in pancreatic cancer patients within
surgery 11 days) (4 months) TCGA and PACA-AU datasets (Figure 3A and B). Notably,
Red blood cell 8.2 3.81 4.73 10 /L the ratios of naïve B cells, CD8 T cells, CD4 memory-
+
+
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Hemoglobin 144 111 142 g/L activated T cells, and monocytes in this patient’s tumor
9
White blood cell 8.2 9.06 5.96 10 /L tissue were higher than in most patients in the TCGA
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Monocytes 0.84 0.83 0.49 10 /L and PACA-AU datasets (exceeding the mean + standard
Platelet 370 508 235 10 /L error value for each cell type). In addition, the patient
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exhibited higher proportions of naïve B cells, memory B
Albumin 42.9 41.7 41.8 g/L cells, CD4 memory-activated T cells, regulatory T cells,
+
Globulin 29.1 28.7 27.2 g/L resting natural killer cells, and activated dendritic cells in
Serum creatinine 71 82.4 75.6 μmol/L the lymph nodes compared to patients in the GSE103787
Serum urea 3.6 3.3 2.6 μmol/L dataset (exceeding the mean + standard error value for
CA19-9 99 - 7.21 U/mL each cell type) (Figure 3C). To estimate the immune
Carcinoembryonic 6.71 - 3.88 U/mL status of this patient, we further compared the expression
antigen of cytotoxic genes – such as granzyme B (GZMB), IL2,
Abbreviation: CA19-9: Carbohydrate antigen 19-9. interferon-gamma, IL12B, IL4, IL10, IL12A, perforin 1
(PRF1), lysosomal associated membrane protein 1, and
Table 2. Timeline of the case report tumor necrosis factor – in the tumor tissue and lymph
node of this patient with those in the TCGA, PACA-AU,
Date Information and GSE103787 datasets. We found that the GZMB and
December 8, 2022 Patient referred to our hospital PiRF1 expression levels in this patient were higher than
December 9 – 10, 2022 Pre-operative examination those observed in the TCGA, PACA-AU, and GSE103787
December 9, 2022 Percutaneous transhepatic cholecystostomy datasets (higher than the value of mean + standard error)
December 14, 2022 Pancreaticoduodenectomy (Figure 3D-F). This finding suggests that this patient may
have enhanced T-cell cytotoxic function and anti-tumor
December 14–26, 2022 Post-operative observation immunity. Immunochemistry was also performed to detect
February 7, 2023 Chemotherapy: Tegafur, 80 mg QD GZMB and PRF1 expression in tumor tissues (Figure 4A),

Volume 3 Issue 3 (2024) 3 doi: 10.36922/gtm.2893