Genomic characterization of malignant progression in neoplastic pancreatic cysts

Nat Commun. 2020 Aug 14;11(1):4085. doi: 10.1038/s41467-020-17917-8.

Abstract

Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) are non-invasive neoplasms that are often observed in association with invasive pancreatic cancers, but their origins and evolutionary relationships are poorly understood. In this study, we analyze 148 samples from IPMNs, MCNs, and small associated invasive carcinomas from 18 patients using whole exome or targeted sequencing. Using evolutionary analyses, we establish that both IPMNs and MCNs are direct precursors to pancreatic cancer. Mutations in SMAD4 and TGFBR2 are frequently restricted to invasive carcinoma, while RNF43 alterations are largely in non-invasive lesions. Genomic analyses suggest an average window of over three years between the development of high-grade dysplasia and pancreatic cancer. Taken together, these data establish non-invasive IPMNs and MCNs as origins of invasive pancreatic cancer, identifying potential drivers of invasion, highlighting the complex clonal dynamics prior to malignant transformation, and providing opportunities for early detection and intervention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinogenesis / genetics
  • Cell Transformation, Neoplastic / genetics
  • Disease Progression*
  • Exome / genetics
  • Gene Dosage
  • Genomics*
  • Humans
  • Mutation
  • Pancreatic Cyst / genetics*
  • Pancreatic Cyst / pathology
  • Pancreatic Neoplasms / genetics*
  • Receptor, Transforming Growth Factor-beta Type II / genetics
  • Smad4 Protein / genetics

Substances

  • SMAD4 protein, human
  • Smad4 Protein
  • Receptor, Transforming Growth Factor-beta Type II
  • TGFBR2 protein, human