ATRX loss is an independent predictor of poor survival in pancreatic neuroendocrine tumours.

Chou, Angela; Itchins, Malinda; de Reuver, Philip R; BSc, Jennifer Arena; BSc, Adele Clarkson; BSc, Amy Sheen; BSc, Loretta Sioson; MChD, Veronica Cheung; Perren, Aurel; Nahm, Christopher; Mittal, Anubhav; Samra, Jaswinder S; Pajic, Marina; Gill, Anthony J (2018). ATRX loss is an independent predictor of poor survival in pancreatic neuroendocrine tumours. Human pathology, 82, pp. 249-257. Elsevier 10.1016/j.humpath.2018.07.032

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Pancreatic neuroendocrine tumours (PanNETs) are rare neoplasms accounting for 1-2% of all pancreatic tumours. The biological behaviour of PanNETs is heterogeneous and unpredictable, adding to the difficulties of clinical management. The DAXX (death domain associated protein) and ATRX (alpha-thalassemia/mental retardation syndrome X-linked) genes encode proteins involved in SWI/SNF-like chromatin remodelling. Somatic inactivating mutations in DAXX and ATRX are frequent in PanNETs, mutually exclusive, and associated with telomere dysfunction resulting in genomic instability and alternate lengthening of telomeres. We sought to assess the clinical significance of the loss of the ATRX and DAXX proteins as determined by immunohistochemistry (IHC) in patients with PanNET. From an unselected cohort of 105 patients, we found ATRX loss in 10 tumours (9.5%) and DAXX loss in 16 (15.2%). DAXX and ATRX loss were confirmed mutually exclusive and associated with other adverse clinicopathological variables and poor survival in univariate analysis. In addition ATRX loss was also associated with higher AJCC stage and infiltrative tumour borders. However only ATRX loss, lymphovascular invasion and perineural spread were independent predictors of poor overall survival in multivariate analysis. In conclusion, loss of expression of ATRX as determined by IHC is a useful independent predictor of poor overall survival in PanNETs. Given its relative availability, ATRX loss as determined by IHC may have a role in routine clinical practice to refine prognostication in patients with PanNET.

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