Identification and validation of a biomarker signature in patients with resectable pancreatic cancer via genome-wide screening for functional genetic variants

Research output: Contribution to journalArticlepeer-review


  • Christos Dimitrakopoulos
  • Bart Vrugt
  • Renata Flury
  • Peter Schraml
  • Uwe Knippschild
  • Peter Wild
  • Simon Hoerstrup
  • Doris Henne-Bruns
  • Peter Wuerl
  • Rolf Graf
  • Stefan Breitenstein
  • Niko Beerenwinkel
  • Lukasz Filip Grochola

Colleges, School and Institutes

External organisations

  • SIB Swiss Institute of Bioinformatics, Basel, Switzerland.
  • University Hospital Zürich
  • Institute for Pathology, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
  • Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany.
  • Senckenberg Institute for Pathology, Goethe University Hospital Frankfurt, Frankfurt, Germany.
  • University of Zurich
  • Department of General, Visceral and Thoracic Surgery, Klinikum Dessau, Dessau, Germany.
  • Department of Visceral- and Thoracic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.


Importance: Surgery currently offers the only chance for a cure in pancreatic ductal adenocarcinoma (PDAC), but it carries a significant morbidity and mortality risk and results in varying oncologic outcomes. At present, to our knowledge, there are no tests available before surgical resection to identify tumors with an aggressive biological phenotype that could guide personalized treatment strategies.

Objective: Identification of noninvasive genetic biomarkers that could direct therapy in patients whose cases are amenable to pancreatic cancer resection.

Design, Setting, and Participants: This multicenter study combined a prospective European cohort of patients with PDAC who underwent pancreatic resection (from University Hospital of Zurich, Zurich, Switzerland; Cantonal Hospital of Winterthur, Winterthur, Switzerland; and University Clinic of Ulm, Ulm, Germany) with data from the Cancer Genome Atlas database in the United States, which includes prospectively registered patients with PDAC. A genome-wide screening for functional single-nucleotide polymorphisms (SNPs) that affect PDAC survival was conducted using the European cohort for identification and the Cancer Genome Atlas cohort for validation. We used Cox proportional hazards models to screen for high-frequency polymorphic variants that are associated with allelic differences in tumor-associated survival and either result in an altered protein structure and function or reside in known regulatory noncoding genomic regions. The false-discovery rate method was applied for multiple hypothesis-testing corrections. Data analysis occurred from November 2017 to May 2018.

Exposures: Pancreatic resection.

Main Outcomes and Measures: Tumor-associated survival.

Results: A total of 195 patients in the European cohort were included, as well as 136 patients in the Cancer Genome Atlas cohort (overall median [range] age, 66 [19-87] years; 156 [47.1%] were women, and 175 [52.9%] were men). Two SNPs in noncoding, functional regions of genes that regulate cancer progression, invasion, and metastasis were identified (CHI3L2 SNP rs684559 and CD44 SNP rs353630). These were associated with survival after PDAC resection; patients who carry the risk alleles at 1 of both SNP loci had a 2.63-fold increased risk for tumor-associated death compared with those with protective genotypes (hazard ratio for survival, 0.38 [95% CI, 0.27-0.53]; P = 1.0 × 10-8).

Conclusions and Relevance: The identified polymorphisms may serve as a noninvasive biomarker signature of prospective survival after pancreatic resection that is readily available at the time of PDAC diagnosis. This signature can be used to identify a subset of high-risk patients with PDAC with very low survival probability who might be eligible for inclusion in clinical trials of new therapeutic strategies, including neoadjuvant chemotherapy protocols. In addition, the biological knowledge about these SNPs could help guide the development of individualized genomic strategies for PDAC therapies.


Original languageEnglish
Article numbere190484
JournalJAMA Surgery
Issue number6
Early online date3 Apr 2019
Publication statusPublished - Jun 2019