Clinicopathologic analysis of pancreatic adenocarcinoma in African Americans and Caucasians
Clinicopathologic analysis of pancreatic adenocarcinoma in African Americans and Caucasians
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DOI：
10.1097/00006676-200301000-00006
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发表时间：
2003-01-01
期刊：
影响因子：
2.9
通讯作者：
Adsay, NV
中科院分区：
文献类型：
--
作者：
Pernick, NL;Sarkar, FH;Adsay, NV
简介：非裔美国人胰腺癌的发病率高于白人，原因不明。这两组之间是否存在其他临床病理学差异尚不清楚。本研究旨在比较一个机构中一组组织学诊断为常见类型胰腺导管腺癌的患者的临床、病理和生物学表现。方法学：我们研究了410名患者（166名非裔美国人和244名高加索人），组织学诊断为常见类型的胰腺导管腺癌，并分析（a）肿瘤的临床病理学特征，（B）与胰腺癌发生有关的生物标志物的免疫组织化学表达（Fas、Fas配体、HER 2、p21/waf-1、p27和p53），和（c）通过聚合酶链反应介导的扩增确定的密码子12处K-ras突变的存在和类型。并非所有患者的所有数据要素均可用。结果如下：非裔美国人的K-ras基因突变为缬氨酸的比例显著高于白人（分别为58%和22%; p=0.015），并且接受化疗（分别为45%和70%; p=0.001）或放疗（分别为34%和57%; p=0.003）的可能性较小。非裔美国人的手术切缘阳性率也高于白人（分别为56%和25%; p=0.001），尽管两组的平均肿瘤大小相似（非裔美国人，3.4 cm;白人，3.5 cm）。其他临床病理学变量在两组之间相似，包括中位生存期（非洲裔美国人，8.5个月;白人，10.1个月），5年生存期（非洲裔美国人，3%;白人，6%）和临床分期。生物标志物免疫反应性的差异包括非裔美国人中Fas表达频率较低（分别为4%和24%; p=0.048）和HER 2强表达频率较高的趋势（分别为39%和18%，p=0.11）。结论：虽然非裔美国人和白人患者的生存率与普通型胰腺导管腺癌相似，但这两组之间在管理和生物标志物表达方面存在差异。非裔美国人接受放射治疗或化疗的可能性明显低于白人，随着治疗的改善，这可能会变得更加重要。在分子水平上，非裔美国人的K-ras基因突变为缬氨酸的频率高于白种人。
Introduction: African Americans have a higher incidence of pancreatic adenocarcinoma than do Caucasians for unknown reasons. Whether other clinicopathologic differences exist between these two groups is not known. This study was undertaken to compare the clinical, pathologic, and biologic findings for a group of patients with a histologic diagnosis of pancreatic ductal adenocarcinoma of the usual type in a single institution. Methodology: We studied 410 patients (166 African Americans and 244 Caucasians) with a histologic diagnosis of pancreatic ductal adenocarcinoma of the usual type and analyzed (a) the clinicopathologic characteristics of the tumors, (b) the immunohistochemical expression of biomarkers implicated in pancreatic carcinogenesis (Fas, Fas ligand, HER2, p21/waf-1, p27, and p53), and (c) the presence and types of K-ras mutations at codon 12 as determined by polymerase chain reaction-mediated amplification. All elements of data were not available for all patients. Results: African Americans had significantly higher rates of K-ras mutations to valine than did Caucasians (58% versus 22%, respectively; p=0.015) and were less likely to have received chemotherapy (45% versus 70%, respectively; p=0.001) or radiation therapy (34% versus 57%, respectively; p=0.003). African Americans also had more frequent positive surgical margins than did Caucasians (56% versus 25%, respectively; p=0.001), although mean tumor size was similar between the two groups (African Americans, 3.4 cm; Caucasians, 3.5 cm). Other clinicopathologic variables were similar between the two groups, including median survival (African Americans, 8.5 months; Caucasians, 10.1 months), 5-year survival (African Americans, 3%; Caucasians, 6%), and stage at presentation. Differences in biomarker immunoreactivity included less frequent Fas expression (4% versus 24%, respectively; p=0.048) and a trend toward more frequent strong HER2 expression (39% versus 18%, respectively p=0.11) in African Americans than in Caucasians. Conclusion: Although African American and Caucasian patients had similar survival rates associated with usual type pancreatic ductal adenocarcinoma, there were differences in management and expression of biologic markers between these two groups. African Americans were significantly less likely to receive radiation therapy or chemotherapy than were Caucasians, which may assume more importance as treatment improves. At the molecular level, African Americans had more frequent K-ras mutations to valine than did Caucasians.