Clinical and Genomic Features of Classical and Basal Transcriptional Subtypes in Pancreatic Cancer.

IF 10 1区 医学 Q1 ONCOLOGY
Harshabad Singh, Joanne Xiu, Kevin S Kapner, Chen Yuan, Raja R Narayan, Matthew Oberley, Alex Farrell, Rishi Surana, Brandon M Huffman, Kimberly Perez, James M Cleary, Alexander C Jordan, Andressa Dias Costa, Hannah L Williams, Srivatsan Raghavan, Benjamin Weinberg, Michael J Pishvaian, Rachna T Shroff, Sanjay Goel, Stephanie K Dougan, Jonathan A Nowak, David Spetzler, George Sledge, Brian M Wolpin, Andrew J Aguirre
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引用次数: 0

Abstract

Purpose: Transcriptional profiling of pancreatic cancers has defined two main transcriptional subtypes: classical and basal. Initial data suggest shorter survival for patients with basal tumors and differing treatment sensitivity to FOLFIRINOX and gemcitabine plus nab-paclitaxel by transcriptional subtype.

Experimental design: We examined 8,743 patients with RNA sequencing from pancreatic cancers performed at Caris Life Sciences. Classical and basal subtypes were identified using purity independent subtyping algorithm on RNA sequencing, and two cohorts were analyzed: (i) the biomarker cohort included patients with complete molecular profiling data (n = 7,250) and (ii) the outcome cohort included patients with metastatic disease with available survival outcomes (n = 5,335). A total of 3,842 patients were shared between the two cohorts. Kaplan-Meier curves and Cox proportional hazards regression were used to assess patient survival.

Results: In the biomarker cohort, 3,063 tumors (42.2%) were strongly classical (SC) and 2,015 tumors (27.8%) were strongly basal (SB). SC and SB tumors showed strong associations with histologic phenotypes and biopsy sites. SB tumors had higher rates of KRAS, TP53, and ARID1A mutations, lower rates of SMAD4 mutation, and transcriptional evidence of epithelial-mesenchymal transition. Sixty of 77 cases (78%) maintained their transcriptional subtype between temporally and/or spatially disparate lesions. In the outcome cohort, the SB subtype was associated with shorter overall survival time, regardless of whether they received FOLFIRINOX or gemcitabine plus nab-paclitaxel as first-line chemotherapy. The mutant KRAS allele type was prognostic of outcomes; however, this impact was restricted to SC tumors, whereas all mutant KRAS alleles had similarly poor outcomes in SB tumors.

Conclusions: The SB subtype is a strong independent predictor of worse outcomes, regardless of the up-front chemotherapy regimen used. Clinical trials should further investigate pancreatic cancer transcriptional subtypes as a prognostic and predictive biomarker.

胰腺癌经典亚型和基础转录亚型的临床和基因组特征。
目的:胰腺癌(PC)的转录谱分析确定了两种主要的转录亚型:经典型和基底型。初步数据表明,基底型肿瘤患者的生存期较短,转录亚型对FOLFIRINOX(FFX)和吉西他滨nab-紫杉醇(GnP)的治疗敏感性也不同:我们对8743名患者进行了检查,并在Caris生命科学公司(亚利桑那州凤凰城)对PC进行了RNA测序。利用RNA测序的PurIST算法确定了经典亚型和基础亚型,并对两个队列进行了分析:(1)生物标志物队列包括具有完整分子图谱数据的患者(n=7250);(2)结果队列包括具有生存结果的转移性疾病患者(n=5335):在生物标志物队列中,3,063 例肿瘤(42.2%)属于强典型(SC)肿瘤,2,015 例肿瘤(27.8%)属于强基底(SB)肿瘤。SC和SB肿瘤与组织学表型和活检部位密切相关。SB肿瘤的KRAS、TP53和ARID1A突变率较高,SMAD4突变率较低,并有上皮间质转化的转录证据。77 例病例中有 60 例(78%)在时间和/或空间上不同的病灶之间保持了转录亚型。在结果队列中,SB亚型与较短的总生存时间相关,无论他们是接受FFX还是GnP作为一线化疗。突变的KRAS等位基因类型对预后有影响,但这种影响仅限于SC肿瘤,而所有突变的KRAS等位基因在SB肿瘤中的预后都很差:结论:无论前期化疗方案如何,SB亚型都是预后较差的一个强有力的独立预测因素。临床试验应将 PC 转录亚型作为生物标志物进行研究。
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来源期刊
Clinical Cancer Research
Clinical Cancer Research 医学-肿瘤学
CiteScore
20.10
自引率
1.70%
发文量
1207
审稿时长
2.1 months
期刊介绍: Clinical Cancer Research is a journal focusing on groundbreaking research in cancer, specifically in the areas where the laboratory and the clinic intersect. Our primary interest lies in clinical trials that investigate novel treatments, accompanied by research on pharmacology, molecular alterations, and biomarkers that can predict response or resistance to these treatments. Furthermore, we prioritize laboratory and animal studies that explore new drugs and targeted agents with the potential to advance to clinical trials. We also encourage research on targetable mechanisms of cancer development, progression, and metastasis.
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