Logo image
Back
Association of Alterations in Main Driver Genes With Outcomes of Patients With Resected Pancreatic Ductal Adenocarcinoma
Journal article   Open access   Peer reviewed

Association of Alterations in Main Driver Genes With Outcomes of Patients With Resected Pancreatic Ductal Adenocarcinoma

Zhi Rong Qian, Douglas A Rubinson, Jonathan A Nowak, Vicente Morales-Oyarvide, Richard F Dunne, Margaret M Kozak, Marisa W Welch, Lauren K Brais, Annacarolina Da Silva, Tingting Li, …
JAMA oncology, Vol.4(3), pp.e173420-e173420
03/08/2018
DOI: 10.1001/jamaoncol.2017.3420
PMCID: PMC5844844
PMID: 29098284
url
https://doi.org/10.1001/jamaoncol.2017.3420View
Published (Version of record) Open Access

Abstract

Although patients with resected pancreatic adenocarcinoma are at high risk for disease recurrence, few biomarkers are available to inform patient outcomes. To evaluate the alterations of the 4 main driver genes in pancreatic adenocarcinoma and patient outcomes after cancer resection. This study analyzed protein expression and DNA alterations for the KRAS, CDKN2A, SMAD4, and TP53 genes by immunohistochemistry and next-generation sequencing in formalin-fixed, paraffin-embedded tumors in 356 patients with resected pancreatic adenocarcinoma who were treated at the Dana-Farber/Brigham and Women's Cancer Center (October 26, 2002, to May 21, 2012), University of Rochester Medical Center (March 1, 2006, to November 1, 2013), or Stanford Cancer Institute (September 26, 1995, to May 22, 2013). Associations of driver gene alterations with disease-free survival (DFS) and overall survival (OS) were evaluated using Cox proportional hazards regression with estimation of hazard ratios (HRs) and 95% CIs and adjustment for age, sex, tumor characteristics, institution, and perioperative treatment. Data were collected September 9, 2012, to June 28, 2016, and analyzed December 17, 2016, to March 14, 2017. The DFS and OS among patients with resected pancreatic adenocarcinoma. Of the 356 patients studied, 191 (53.7%) were men and 165 (46.3%) were women, with a median (interquartile range [IQR]) age of 67 (59.0-73.5) years. Patients with KRAS mutant tumors had worse DFS (median [IQR], 12.3 [6.7 -27.2] months) and OS (20.3 [11.3-38.3] months) compared with patients with KRAS wild-type tumors (DFS, 16.2 [8.9-30.5] months; OS, 38.6 [16.6-63.1] months) and had 5-year OS of 13.0% vs 30.2%. Particularly poor outcomes were identified in patients with KRAS G12D-mutant tumors, who had a median (IQR) OS of 15.3 (9.8-32.7) months. Patients whose tumors lacked CDKN2A expression had worse DFS (median, 11.5 [IQR, 6.2-24.5] months) and OS (19.7 [10.9-37.1] months) compared with patients who had intact CDKN2A (DFS, 14.8 [8.2-30.5] months; OS, 24.6 [14.1-44.6] months). The molecular status of SMAD4 was not associated with DFS or OS, whereas TP53 status was associated only with shorter DFS (HR, 1.33; 95% CI, 1.02-1.75; P = .04). Patients had worse DFS and OS if they had a greater number of altered driver genes. Compared with patients with 0 to 2 altered genes, those with 4 altered genes had worse DFS (HR, 1.79 [95% CI, 1.24-2.59; P = .002]) and OS (HR, 1.38 [95% CI, 0.98-1.94; P = .06]). Five-year OS was 18.4% for patients with 0 to 2 gene alterations, 14.1% for those with 3 alterations, and 8.2% for those with 4 alterations. Patient outcomes are associated with alterations of the 4 main driver genes in resected pancreatic adenocarcinoma.
 Adenocarcinoma - genetics Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Biomarkers, Tumor - genetics Biomarkers, Tumor - metabolism Carcinoma, Pancreatic Ductal - genetics Carcinoma, Pancreatic Ductal - mortality Carcinoma, Pancreatic Ductal - pathology Carcinoma, Pancreatic Ductal - surgery DNA Mutational Analysis - methods Female Follow-Up Studies Gene Expression Profiling - methods Gene Expression Regulation, Neoplastic - genetics High-Throughput Nucleotide Sequencing Humans Immunohistochemistry Male Middle Aged Mutation Pancreatectomy Pancreatic Neoplasms - genetics Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Prognosis Proto-Oncogene Proteins - genetics Proto-Oncogene Proteins - metabolism Survival Analysis Treatment Outcome

Details

Metrics

30 Record Views
191 Times Cited - Web of Science
Logo image