title: The SMAD4 protein and prognosis of pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  SMAD4 (also called Dpc4) is a tumor suppressor in the TGF-beta signaling pathway that is genetically inactivated in approximately 55% of all pancreatic adenocarcinomas. We investigated whether prognosis after surgical resection for invasive pancreatic adenocarcinoma is influenced by SMAD4 status.
  
  
  METHODS
  Using immunohistochemistry, we characterized the SMAD4 protein status of 249 pancreatic adenocarcinomas resected from patients who underwent pancreaticoduodenectomy (Whipple resection) at The Johns Hopkins Hospital, Baltimore, MD, between 1990 and 1997. The SMAD4 gene status of 56 of 249 (22%) pancreatic carcinomas was also determined. A multivariate Cox proportional hazards model assessed the relative risk of mortality associated with SMAD4 status, adjusting for known prognostic variables.
  
  
  RESULTS
  Patients with pancreatic adenocarcinomas with SMAD4 protein expression had significantly longer survival (unadjusted median survival was 19.2 months as compared with 14.7 months in patients with pancreatic cancers lacking SMAD4 protein expression; P = 0.03). This SMAD4 survival benefit persisted after adjustment for prognostic factors including tumor size, margins, lymph node status, pathological stage, blood loss, and use of adjuvant chemoradiotherapy. The relative hazard of mortality for cancers lacking SMAD4 after adjusting for other prognostic factors was 1.36 (95% confidence interval, 1.01-1.83; P = 0.04).
  
  
  CONCLUSIONS
  Patients undergoing Whipple resection for pancreatic adenocarcinoma survive longer if their cancers express SMAD4.
authors.affiliation: Department of Pathology, The Johns Hopkins University School of Medicine, 632 Ross Building, Baltimore, MD 21205, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tascilar
authors.forename: H G
authors.initials: HG
authors.lastname: Skinner
authors.forename: C
authors.initials: C
authors.lastname: Rosty
authors.forename: T
authors.initials: T
authors.lastname: Sohn
authors.forename: R E
authors.initials: RE
authors.lastname: Wilentz
authors.forename: G J
authors.initials: GJ
authors.lastname: Offerhaus
authors.forename: V
authors.initials: V
authors.lastname: Adsay
authors.forename: R A
authors.initials: RA
authors.lastname: Abrams
authors.forename: J L
authors.initials: JL
authors.lastname: Cameron
authors.forename: S E
authors.initials: SE
authors.lastname: Kern
authors.forename: C J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: R H
authors.initials: RH
authors.lastname: Hruban
authors.forename: M
authors.initials: M
authors.lastname: Goggins
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D004268:DNA-Binding Proteins / Q000032:analysis / Q000235:genetics; D005260:Female; D016147:Genes, Tumor Suppressor; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015398:Signal Transduction; D051901:Smad4 Protein; D015996:Survival Rate; D013997:Time Factors; D015534:Trans-Activators / Q000032:analysis / Q000235:genetics
chemical_list: D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C497796:SMAD4 protein, human; D051901:Smad4 Protein; D015534:Trans-Activators