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Pathways of Progression From Intraductal Papillary Mucinous Neoplasm to Pancreatic Ductal Adenocarcinoma Based on Molecular Features
- Source :
- Gastroenterology. 156(3)
- Publication Year :
- 2017
-
Abstract
- Background & Aims Intraductal papillary mucinous neoplasms (IPMNs) are regarded as precursors of pancreatic ductal adenocarcinomas (PDAs), but little is known about the mechanism of progression. This makes it challenging to assess cancer risk in patients with IPMNs. We investigated associations of IPMNs with concurrent PDAs by genetic and histologic analyses. Methods We obtained 30 pancreatic tissues with concurrent PDAs and IPMNs, and 168 lesions, including incipient foci, were mapped, microdissected, and analyzed for mutations in 18 pancreatic cancer-associated genes and expression of tumor suppressors. Results We determined the clonal relatedness of lesions, based on driver mutations shared by PDAs and concurrent IPMNs, and classified the lesions into 3 subtypes. Twelve PDAs contained driver mutations shared by all concurrent IPMNs, which we called the sequential subtype. This subset was characterized by less diversity in incipient foci with frequent GNAS mutations. Eleven PDAs contained some driver mutations that were shared with concurrent IPMNs, which we called the branch-off subtype. In this subtype, PDAs and IPMNs had identical KRAS mutations but different GNAS mutations, although the lesions were adjacent. Whole-exome sequencing and methylation analysis of these lesions indicated clonal origin with later divergence. Ten PDAs had driver mutations not found in concurrent IPMNs, called the de novo subtype. Expression profiles of TP53 and SMAD4 increased our ability to differentiate these subtypes compared with sequencing data alone. The branch-off and de novo subtypes had substantial heterogeneity among early clones, such as differences in KRAS mutations. Patients with PDAs of the branch-off subtype had a longer times of disease-free survival than patients with PDAs of the de novo or the sequential subtypes. Conclusions Detailed histologic and genetic analysis of PDAs and concurrent IPMNs identified 3 different pathways by which IPMNs progress to PDAs—we call these the sequential, branch-off, and de novo subtypes. Subtypes might be associated with clinical and pathologic features and be used to select surveillance programs for patients with IPMNs.
- Subjects :
- 0301 basic medicine
Male
endocrine system diseases
Tumor suppressor gene
Databases, Factual
education
DNA Mutational Analysis
Pancreatic Intraepithelial Neoplasia
medicine.disease_cause
Genetic analysis
Risk Assessment
Cohort Studies
Hospitals, University
03 medical and health sciences
0302 clinical medicine
medicine
GNAS complex locus
Humans
Neoplasm Invasiveness
Aged
Neoplasm Staging
Retrospective Studies
Hepatology
Intraductal papillary mucinous neoplasm
biology
Gastroenterology
Cell Differentiation
Middle Aged
medicine.disease
Adenocarcinoma, Mucinous
Survival Analysis
Carcinoma, Papillary
Gene Expression Regulation, Neoplastic
Pancreatic Neoplasms
030104 developmental biology
medicine.anatomical_structure
Cancer research
biology.protein
Critical Pathways
Disease Progression
030211 gastroenterology & hepatology
Female
KRAS
Carcinogenesis
Pancreas
Carcinoma, Pancreatic Ductal
Follow-Up Studies
Subjects
Details
- ISSN :
- 15280012
- Volume :
- 156
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Gastroenterology
- Accession number :
- edsair.doi.dedup.....2c9ef3b924dced2ab8ee25647be0ce0e