Failure patterns in resected pancreas adenocarcinoma: lack of predicted benefit to SMAD4 expression.
Failure patterns in resected pancreas adenocarcinoma: lack of predicted benefit to SMAD4 expression.
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DOI：
10.1097/sla.0b013e31827fe9ce
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发表时间：
2013-08
影响因子：
9
通讯作者：
Allen PJ
中科院分区：
文献类型：
--
作者：
Winter JM;Tang LH;Klimstra DS;Liu W;Linkov I;Brennan MF;DʼAngelica MI;DeMatteo RP;Fong Y;Jarnagin WR;Oʼreilly EM;Allen PJ
确定 SMAD4 表达是否与胰腺导管腺癌 (PDA) 切除后的复发模式相关 据报道，SMAD4 表达状态与 PDA 失败模式相关，但研究尚未检查切除后的复发模式。构建了组织微阵列，包括 127 名已切除 PDA 且生存期短（<12 个月）或长（>30 个月）的患者。通过免疫组织化学评估 SMAD4 表达，并将其分类为肿瘤细胞中存在或缺失。记录常规病理特征（淋巴结转移、切除切缘阳性、分级不良、肿瘤大小），并确定疾病特异性结果（例如复发模式和早期癌症特异性死亡率）。 127 名患者中有 40 名 (32%) 发现胰腺腺癌中 SMAD4 表达缺失。 SMAD4 缺失发生在 27% 的孤立局部复发患者、33% 的远处复发患者、33% 的局部和远处复发患者以及 25% 的无复发证据的患者中（Fisher 精确，p=0.9）。在多变量分析中，区域淋巴结转移的存在是与远处转移发生相关的唯一因素（比值比，OR=4.7，p=0.02）。 SMAD4 既不与复发模式相关（OR=0.9，p=0.9），也不与早期死亡相关（OR=0.5，p=0.15）。在大量 PDA 切除患者中，原发肿瘤 SMAD4 表达状态并不是复发模式的预测因子。
To determine if SMAD4 expression is associated with recurrence pattern after resection for pancreatic ductal adenocarcinoma (PDA) SMAD4 expression status has been reported to be associated with patterns of failure in PDA, but studies have not examined recurrence patterns after resection. A tissue microarray was constructed including 127 patients with resected PDA and either short (<12 months) or long (>30 months) survival. SMAD4 expression was evaluated by immunohistochemistry and categorized as present or lost in tumor cells. Conventional pathologic features (lymph node metastases, positive resection margin, poor grade, tumor size) were recorded, and disease-specific outcomes (e.g. recurrence pattern and early cancer-specific mortality) determined. Loss of SMAD4 expression in pancreatic adenocarcinoma was identified in 40 of 127 patients (32 %). SMAD4 loss occurred in 27% of patients who experienced isolated local recurrence, 33% of patients with a distant recurrence, 33% of patients who recurred locally and at distant sites, and 25% of patients who were without evidence of recurrence (Fisher's exact, p=0.9). In a multivariate analysis, the presence of regional lymph node metastases was the only factor associated with the development of distant metastases (odds ratio, OR=4.7, p=0.02). SMAD4 was neither associated with recurrence pattern (OR=0.9, p=0.9), nor early death (OR=0.5, p=0.15). Primary tumor SMAD4 expression status was not a predictor of recurrence pattern in a large cohort of patients with resected PDA.