Pancreatic endocrine tumor EUS-guided FNA DNA microsatellite loss and mortality

• Published in: Gastrointestinal endoscopy 2009-05, Vol.69 (6), p.1074-1080
• Main Authors: Fasanella, Kenneth E., MD, McGrath, Kevin M., MD, Sanders, Michael, MD, Brody, Debra, RN, Domsic, Robyn, MD, Khalid, Asif, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Fine-Needle; Carcinoma, Islet Cell - diagnostic imaging; Carcinoma, Islet Cell - genetics; Carcinoma, Islet Cell - mortality; Carcinoma, Islet Cell - pathology; Digestive system. Abdomen; Disease Progression; Endoscopy; Endosonography; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Kaplan-Meier Estimate; Ki-67 Antigen - genetics; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Loss of Heterozygosity - genetics; Male; Medical sciences; Middle Aged; Neoplasm Staging; Pancreas - diagnostic imaging; Pancreas - pathology; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - genetics; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Prognosis; Tumors; Ultrasonography, Interventional
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2008.06.023

Background The clinical course of pancreatic endocrine tumors (PET) depends on tumor size, the presence of invasion or metastasis, the Ki-67 index, mitoses per high power field, and mutational damage. Most of this information is not available before surgery for clinical decision making or prognostication. Objective To evaluate PET EUS-guided FNA (EUS-FNA) microsatellite loss analysis in the context of PET-related mortality. Design A single institution retrospective cohort. Patients Patients with PET diagnosed by EUS-FNA who underwent DNA microsatellite loss analysis and at least 1 year of follow-up or subsequent death. Intervention PET microsatellite loss analysis results and current clinical status were compared. Results Twenty-nine patients were included in the final analysis; the mean age of the patients was 57 years, and 10 were women (35%). The mean follow-up was 33.7 months (median 30 months, range 2-66 months). Twelve patients had disease progression, and 8 died, all from disease-specific causes. Malignant PET contained multiple microsatellite losses, with a median fractional allelic loss (FAL) of 0.37 (range 0.12-0.69, interquartile range [IQR] 0.23-0.42), significantly different from benign PET, median FAL 0 (range 0-0.18, IQR 0-0.08, P < .0001). Survival analysis revealed a significant difference in disease recurrence or progression at 2 years ( P < .0001) and in the 5-year survival between patients with FAL ≤0.2 compared with >0.2 ( P < .0001). Logistic regression could not be performed because of the perfect association between an FAL >0.2 and disease status or mortality. Limitations Retrospective design, referral bias, and DNA analysis availability. Conclusions PET EUS-FNA microsatellite loss analysis provides preoperative prognostic information. An FAL >0.2 is not only associated with disease progression but also with mortality.