The Yale Gastrointestinal Cancer Biorepository: A comprehensive biospecimen and data resource for studying determinants of pancreatic ductal adenocarcinoma prognosis following curative-intent pancreaticoduodenectomy.

Abstract

272 Background: Although surgical resection can be curative for pancreatic ductal adenocarcinoma (PDAC), only 20% of patients qualify and, of these, only 20% survive for 5 or more years. Because tumor biology, germline genetics, environmental exposures and lifestyle factors all contribute, we designed the Yale Gastrointestinal (GI) Cancer Biorepository to partner biospecimen science best practices with comprehensive clinico-epidemiologic annotations evaluate determinants of outcome for PDAC and other GI cancers. Methods: Adult patients presenting to Yale GI Oncology Clinics with incident cancers who consent are interviewed using a validated instrument to capture demographics, medical comorbidities, family history of cancer, employment history and lifestyle choices including tobacco, alcohol, diet and physical activity. Buffy coat and 20 mL of plasma are collected pre-operatively. Surgical Pathology provides three 3 mm tissue cores to be stored in RNALater at -190°C in addition to formalin-fixed tissue blocks with time to fixation at ≤30 minutes. Confirmatory touch-preparations are required for all RNALater-preserved specimens. Periodic medical record abstraction documents recurrence, progression, treatment and vital status. Quality-of-life and lifestyle reassessments occur at 6 and 12 months post-diagnosis then annually thereafter. Results: Since our March 2012 launch, we consented 388 individuals including 57 PDAC patients undergoing pancreaticoduodenectomy with 16 (28%) having received FOLFIRINOX-based neoadjuvant therapy prior to surgery. Median follow-up is 7.9 months with 11 PDAC recurrences and 7 PDAC-related deaths confirmed. Receipt of neoadjuvant therapy trended towards downstaged cancers upon resection (p=0.08). Women (n=20) were more likely to be older (p=0.02) and trended towards less advanced cancers (p=0.06) but smoked, used aspirin similarly and have BMIs comparable with men (n=37). Exome and transcriptome analysis of tumor and germline are ongoing. Conclusions: Determinants of early-stage PDAC prognosis will emerge as this cohort matures.