Mutational spectrum for guiding the decision of adjuvant treatment in patients with resected biliary tract carcinoma

Author:

Li Yunfeng1,Tan Chaochao2,Yin Xinmin1,Zhu Siwei1,Cai Rongyao1,Liao Chunhong1,Wu Yifei1,Zeng Qihong1,Cai Chengzhi1,Xie Wang1,He Xiangyu1,Wen Hao‐quan1,Lin Guomin3,He Qingqing3,He Tingting3,Gu Peng3,Liu Chang‐jun1ORCID

Affiliation:

1. Department of Hepatobiliary Surgery Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University Changsha China

2. Department of Clinical Medical Laboratory Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University Changsha China

3. Shanghai OrigiMed Co., Ltd. Shanghai China

Abstract

BackgroundSystemic chemotherapy or chemoradiation therapy has proven to be effective in treating advanced biliary tract carcinoma (BTC). However, its efficacy in the adjuvant setting remains controversial. Therefore, this study aimed to determine the prognostic significance of genomic biomarkers in resected BTC and their potential role in stratifying patients for adjuvant treatment.MethodsWe retrospectively reviewed 113 BTC patients who underwent curative‐intent surgery and had available tumor sequencing data. Disease‐free survival (DFS) was the primary outcome examined and univariate analysis was used to identify gene mutations with prognostic value. Favorable and unfavoratble gene subsets were distinguished from the selected genes through grouping, respectively. Multivariate Cox regression was used to identify independent prognostic factors of DFS.ResultsOur results indicated that mutations in ACVR1B, AR, CTNNB1, ERBB3, and LRP2 were favorable mutations, while mutations in ARID1A, CDKN2A, FGFR2, NF1, NF2, PBRM1, PIK3CA, and TGFBR1 were unfavorable mutations. In addition to age, sex, and node positive, favorable genes (HR = 0.15, 95% CI = 0.04–0.48, p = 0.001) and unfavorable genes (HR = 2.86, 95% CI = 1.51–5.29, p = 0.001) were identified as independent prognostic factors for DFS. Out of the 113 patients, only 35 received adjuvant treatment whereas the majority (78) did not. For patients with both favorable and unfavorable mutations undetected, adjuvant treatment showed negative effect on DFS (median DFS: S441 vs. 956 days, p = 0.010), but there was no significant difference in DFS among those in other mutational subgroups.ConclusionsGenomic testing might be useful in guiding the decisions regarding adjuvant treatment in BTC.

Publisher

Wiley

Subject

Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology

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