Pancreatic endocrine tumor EUS-guided FNA DNA microsatellite loss and mortality.
BACKGROUND
The clinical course of pancreatic endocrine tumors (PET) depends on tumor size, the presence of invasion or metastasis, the Ki-67 index, mitoses per high power field, and mutational damage. Most of this information is not available before surgery for clinical decision making or prognostication.


OBJECTIVE
To evaluate PET EUS-guided FNA (EUS-FNA) microsatellite loss analysis in the context of PET-related mortality.


METHODS
A single institution retrospective cohort.


METHODS
Patients with PET diagnosed by EUS-FNA who underwent DNA microsatellite loss analysis and at least 1 year of follow-up or subsequent death.


METHODS
PET microsatellite loss analysis results and current clinical status were compared.


RESULTS
Twenty-nine patients were included in the final analysis; the mean age of the patients was 57 years, and 10 were women (35%). The mean follow-up was 33.7 months (median 30 months, range 2-66 months). Twelve patients had disease progression, and 8 died, all from disease-specific causes. Malignant PET contained multiple microsatellite losses, with a median fractional allelic loss (FAL) of 0.37 (range 0.12-0.69, interquartile range [IQR] 0.23-0.42), significantly different from benign PET, median FAL 0 (range 0-0.18, IQR 0-0.08, P < .0001). Survival analysis revealed a significant difference in disease recurrence or progression at 2 years (P < .0001) and in the 5-year survival between patients with FAL </=0.2 compared with >0.2 (P < .0001). Logistic regression could not be performed because of the perfect association between an FAL >0.2 and disease status or mortality.


CONCLUSIONS
Retrospective design, referral bias, and DNA analysis availability.


CONCLUSIONS
PET EUS-FNA microsatellite loss analysis provides preoperative prognostic information. An FAL >0.2 is not only associated with disease progression but also with mortality.
Fasanella
Kenneth E
KE
Department of Medicine, the University of Pittsburgh Medical Center, PA, USA.
McGrath
Kevin M
KM
Sanders
Michael
M
Brody
Debra
D
Domsic
Robyn
R
Khalid
Asif
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D018273:Carcinoma, Islet Cell / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D018450:Disease Progression; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000235:genetics; D019656:Loss of Heterozygosity / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D018084:Ultrasonography, Interventional
D019394:Ki-67 Antigen