Combination of mutations in genes controlling DNA repair and high mutational load plays a prognostic role in pancreatic ductal adenocarcinoma (PDAC): a retrospective real-life study in Sardinian population

Author:

Sini MariaCristina1,Doro MariaGrazia1,Frogheri Laura1,Zinellu Angelo2,Paliogiannis Panagiotis2,Porcu Alberto2,Scognamillo Fabrizio2,Delogu Daniele3,Santeufemia Davide Adriano4,Persico Ivana1,Palomba Grazia1,Maestrale GiovanniBattista1,Cossu Antonio2,Palmieri Giuseppe1ORCID

Affiliation:

1. IRGB CNR Sassari: Istituto di Ricerca Genetica e Biomedica Consiglio Nazionale delle Ricerche Sede di Sassari

2. Universita degli Studi di Sassari

3. Azienda Ospedaliero-Universitaria di Sassari

4. Ospedale Civile Alghero

Abstract

Abstract Background Patients with pancreatic ductal adenocarcinoma (PDCA) carrying impaired mismatch repair mechanisms seem to have an outcome advantage under treatment with conventional chemotherapy, whereas the role for the tumor mutation burden on prognosis is controversial. In this study, we evaluated the prognostic role of the mutated genes involved in genome damage repair in a real-life series of PDAC patients in a hospital-based manner from the main Institution deputed to surgically treat such a disease in North Sardinia. Methods A cohort of fifty-five consecutive PDAC patients with potentially resectable/border line resectable PDAC (stage IIB-III) or oligometastatic disease (stage IV) and tumor tissue availability underwent next-generation sequencing (NGS)-based analysis using a panel containing driver oncogenes and tumor suppressor genes as well as genes controlling DNA repair mechanisms. Results Genes involved in the both genome damage repair (DR) and DNA mismatch repair (MMR) were found mutated in 17 (31%) and 15 (27%) cases, respectively. One fourth of PDAC cases (14/55; 25.5%) carried tumors presenting a combination of mutations in repair genes (DR and MMR) and the highest mutation load rates (MLR-H). After correction for confounders (surgery, adjuvant therapy, stage T, and metastasis), multivariate Cox regression analysis indicated that mutations in DR genes (HR = 3.0126, 95% CI 1.0707 to 8.4764, p = 0.0367) and the MLR (HR = 1.0018, 95%CI 1.0005 to 1.0032, p = 0.009) were significantly related to worse survival. Conclusions The combination of mutated repair genes and MLR-H, which is associated with a worse survival in our series of PDAC patients treated with conventional chemotherapy protocols, might become a predictive biomarker of response to immunotherapy in addition to its prognostic role in predicting survival.

Publisher

Research Square Platform LLC

Reference71 articles.

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