The Utility of SMAD4 and S100P as Diagnostic Immunohistochemical Markers for Pancreatic Ductal Adenocarcinomas in Egyptian Patients

Background: Pancreatic ductal adenocarcinoma (PDAC) is the seventh cause of death caused by the cancer worldwide. It mostly presents at advanced stage. Aim of the Study: To analyze immunohistochemical expressions of SMAD4 and S100P in PDACs as well as correlation between their expressions and other clinical and pathological features. Materials and Methods: Sixty cases of Egyptian patients proved to be PDAC, 19 cases of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsies, and 41 cases of resection specimens, were collected. Results: S100P positive was expressed in 90% of studied cases. Most cases showed focal and strong-to-moderate nuclear expression for S100P. A statistically significant correlation between S100P expression and tumor grade was established in studied cases ( P = 0.015). SMAD4 was lost in 81.7% of studied cases in neoplastic tissue. No scientifically significant correlations exist among SMAD4 expression and any of other clinicopathological variables. S100P and SMAD4 expressions in neoplastic tissue of studied cases were scientifically correlated with its expression in adjacent normal tissue ( P < 0.001). S100P and SMAD4 had sensitivity of 90% and 81.70%, respectively, for the diagnosis of PDACs, with combined sensitivity of both markers was 98.30%. Conclusion: Our data suggest the role of S100P and SMAD4 in pancreatic carcinogenesis. SMAD4 could be used as the diagnostic biomarker for pancreatic adenocarcinomas. There is combined classification accuracy of 98.9%, suggesting that they are a sensitive and specific approach for adenocarcinomas in limited material of EUS-FNAs and that combined panel approach was significantly more accurate than any other individual approach.