Switch/sucrose nonfermenting nucleosome complex-deficient 结直肠癌细胞具有独特的临床病理特征。

Switch/sucrose nonfermenting nucleosome complex-deficient colorectal carcinomas have distinct clinicopathologic features.

机构信息

Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

出版信息

Hum Pathol. 2020 May;99:53-61. doi: 10.1016/j.humpath.2020.03.009. Epub 2020 Mar 25.

Abstract

The switch/sucrose nonfermenting (SWI/SNF) nucleosome complex consists of several proteins that are involved in cellular proliferation and tumor suppression. The aim of this study was to correlate immunohistochemical expression of four SWI/SNF complex subunits, SMARCA2, SMARCB1, SMARCA4, and ARID1A, with clinicopathologic and molecular features and patient survival in 338 patients with colorectal adenocarcinoma using a tissue microarray approach. Twenty-three (7%) colorectal adenocarcinomas demonstrated deficient SWI/SNF expression: 7 had SMARCA2 deficiency, 12 had ARID1A deficiency, and 4 had both SMARCA2 and ARID1A deficiency. No cases were SMARCB1 or SMARCA4 deficient. Twelve (52%) SWI/SNF complex-deficient tumors demonstrated mismatch repair (MMR) deficiency (p = 0.02), 6 (26%) showed medullary differentiation (p = 0.001), and 9 were negative for CDX2 expression (p < 0.001). Among the MMR-deficient SWI/SNF complex-deficient tumors, 8 were sporadic MLH1 deficient, and 4 were seen in patients with Lynch syndrome. Compared with tumors with ARID1A deficiency alone, SMARCA2-deficient tumors were less likely to exhibit MMR deficiency (27% vs. 75%, p = 0.04), medullary differentiation (0% vs. 50%, p = 0.01), and mucinous differentiation (0% vs. 42%, p = 0.04). Conventional gland-forming histology was more often identified in SMARCA2-deficient tumors (11/11, 100%) than in tumors with ARID1A deficiency alone (4/12, 33%) (p = 0.001). There was no difference in KRAS mutation, BRAF mutation, stage, disease-specific survival, or disease-free survival for patients stratified by SWI/SNF expression (all with p > 0.05). In conclusion, SMARCA2-deficient and ARID1A-deficient colorectal carcinomas had distinctly different clinicopathologic features, with ARID1A-deficient tumors exhibiting medullary and mucinous differentiation and MMR deficiency and SMARCA2-deficient tumors demonstrating conventional gland-forming histologic growth with less frequent MMR deficiency.

摘要

SWI/SNF 核小体重塑复合物由几个参与细胞增殖和肿瘤抑制的蛋白质组成。本研究的目的是通过组织微阵列方法,在 338 例结直肠腺癌患者中,将四种 SWI/SNF 复合物亚基(SMARCA2、SMARCB1、SMARCA4 和 ARID1A)的免疫组织化学表达与临床病理和分子特征以及患者生存相关联。23 例(7%)结直肠腺癌表现出 SWI/SNF 表达缺失:7 例 SMARCA2 缺失,12 例 ARID1A 缺失,4 例 SMARCA2 和 ARID1A 均缺失。没有 SMARCB1 或 SMARCA4 缺失的病例。12 例(52%)SWI/SNF 复合物缺陷肿瘤表现出错配修复(MMR)缺陷(p=0.02),6 例(26%)表现出髓样分化(p=0.001),9 例 CDX2 表达阴性(p<0.001)。在 MMR 缺陷的 SWI/SNF 复合物缺陷肿瘤中,8 例为散发性 MLH1 缺陷,4 例见于林奇综合征患者。与 ARID1A 缺陷单独的肿瘤相比,SMARCA2 缺陷的肿瘤更不可能表现出 MMR 缺陷(27%对 75%,p=0.04)、髓样分化(0%对 50%,p=0.01)和黏液分化(0%对 42%,p=0.04)。SMARCA2 缺陷肿瘤中更常发现常规腺形成组织学(11/11,100%),而 ARID1A 缺陷肿瘤中仅为 4/12(33%)(p=0.001)。根据 SWI/SNF 表达对患者进行分层,KRAS 突变、BRAF 突变、分期、疾病特异性生存率或无病生存率无差异(均 p>0.05)。总之,SMARCA2 缺陷和 ARID1A 缺陷的结直肠腺癌具有明显不同的临床病理特征,ARID1A 缺陷肿瘤表现出髓样和黏液分化以及 MMR 缺陷,而 SMARCA2 缺陷肿瘤则表现出常规腺形成组织学生长,MMR 缺陷的频率较低。

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