title: Immunohistochemistry - microarray analysis of patients with peritoneal metastases of appendiceal or colorectal origin.
abstract: BACKGROUND
  The value of immunohistochemistry (IHC)-microarray analysis of pathological specimens in the management of patients is controversial, although preliminary data suggest potential benefit. We describe the characteristics of patients undergoing a commercially available IHC-microarray method in patients with peritoneal metastases (PM) and the feasibility of this technique in this population.
  
  
  METHODS
  We retrospectively analyzed consecutive patients with pathologically confirmed PM from appendiceal or colorectal primary who underwent Caris Molecular Intelligence(™) testing. IHC, microarray, FISH, and mutational analysis were included and stratified by Peritoneal Carcinomatosis Index (PCI) score, histology, and treatment characteristics. Statistical analysis was performed using non-parametric tests.
  
  
  RESULTS
  Our study included 5 patients with appendiceal and 11 with colorectal PM. The median age of patients was 51 (IQR 39-65) years, with 11 (68%) female. The median PCI score of the patients was 17 (IQR 10-25). Hyperthermic intra-peritoneal chemoperfusion was performed in 4 (80%) patients with appendiceal primary tumors and 4 (36%) with colorectal primary. KRAS mutations were encountered in 40% of appendiceal vs. 30% colorectal tumors, while BRAF mutations were seen in 40% of colorectal PM and none of the patients with appendiceal PM (p = 0.06). IHC biomarker expression was not significantly different between the two primaries. Sufficient tumor for microarray analysis was found in 44% (n = 7) patients, which was not associated with previous use of chemotherapy (p > 0.20 for 5-FU/LV, Irinotecan and Oxaliplatin).
  
  
  CONCLUSIONS
  In a small sample of patients with PM, the feasibility and results of IHC-microarray staining based on a commercially available test is reported. The apparent high incidence of the BRAF mutation in patients with PM may potentially offer opportunities for novel therapeutics and suggest that IHC-microarray is a method that can be used in this population.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin , Milwaukee, WI , USA.
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Green
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin , Milwaukee, WI , USA.
authors.forename: Thejus T
authors.initials: TT
authors.lastname: Jayakrishnan
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin , Milwaukee, WI , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hwang
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center , Maywood, IL , USA.
authors.forename: Sam G
authors.initials: SG
authors.lastname: Pappas
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin , Milwaukee, WI , USA.
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin , Milwaukee, WI , USA.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
keywords: DNA mutational analysis; appendiceal neoplasms; colorectal neoplasms; immunohistochemistry; microarray analysis; peritoneal neoplasms