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


Authors: Narayan, R. R.; Creasy, J. M.; Goldman, D. A.; Gönen, M.; Kandoth, C.; Kundra, R.; Solit, D. B.; Askan, G.; Klimstra, D. S.; Basturk, O.; Allen, P. J.; Balachandran, V. P.; D’Angelica, M. I.; DeMatteo, R. P.; Drebin, J. A.; Kingham, T. P.; Simpson, A. L.; Abou-Alfa, G. K.; Harding, J. J.; O’Reilly, E. M.; Butte, J. M.; Matsuyama, R.; Endo, I.; Jarnagin, W. R.
Article Title: Regional differences in gallbladder cancer pathogenesis: Insights from a multi-institutional comparison of tumor mutations
Abstract: 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. © 2018 American Cancer Society
Keywords: precision medicine; cancer genes; gene target; gallbladder neoplasm; tumor mutation
Journal Title: Cancer
Volume: 125
Issue: 4
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2019-02-15
Start Page: 575
End Page: 585
Language: English
DOI: 10.1002/cncr.31850
PUBMED: 30427539
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 March 2019 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    599 DeMatteo
  2. David Solit
    435 Solit
  3. Mithat Gonen
    713 Gonen
  4. Olca Basturk
    203 Basturk
  5. James Joseph Harding
    66 Harding
  6. Ghassan Abou-Alfa
    225 Abou-Alfa
  7. David S Klimstra
    849 Klimstra
  8. Peter Allen
    440 Allen
  9. William R Jarnagin
    590 Jarnagin
  10. T Peter Kingham
    288 Kingham
  11. Eileen O'Reilly
    321 O'Reilly
  12. Debra Alyssa Goldman
    94 Goldman
  13. Amber L Simpson
    51 Simpson
  14. Gokce Askan
    40 Askan
  15. Cyriac Kandoth
    17 Kandoth
  16. Ritika   Kundra
    16 Kundra
  17. John Creasy
    9 Creasy
  18. Jeffrey Adam Drebin
    13 Drebin