作为恶性胸膜间皮瘤中CDKN2A(p16)荧光原位杂交的补充,BAP1免疫组化的预后效用有限。
BAP1 immunohistochemistry has limited prognostic utility as a complement of CDKN2A (p16) fluorescence in situ hybridization in malignant pleural mesothelioma.
作者信息
McGregor Stephanie M, McElherne James, Minor Agata, Keller-Ramey Jennifer, Dunning Ryan, Husain Aliya N, Vigneswaran Wickii, Fitzpatrick Carrie, Krausz Thomas
机构信息
Department of Pathology, University of Chicago Medicine, Chicago, IL 60637; Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792.
Department of Pathology, University of Chicago Medicine, Chicago, IL 60637.
出版信息
Hum Pathol. 2017 Feb;60:86-94. doi: 10.1016/j.humpath.2016.09.026. Epub 2016 Oct 19.
BRCA-associated protein 1 (BAP1) immunohistochemistry (IHC) and CDKN2A (p16) fluorescence in situ hybridization (FISH) have shown clinical utility in confirming the diagnosis of malignant pleural mesothelioma (MPM), but the role for using these 2 markers to guide clinical management is not yet clear. Although p16 loss is predictive of poor prognosis, there is controversy as to whether BAP1 loss is predictive of a more favorable prognosis; how these results interact with one another has not been explored. We performed CDKN2A FISH on a previously published tissue microarray on which we had performed BAP1 IHC, revealing combined BAP1/p16 status for 93 MPM cases. As expected, BAP1 IHC in combination with CDKN2A FISH resulted in high sensitivity (84%) and specificity (100%) for MPM, and p16 loss was an independent predictor of poor survival (hazard ratio, 2.2553; P = .0135). There was no association between BAP1 loss and p16 loss, as 26%, 28%, 30%, and 16% of overall cases demonstrated loss of BAP1 alone, loss of p16 alone, loss of both BAP1 and p16, or neither abnormality, respectively. Although multivariate analysis demonstrated that BAP1 IHC is not an independent predictor of prognosis, when viewed in combination with homozygous CDKN2A deletion, risk stratification was evident. More specifically, patients with CDKN2A disomy and loss of BAP1 expression had improved outcomes compared with those with CDKN2A disomy and retained BAP1 expression (hazard ratio, 0.2286; P = .0017), and this finding was notably evident among epithelioid cases. We conclude that BAP1 IHC provides prognostic information within the context of CDKN2A FISH that may have clinical utility beyond diagnosis.
乳腺癌相关蛋白1(BAP1)免疫组化(IHC)和细胞周期蛋白依赖性激酶抑制剂2A(CDKN2A,即p16)荧光原位杂交(FISH)已显示出在确诊恶性胸膜间皮瘤(MPM)方面的临床实用性,但使用这两种标志物指导临床管理的作用尚不清楚。虽然p16缺失预示预后不良,但关于BAP1缺失是否预示预后更良好仍存在争议;尚未探讨这些结果如何相互作用。我们对之前发表的组织芯片进行了CDKN2A FISH检测,在该芯片上我们已进行了BAP1 IHC检测,从而揭示了93例MPM病例的BAP1/p16联合状态。正如预期的那样,BAP1 IHC联合CDKN2A FISH对MPM具有高敏感性(84%)和特异性(100%),并且p16缺失是生存不良的独立预测因素(风险比,2.2553;P = 0.0135)。BAP1缺失与p16缺失之间无关联,因为总体病例中分别有26%、28%、30%和16%仅显示BAP1缺失、仅显示p16缺失、BAP1和p16均缺失或两者均无异常。虽然多变量分析表明BAP1 IHC不是预后的独立预测因素,但与纯合性CDKN2A缺失联合观察时,风险分层很明显。更具体地说,与CDKN2A二体性且保留BAP1表达的患者相比,CDKN2A二体性且BAP1表达缺失的患者预后更好(风险比,0.2286;P = 0.0017),并且这一发现在上皮样病例中尤为明显。我们得出结论,在CDKN2A FISH的背景下,BAP1 IHC提供了预后信息,其临床实用性可能超出诊断范围。