Precision Oncology in Surgery: Patient Selection for Operable Pancreatic Cancer

Dreyer SB, Pinese M, Jamieson NB, Scarlett CJ, Colvin EK, Pajic M, Johns AL, Humphris J, Wu J, Cowley MJ, Chou A, Nagrial AM, Chantrill LA, Chin VT, Jones MD, Moran-Jones K, Carter CR, Dickson EJ, Samra JS, Merrett ND, Gill AJ, Kench JG, Duthie FR, Miller DK, Cooke S, Aust D, Knoesel T, Rümmele P, Grützmann R, Pilarsky C, Nguyen NQ, Musgrove EA, Bailey P, Mckay CJ, Biankin AV, Chang DK (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Annals of Surgery Lippincott, Williams & Wilkins

DOI: 10.1097/SLA.0000000000003143

Abstract

OBJECTIVE: We aimed to define preoperative clinical and molecular characteristics that would allow better patient selection for operative resection. BACKGROUND: Although we use molecular selection methods for systemic targeted therapies, these principles are not applied to surgical oncology. Improving patient selection is of vital importance for the operative treatment of pancreatic cancer (pancreatic ductal adenocarcinoma). Although surgery is the only chance of long-term survival, 80% still succumb to the disease and approximately 30% die within 1 year, often sooner than those that have unresected local disease. METHOD: In 3 independent pancreatic ductal adenocarcinoma cohorts (total participants = 1184) the relationship between aberrant expression of prometastatic proteins S100A2 and S100A4 and survival was assessed. A preoperative nomogram based on clinical variables available before surgery and expression of these proteins was constructed and compared to traditional measures, and a postoperative nomogram. RESULTS: High expression of either S100A2 or S100A4 was independent poor prognostic factors in a training cohort of 518 participants. These results were validated in 2 independent patient cohorts (Glasgow, n = 198; Germany, n = 468). Aberrant biomarker expression stratified the cohorts into 3 distinct prognostic groups. A preoperative nomogram incorporating S100A2 and S100A4 expression predicted survival and nomograms derived using postoperative clinicopathological variables. CONCLUSIONS: Of those patients with a poor preoperative nomogram score, approximately 50% of patients died within a year of resection. Nomograms have the potential to improve selection for surgery and neoadjuvant therapy, avoiding surgery in aggressive disease, and justifying more extensive resections in biologically favorable disease.

Authors with CRIS profile

Robert Grützmann Department of Surgery Christian Pilarsky Professur für Chirurgische Forschung

Involved external institutions

Garvan Institute of Medical Research AU Australia (AU) Kinghorn Cancer Centre AU Australia (AU) Bankstown-Lidcombe Hospital AU Australia (AU) Glasgow Royal Infirmary (GRI) GB United Kingdom (GB) Royal Adelaide Hospital AU Australia (AU) Illumina Inc US United States (USA) (US) University of Newcastle (UoN) AU Australia (AU) University of Glasgow GB United Kingdom (GB) Queen Elizabeth University Hospital GB United Kingdom (GB) Technische Universität Dresden DE Germany (DE) University of Sydney (USYD) AU Australia (AU) Ludwig-Maximilians-Universität (LMU) DE Germany (DE)

How to cite

APA:

Dreyer, S.B., Pinese, M., Jamieson, N.B., Scarlett, C.J., Colvin, E.K., Pajic, M.,... Chang, D.K. (2018). Precision Oncology in Surgery: Patient Selection for Operable Pancreatic Cancer. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000003143

MLA:

Dreyer, Stephan B, et al. "Precision Oncology in Surgery: Patient Selection for Operable Pancreatic Cancer." Annals of Surgery (2018).

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