Phosphorylated Histone H3 (PHH3) Is a Superior Proliferation Marker for Prognosis of Pancreatic Neuroendocrine Tumors

• Published in: Annals of surgical oncology Vol. 23; no. Suppl 5; pp. 609 - 617
• Main Authors: Villani, Vincenzo, Mahadevan, Krishnan K., Ligorio, Matteo, Fernández-del Castillo, Carlos, Ting, David T., Sabbatino, Francesco, Zhang, Irene, Vangel, Mark, Ferrone, Soldano, Warshaw, Andrew L., Lillemoe, Keith D., Wargo, Jennifer, Deshpande, Vikram, Ferrone, Cristina R.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor - metabolism; Cell Proliferation; Coloring Agents; Disease-Free Survival; Eosine Yellowish-(YS); Female; Hematoxylin; Histones - metabolism; Humans; Kaplan-Meier Estimate; Ki-67 Antigen - metabolism; Male; Medicine; Medicine & Public Health; Middle Aged; Mitotic Index - methods; Neuroendocrine Tumors - metabolism; Neuroendocrine Tumors - pathology; Oncology; Pancreatic Neoplasms - metabolism; Pancreatic Neoplasms - pathology; Phosphorylation; Proportional Hazards Models; ROC Curve; Surgery; Surgical Oncology; Survival Rate; Time Factors; Translational Research and Biomarkers; Young Adult; Ki67 Label Index; Nonfunctional Tumor; Mitotic Count; NCCN; Pancreatic Neuroendocrine Tumor
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-016-5171-x

Background The staging of pancreatic neuroendocrine tumors (PNETs) is continuously evolving. Mitotic count, as measured by hematoxylin and eosin (H&E) or Ki67 labeling index (Ki67LI), is the best predictor of disease biology. However, both of these methods have several limitations. Phosphorylated histone H3 (PHH3), a novel mitotic marker, is potentially more accurate and easier to evaluate. This study aimed to evaluate the prognostic impact of PHH3 on patients with PNETs. Methods Clinicopathologic data and paraffin-embedded tissue were evaluated for 100 of the 247 PNET patients whose tumors were resected between 1998 and 2010. Mitotic counts were analyzed on H&E-, Ki67-, and PHH3-stained slides by two independent pathologists. Kaplan–Meier curves, log-rank tests, Cox regression models, and time-dependent receiver operative characteristics (ROC) curves were used to evaluate the prognostic power of these markers. An internal data cross-validation was performed to select the best cutoff. Results Of the 100 PNET patients resected, 53 were men. The median age of the patients was 59 years (range 19–96 years). The median follow-up period was 68 months (range 3–186 months). The median time for evaluation of an H&E- or PHH3-stained slide was 3 min, relative to 15 min for Ki67. The findings showed H&E, Ki67, and PHH3 all to be excellent predictors of disease-specific survival (DSS). However, PHH3 was superior to H&E and Ki67 in predicting both disease-free survival (DFS) ( p  = 0.006) and DSS ( p  = 0.001). Evaluation of the PHH3 mitotic count showed 7 mitoses per 10 high-power fields (HPFs) to be the optimal cutoff for differentiating between low- and high-risk PNET patients. Conclusions PHH3 is a better predictor of both DFS and DSS than H&E or Ki67 in PNET. In addition, PHH3 appears to be both easier to interpret and more accurate when compared to current prognostic markers.