Surgery Unit, Azienda USL-Maggiore Hospital, Bologna, Italy.
Department of Medicine (Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale) - Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna School of Medicine, Bologna, Italy.
Cancer Biomark. 2018 Feb 6;21(2):323-334. doi: 10.3233/CBM-170464.
BACKGROUND: Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is currently the only effective treatment for PDAC, most patients survive less than 20 months after tumor resection. OBJECTIVE: The primary goal was to investigate alterations in KRAS, TP53, SMAD4 and CDKN2A/p16 in tumors from patients with exceptionally long survival after surgery. METHODS: Tumors from 15 patients with PDAC that survived more than 55 months after surgery ("LS") were analyzed for KRAS, TP53, IDH1, NRAS and BRAF using next-generation sequencing. SMAD4 and CDKN2A/p16 was tested using immunohistochemistry. MGMT promoter methylation was investigated. RESULTS: Tumors from "LS" have a lower prevalence of KRAS and TP53 mutations and had more frequently SMAD4 retained expression, if compared with that of patients died within 24 months from surgery. The survival of patients with wild-type KRAS and TP53 tumors was more than twice longer than that of patients bearing KRAS and TP53 mutations (90.2 vs. 41.1 months). Patients with KRAS wild-type tumors and that retained SMAD4 expression had a survival twice longer than cases with alterations in both genes (83.8 vs. 36.7 months). Eleven tumors (39.3%) showed MGMT methylation. CONCLUSIONS: Our data indicate that absence of KRAS, TP53 and SMAD4 genetic alterations may identify a subset of pancreatic carcinomas with better outcome.
背景:胰腺导管腺癌(PDAC)是人类最致命的恶性肿瘤之一。尽管手术目前是治疗 PDAC 的唯一有效方法,但大多数患者在肿瘤切除后生存时间不到 20 个月。 目的:主要目的是研究手术后生存时间异常长的患者肿瘤中 KRAS、TP53、SMAD4 和 CDKN2A/p16 的变化。 方法:使用下一代测序分析了 15 例 PDAC 患者的肿瘤,这些患者在手术后超过 55 个月存活(“LS”),并检测 KRAS、TP53、IDH1、NRAS 和 BRAF。使用免疫组织化学检测 SMAD4 和 CDKN2A/p16。研究了 MGMT 启动子甲基化。 结果:与手术后 24 个月内死亡的患者相比,“LS”患者的 KRAS 和 TP53 突变发生率较低,且 SMAD4 表达保留更为常见。KRAS 和 TP53 野生型肿瘤患者的生存时间是 KRAS 和 TP53 突变患者的两倍以上(90.2 与 41.1 个月)。KRAS 野生型肿瘤且 SMAD4 表达保留的患者的生存时间是两个基因均发生改变的患者的两倍(83.8 与 36.7 个月)。有 11 个肿瘤(39.3%)显示 MGMT 甲基化。 结论:我们的数据表明,KRAS、TP53 和 SMAD4 基因改变的缺失可能会确定一组具有更好预后的胰腺肿瘤。
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