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Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations.

Publication ,  Journal Article
Narayan, RR; Creasy, JM; Goldman, DA; Gönen, M; Kandoth, C; Kundra, R; Solit, DB; Askan, G; Klimstra, DS; Basturk, O; Allen, PJ; DeMatteo, RP ...
Published in: Cancer
February 15, 2019

BACKGROUND: Although rare in the United States, gallbladder cancer (GBCA) is a common cause of cancer death in some parts of the world. To investigate regional differences in pathogenesis and outcomes for GBCA, tumor mutations were analyzed from a sampling of specimens. METHODS: Primary tumors from patients with GBCA who were treated in Chile, Japan, and the United States between 1999 and 2016 underwent targeted sequencing of known cancer-associated genes. Fisher exact and Kruskal-Wallis tests assessed differences in clinicopathologic and genetic factors. Kaplan-Meier methods evaluated differences in overall survival from the time of surgery between mutations. RESULTS: A total of 81 patients were included. Japanese patients (11 patients) were older (median age, 72 years [range, 54-81 years]) compared with patients from Chile (21 patients; median age, 59 years [range, 32-73 years]) and the United States (49 patients; median age, 66 years [range, 46-87 years]) (P = .002) and had more well-differentiated tumors (46% vs 0% for Chile/United States; P < .001) and fewer gallstone-associated cancers (36% vs 67% for Chile and 69% for the United States; P = .13). Japanese patients had a median mutation burden of 6 (range, 1-23) compared with Chile (median mutation burden, 7 [range, 3-20]) and the United States (median mutation burden, 4 [range, 0-27]) (P = .006). Tumors from Japanese patients lacked AT-rich interaction domain 1A (ARID1A) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutations, whereas Chilean tumors lacked Erb-B2 receptor tyrosine kinase 3 (ERBB3) and AT-rich interaction domain 2 (ARID2) mutations. SMAD family member 4 (SMAD4) was found to be mutated similarly across centers (38% in Chile, 36% in Japan, and 27% in the United States; P = .68) and was univariately associated with worse overall survival (median, 10 months vs 25 months; P = .039). At least one potentially actionable gene was found to be altered in 80% of tumors. CONCLUSIONS: Differences in clinicopathologic variables suggest the possibility of distinct GBCA pathogenesis in Japanese patients, which may be supported by differences in mutation pattern. Among all centers, SMAD4 mutations were detected in approximately one-third of patients and may represent a converging factor associated with worse survival. The majority of patients carried mutations in actionable gene targets, which may inform the design of future trials.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

February 15, 2019

Volume

125

Issue

4

Start / End Page

575 / 585

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Prognosis
  • Oncology & Carcinogenesis
  • Mutation
  • Middle Aged
  • Male
  • Japan
  • Humans
  • Gallbladder Neoplasms
 

Citation

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Narayan, R. R., Creasy, J. M., Goldman, D. A., Gönen, M., Kandoth, C., Kundra, R., … Jarnagin, W. R. (2019). Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations. Cancer, 125(4), 575–585. https://doi.org/10.1002/cncr.31850
Narayan, Raja R., John M. Creasy, Debra A. Goldman, Mithat Gönen, Cyriac Kandoth, Ritika Kundra, David B. Solit, et al. “Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations.Cancer 125, no. 4 (February 15, 2019): 575–85. https://doi.org/10.1002/cncr.31850.
Narayan RR, Creasy JM, Goldman DA, Gönen M, Kandoth C, Kundra R, et al. Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations. Cancer. 2019 Feb 15;125(4):575–85.
Narayan, Raja R., et al. “Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations.Cancer, vol. 125, no. 4, Feb. 2019, pp. 575–85. Pubmed, doi:10.1002/cncr.31850.
Narayan RR, Creasy JM, Goldman DA, Gönen M, Kandoth C, Kundra R, Solit DB, Askan G, Klimstra DS, Basturk O, Allen PJ, Balachandran VP, D’Angelica MI, DeMatteo RP, Drebin JA, Kingham TP, Simpson AL, Abou-Alfa GK, Harding JJ, O’Reilly EM, Butte JM, Matsuyama R, Endo I, Jarnagin WR. Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations. Cancer. 2019 Feb 15;125(4):575–585.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

February 15, 2019

Volume

125

Issue

4

Start / End Page

575 / 585

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Prognosis
  • Oncology & Carcinogenesis
  • Mutation
  • Middle Aged
  • Male
  • Japan
  • Humans
  • Gallbladder Neoplasms