title: Simultaneous deregulation of p16 and cyclin D1 genes in pancreatic ductal adenocarcinoma: a combined immunohistochemistry and image analysis study based on tissue microarrays.
abstract: OBJECTIVE
  Deregulation of cell cycle control molecules, such as cyclins and their inhibitors, is a crucial event in the carcinogenetic process. Our aim was to identify potential correlations between p16 and cyclin D1 expression in pancreatic ductal adenocarcinoma (PDAC) that affect the biological behavior of this neoplasm.
  
  
  METHODS
  Using tissue microarray (TMA) technology, 50 paraffin-embedded tissue samples of histologically confirmed primary PDACs were cored twice and re-embedded to the final recipient block. Immunohistochemistry (IHC) was performed using monoclonal anti-p16 and anti-cyclin D1 antibodies. Protein expression levels were determined by performing computerized image analysis (CIA; estimation of Nuclear Labeling Index-NLI). SPSS (chi square test and interrater Cohen's kappa) was used for statistical analysis.
  
  
  RESULTS
  Cyclin D1 overexpression was observed in 24/50 (48%) of the examined carcinomas, whereas p16 loss or reduced expression was detected in 40/50 (80%) cases. Statistical significance was noted when correlating grade to cyclin D1 (p=0.038), stage to p16 (p=0.012) and also to cyclin D1 (p=0.011). Interestingly, combined protein alterations (p16 loss and cyclin D1 overexpression) were observed in 23/50 (46%) cases associated with advanced stage (p=0.019). Overall combined expression of the two molecules demonstrated a significantly low value (kappa=0.012; 95% confidence interval-CI: 0.010-0.014).
  
  
  CONCLUSIONS
  A significant proportion of PDACs is characterized by simultaneous protein alterations regarding p16 and cyclin D1 genes. This mechanism of genetic deregulation in cell cycle potentially explains in part the aggressive phenotype of this neoplasm.
authors.affiliation: Department of Immunohistochemistry and Molecular Cytopathology, 401 General Army Hospital, Athens, Greece. tsiambasecyto@yahoo.gr
authors.forename: E
authors.initials: E
authors.lastname: Tsiambas
authors.forename: A
authors.initials: A
authors.lastname: Karameris
authors.forename: S
authors.initials: S
authors.lastname: Gourgiotis
authors.forename: N
authors.initials: N
authors.lastname: Salemis
authors.forename: A E
authors.initials: AE
authors.lastname: Athanassiou
authors.forename: P
authors.initials: P
authors.lastname: Karakitsos
authors.forename: A
authors.initials: A
authors.lastname: Papalois
authors.forename: E
authors.initials: E
authors.lastname: Merikas
authors.forename: P
authors.initials: P
authors.lastname: Kosmidis
authors.forename: E
authors.initials: E
authors.lastname: Patsouris
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000235:genetics*; D019938:Cyclin D1 / Q000096:biosynthesis* / Q000235:genetics; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000096:biosynthesis* / Q000235:genetics; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D019940:Genes, bcl-1; D019942:Genes, p16; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000235:genetics*; D046888:Tissue Array Analysis
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16; D019938:Cyclin D1