Low incidence of KRAS, BRAF, and PIK3CA mutations in adenocarcinomas of the ampulla of Vater and their prognostic value

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• 作者：Mi Jung Kwon ; MD ; PhD^a ; Jeong Won Kim ; MD^b ; Jae Pil Jung ; MD ; PhD^c ; Ji Woong Cho ; MD ; PhD^d ; Eun Sook Nam ; MD ; PhD^e ; Seong Jin Cho ; MD ; PhD^e ; Joo Seop Kim ; MD ; PhD^f ; Hye-Rim Park ; MD ; PhD^a ; Soo Kee Min ; MD ; PhD^a ; Jinwon Seo ; MD^a ; Kyueng-Whan Min ; MD ; PhD^a ; Dong Hoon Kim ; MD ; PhD^g ; ^{homed@hallym.or.kr" class="auth_mail" title="E-mail the corresponding author} ; Jang Yong Jeon ; MD ; PhD^d ; ^{jjy1030@hallym.or.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Ampulla of Vater ; Adenocarcinoma ; KRAS ; BRAF ; PIK3CA ; Mutation ; Prognosis
• 刊名：Human Pathology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：50
• 期：Complete
• 页码：90-100
• 全文大小：1160 K

文摘

Ampullary adenocarcinomas (A-ACs) are rare malignancies with considerable importance because of their high curable resection rate and improved survival rate among periampullary cancers. The RAS-RAF-MAPK pathway is involved in the development of A-ACs and is a potential therapeutic target. However, molecular profiles of A-ACs and their prognostic impact are poorly understood. Peptide nucleic acid–mediated polymerase chain reaction clamping and Mutyper were used to detect KRAS, BRAF, and PIK3CA mutations in 62 paraffinized samples of A-ACs. Of 62 A-ACs, 30.6% had KRAS mutations, but no BRAF mutations and low frequency (1.6%) of PIK3CA mutation were detected. KRAS mutation was correlated with poor tumor differentiation and was a predictor of shorter recurrence-free survival period in overall A-ACs, whereas the prognosis according to the histologic subtypes was not affected by KRAS mutation. Lymph node metastasis was an independent prognostic factor of poor overall survival. Intestinal- and pancreatobiliary-type A-ACs had similar prognosis. Intestinal- and pancreatobiliary-type A-ACs had different prognostic factors; tumor differentiation and lymph node metastasis strongly predicted overall survival and recurrence-free survival in pancreatobiliary-type tumors, respectively, whereas no independent prognostic factors were demonstrated for intestinal-type tumors. Low incidence of KRAS mutations and their strong prognostic value in A-ACs may suggest the potential of survival benefit depending on the epidermal growth factor receptor–targeted therapy. Much lower frequencies of BRAF and PIK3CA mutations may suggest that they do not play a major role in the tumorigenesis of A-ACs. Different therapeutic protocols should be considered for treating pancreatobiliary- and intestinal-type A-ACs.