Cathepsin D Expression and Gemcitabine Resistance in Pancreatic Cancer.


Journal

JNCI cancer spectrum
ISSN: 2515-5091
Titre abrégé: JNCI Cancer Spectr
Pays: England
ID NLM: 101721827

Informations de publication

Date de publication:
Feb 2020
Historique:
received: 20 05 2019
revised: 01 07 2019
accepted: 06 08 2019
entrez: 17 4 2020
pubmed: 17 4 2020
medline: 17 4 2020
Statut: epublish

Résumé

Cathepsin-D (CatD), owing to its dual role as a proteolytic enzyme and as a ligand, has been implicated in cancer progression. The role of CatD in pancreatic ductal adenocarcinoma is unknown. CatD expression quantified by immunohistochemistry of tumor-tissue microarrays of 403 resected pancreatic cancer patients from the ESPAC-Tplus trial, a translational study within the ESPAC (European Study Group for Pancreatic Cancer) trials, was dichotomously distributed to low and high H scores (cut off 22.35) for survival and multivariable analysis. The validation cohort (n = 69) was recruited based on the hazard ratio of CatD from ESPAC-Tplus. 5-fluorouracil-, and gemcitabine-resistant pancreatic cancer cell lines were employed for mechanistic experiments. All statistical tests were two-sided. Median overall survival was 23.75 months and median overall survival for patients with high CatD expression was 21.09 (95% confidence interval [CI] = 17.31 to 24.80) months vs 27.20 (95% CI = 23.75 to 31.90) months for low CatD expression (χ Adjuvant gemcitabine is less effective in pancreatic ductal adenocarcinoma with high CatD expression, and thus CatD could serve as a marker for biomarker-driven therapy.

Sections du résumé

BACKGROUND BACKGROUND
Cathepsin-D (CatD), owing to its dual role as a proteolytic enzyme and as a ligand, has been implicated in cancer progression. The role of CatD in pancreatic ductal adenocarcinoma is unknown.
METHODS METHODS
CatD expression quantified by immunohistochemistry of tumor-tissue microarrays of 403 resected pancreatic cancer patients from the ESPAC-Tplus trial, a translational study within the ESPAC (European Study Group for Pancreatic Cancer) trials, was dichotomously distributed to low and high H scores (cut off 22.35) for survival and multivariable analysis. The validation cohort (n = 69) was recruited based on the hazard ratio of CatD from ESPAC-Tplus. 5-fluorouracil-, and gemcitabine-resistant pancreatic cancer cell lines were employed for mechanistic experiments. All statistical tests were two-sided.
RESULTS RESULTS
Median overall survival was 23.75 months and median overall survival for patients with high CatD expression was 21.09 (95% confidence interval [CI] = 17.31 to 24.80) months vs 27.20 (95% CI = 23.75 to 31.90) months for low CatD expression (χ
CONCLUSIONS CONCLUSIONS
Adjuvant gemcitabine is less effective in pancreatic ductal adenocarcinoma with high CatD expression, and thus CatD could serve as a marker for biomarker-driven therapy.

Identifiants

pubmed: 32296755
doi: 10.1093/jncics/pkz060
pii: pkz060
pmc: PMC7050148
doi:

Types de publication

Journal Article

Langues

eng

Pagination

pkz060

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press.

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Auteurs

Ujjwal M Mahajan (UM)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Elisabetta Goni (E)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Enno Langhoff (E)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Qi Li (Q)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Eithne Costello (E)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

William Greenhalf (W)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Stephan Kruger (S)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Steffen Ormanns (S)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Christopher Halloran (C)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Paula Ganeh (P)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Manuela Marron (M)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Felix Lämmerhirt (F)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Yue Zhao (Y)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Georg Beyer (G)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Frank-Ulrich Weiss (FU)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Matthias Sendler (M)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Christiane J Bruns (CJ)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Thomas Kohlmann (T)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Thomas Kirchner (T)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Jens Werner (J)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Jan G D'Haese (JG)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Michael von Bergwelt-Baildon (M)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Volker Heinemann (V)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

John P Neoptolemos (JP)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Markus W Büchler (MW)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Claus Belka (C)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Stefan Boeck (S)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Markus M Lerch (MM)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

Julia Mayerle (J)

Department of Medicine II (UMM, EG, QL, FL, GB, JM), Department of Medicine III (SK, MvBB, VH, SB), Department of Radiation Oncology (CB), University Hospital, LMU-Munich, Munich, Germany; Department of Medicine A, University Medicine Greifswald, Greifswald, Germany (UMM, EL, GB, FUW, MS, MML, JM); National Institute for Health Research Liverpool Pancreas Biomedical Research Centre, University of Liverpool, UK (EC, WG, CH, PG, JPN); Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany (SO, TKi); Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany (MM); Department of General, Visceral, and Tumor Surgery, University Hospital Cologne, Cologne, Germany (YZ, CJB); Department of Community Medicine, University Medicine Greifswald, Greifswald, Germany (TKo); Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany (JW, JGD); Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (JPN, MWB); German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany (TKi, VH, SB).

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