Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Mutational Landscape in Resected Periampullary Adenocarcinoma: Relationship With Morphology and Clinical Outcome

Lundgren, Sebastian LU ; Olsson Hau, Sofie LU ; Elebro, Jacob LU ; Heby, Margareta LU ; Karnevi, Emelie LU ; Nodin, Björn LU ; Eberhard, Jakob LU ; Holm, Karolina LU ; Staaf, Johan LU orcid and Jönsson, Göran B LU , et al. (2019) In JCO Precision Oncology 3. p.1-8
Abstract
PURPOSE Periampullary adenocarcinomas encompass a heterogeneous group of tumors with dismal prognosis
and limited treatment options. Emerging evidence shows that tumor morphology (ie, intestinal type [I-type] or
pancreatobiliary type [PB-type]) is a more relevant prognostic factor than tumor origin. Knowledge is sparse,
however, on whether key mutations differ according to morphology.
MATERIALS AND METHODS Next-generation sequencing was applied to assess the mutational status of 70 genes
in 102 tumors from a retrospective cohort of 175 patients with resected periampullary adenocarcinoma.
Brahma-related gene 1 protein expression was examined by immunohistochemistry on tissue microarrays with
primary tumors from... (More)
PURPOSE Periampullary adenocarcinomas encompass a heterogeneous group of tumors with dismal prognosis
and limited treatment options. Emerging evidence shows that tumor morphology (ie, intestinal type [I-type] or
pancreatobiliary type [PB-type]) is a more relevant prognostic factor than tumor origin. Knowledge is sparse,
however, on whether key mutations differ according to morphology.
MATERIALS AND METHODS Next-generation sequencing was applied to assess the mutational status of 70 genes
in 102 tumors from a retrospective cohort of 175 patients with resected periampullary adenocarcinoma.
Brahma-related gene 1 protein expression was examined by immunohistochemistry on tissue microarrays with
primary tumors from the original cohort.
RESULTS APC mutations were significantly more common in I-type than in PB-type tumors (27.5% v 0%;
P , .001), as were ERBB3 mutations (20.8% v 4.8%; P = .016), whereas CDKN2A mutations were more
common in PB-type than in I-type tumors (19.4% v 2.5%; P = .013). KRAS mutation was an independent
factor of poor prognosis in I-type tumors (hazard ratio, 3.73; 95% CI, 1.10 to 12.67). In PB-type tumors,
SMARCA4 mutation was an adverse prognostic factor in patients not receiving adjuvant chemotherapy,
and there was a significant treatment interaction between expression of Brahma-related gene 1 protein, the
protein encoded by SMARCA4, and adjuvant chemotherapy (Pinteraction = .007).
CONCLUSION To our knowledge, this is the first description of the mutational landscape in the full spectrum of
periampullary adenocarcinoma that demonstrates that the distribution and prognostic and predictive significance
of commonly mutated genes differ by morphology. The results emphasize that morphology is an important
factor to consider in the search for novel biomarkers and targeted personalized treatment of these patients. In
addition, the findings support the concept that molecular profiling of these tumors could be of clinical benefit. (Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JCO Precision Oncology
volume
3
pages
1 - 8
publisher
American Society of Clinical Oncology
external identifiers
  • scopus:85075555488
  • pmid:32914025
ISSN
2473-4284
DOI
10.1200/PO.18.00323
language
English
LU publication?
yes
id
55fb81e8-b8be-4c2a-90e0-6c9481a8dcce
date added to LUP
2019-05-27 22:40:58
date last changed
2024-01-29 02:56:30
@article{55fb81e8-b8be-4c2a-90e0-6c9481a8dcce,
  abstract     = {{PURPOSE Periampullary adenocarcinomas encompass a heterogeneous group of tumors with dismal prognosis<br/>and limited treatment options. Emerging evidence shows that tumor morphology (ie, intestinal type [I-type] or<br/>pancreatobiliary type [PB-type]) is a more relevant prognostic factor than tumor origin. Knowledge is sparse,<br/>however, on whether key mutations differ according to morphology.<br/>MATERIALS AND METHODS Next-generation sequencing was applied to assess the mutational status of 70 genes<br/>in 102 tumors from a retrospective cohort of 175 patients with resected periampullary adenocarcinoma.<br/>Brahma-related gene 1 protein expression was examined by immunohistochemistry on tissue microarrays with<br/>primary tumors from the original cohort.<br/>RESULTS APC mutations were significantly more common in I-type than in PB-type tumors (27.5% v 0%;<br/>P , .001), as were ERBB3 mutations (20.8% v 4.8%; P = .016), whereas CDKN2A mutations were more<br/>common in PB-type than in I-type tumors (19.4% v 2.5%; P = .013). KRAS mutation was an independent<br/>factor of poor prognosis in I-type tumors (hazard ratio, 3.73; 95% CI, 1.10 to 12.67). In PB-type tumors,<br/>SMARCA4 mutation was an adverse prognostic factor in patients not receiving adjuvant chemotherapy,<br/>and there was a significant treatment interaction between expression of Brahma-related gene 1 protein, the<br/>protein encoded by SMARCA4, and adjuvant chemotherapy (Pinteraction = .007).<br/>CONCLUSION To our knowledge, this is the first description of the mutational landscape in the full spectrum of<br/>periampullary adenocarcinoma that demonstrates that the distribution and prognostic and predictive significance<br/>of commonly mutated genes differ by morphology. The results emphasize that morphology is an important<br/>factor to consider in the search for novel biomarkers and targeted personalized treatment of these patients. In<br/>addition, the findings support the concept that molecular profiling of these tumors could be of clinical benefit.}},
  author       = {{Lundgren, Sebastian and Olsson Hau, Sofie and Elebro, Jacob and Heby, Margareta and Karnevi, Emelie and Nodin, Björn and Eberhard, Jakob and Holm, Karolina and Staaf, Johan and Jönsson, Göran B and Jirström, Karin}},
  issn         = {{2473-4284}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{1--8}},
  publisher    = {{American Society of Clinical Oncology}},
  series       = {{JCO Precision Oncology}},
  title        = {{Mutational Landscape in Resected Periampullary Adenocarcinoma: Relationship With Morphology and Clinical Outcome}},
  url          = {{http://dx.doi.org/10.1200/PO.18.00323}},
  doi          = {{10.1200/PO.18.00323}},
  volume       = {{3}},
  year         = {{2019}},
}