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Murcia O, Juárez M, Hernández-Illán E, Rodriguez-Soler M, Giner-Calabuig M, Alustiza M, Egoavil C, Castillejo A, Alenda C, Mangas C, Barberá V, Yuste A, Bujanda L, Clofent J, Andreu M, Castells A, Llor X, Zapater P, Jover R. Colorectal cancer molecular classification using BRAF, KRAS, microsatellite instability, and CIMP status: Prognostic implications and response to chemotherapy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
668 Background: The aim of this study was to validate a molecular classification of colorectal cancer (CRC) based on microsatellite instability (MSI), CpG island methylator phenotype (CIMP) status, BRAF, and KRAS and investigate each subtype’s response to chemotherapy. Methods: This retrospective observational study included a population-based cohort of 878 CRC patients. We classified tumours into five different subtypes based on BRAF and KRAS mutation, CIMP status, and MSI. Patients with advanced stage II (T4N0M0) and stage III tumours received 5-fluoruracil (5-FU)-based chemotherapy or no adjuvant treatment based on clinical criteria. The main outcome was disease-free survival (DFS). Results: Patients with the combination of microsatellite stable (MSS) tumours, BRAF mutation and CIMP positive exhibited the worst prognosis in univariate (log rank P < 0.0001) and multivariate analyses (hazard ratio 1.75, 95% CI 1.05-2.93, P = 0.03) after adjusting for age, sex, chemotherapy, and TNM stage. Treatment with 5-FU-based regimens improved prognosis in patients with the combination of MSS tumours, KRAS mutation and CIMP negative (log rank P = 0.003) as well as in patients with MSS tumours plus BRAF and KRAS wild-type and CIMP negative (log-rank P < 0.001). After adjusting for age, sex, and TNM stage in the multivariate analysis, only patients with the latter molecular combination had independently improved prognosis after adjuvant chemotherapy (hazard ratio 2.06, 95% CI 1.24-3.44, P = 0.005). Conclusions: We confirmed the prognostic value of stratifying CRC according to molecular subtypes using MSI, CIMP status, and somatic KRAS and BRAF mutation. Patients with traditional chromosomally unstable tumours obtained the best benefit from adjuvant 5-FU-based chemotherapy.
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Affiliation(s)
- Oscar Murcia
- Hospital General Universitario de Alicante, Elche, Spain
| | - Miriam Juárez
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Eva Hernández-Illán
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | | | - Mar Giner-Calabuig
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Miren Alustiza
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Cecilia Egoavil
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Adela Castillejo
- Hospital General Universitario de Elche, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Cristina Alenda
- Hospital General Universitario de Alicante/ Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | | | - Victor Barberá
- Hospital General Universitario de Elche, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Ana Yuste
- Hospital General Universitario de Alicante, Elche, Spain
| | - Luís Bujanda
- Biodonostia, Universidad del País Vasco, Centro de Investigación Biomédica en Red de Enfermedades Hepaticas y Digestivas, San Sebastián, Spain
| | | | - Montserrat Andreu
- Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Xavier Llor
- Colorectal Cancer Prevention Program, Chicago, IL
| | - Pedro Zapater
- Hospital General Universitario de Alicante/ Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Rodrigo Jover
- Alicante University General Hospital, Alicante, Spain
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Murcia O, Juárez M, Rodriguez-Soler M, Hernández-Illán E, Egoavil C, Giner-Calabuig M, Alustiza M, Alenda C, Mangas C, García A, Aparicio JR, Ruiz FA, Martínez JF, Casellas JA, Soto JL, Zapater P, Jover R. Genetic profile of polyps and risk of advanced metachronous lesions. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
555 Background: The role of genetic profile of polyps to predict advanced metachronous lesions (AML) remains unknown. The aim is to study the relation between genetic profile of polyps and both risk of AMLs and time to develop them in surveillance. Methods: 308 patients with colonic polyps were consecutively enrolled between 2007 and 2009 for this cohort study, and followed up to 2014 (median 26 months, range 63). Variables as age, sex, smoking, weight, number of colonoscopies and number and characteristics of polyps were collected. 995 polyps were analyzed for somatic mutations on BRAF and KRAS genes using allelic discrimination by real-time PCR and direct DNA sequenciation, respectively. High level of methylation on CpG islands (CIMP-H) was also tested using MS-MLPA. AML was defined by a size higher than 9mm, high grade dysplasia or villous component. Risk of developing AML for individual genetic markers was studied using Chi-square tests and logistic regression. Log-rank test with Kaplan Meier survival curves and Cox-regression model were also performed. Multivariate analysis were adjusted by sex, age, familial colorectal cancer, smoking and features of AML in first colonoscopy. Results: 21% of polyps in first colonoscopy were CIMP-H. KRAS and BRAF mutations accounted for 25% and 17% of polyps, respectively. In univariate analysis, KRAS-mutated polyps were related to higher risk of AML in surveillance (52% KRAS-mutated polyps vs 31% non-mutated; p = 0.01). Similar results were obtained regarding CIMP-H (77% CIMP-H polyps vs 38% non-CIMP; p = 0.005). Logistic regression showed CIMP-H as the unique genetic marker of risk for AML (OR 11.41, 95% CI 2.04-63.70; p = 0.006). Regarding time to develop AML, shorter intervals were found related to CIMP-H (median of 31 vs 48 months in non-CIMP-H; p = 0.002) and KRAS-mutations (median of 36 vs 49 months in non-mutated; p = 0.029) in univariate analysis. Multivariate analysis highlighted CIMP-H as the unique independent marker associated to shorter time to develop AML (HR 4.01, 95% CI 1.36-10.46; p = 0.01). Conclusions: Presence of CIMP-H in polyps associates higher risk of subsequent AML and shorter interval to their development. Genetic profile of polyps emerges as useful tool for colonoscopy surveillance.
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Affiliation(s)
- Oscar Murcia
- Hospital General Universitario de Alicante, Elche, Spain
| | - Miriam Juárez
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | | | - Eva Hernández-Illán
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Cecilia Egoavil
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Mar Giner-Calabuig
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Miren Alustiza
- Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIA, Alicante, Spain
| | - Cristina Alenda
- Hospital General Universitario de Alicante/ Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | | | - Araceli García
- Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - José Ramón Aparicio
- Hospital General Universitario de Alicante Hospital, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Francisco Antonio Ruiz
- Hospital General Universitario de Alicante Hospital, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Juan Francisco Martínez
- Hospital General Universitario de Alicante Hospital, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Juan Antonio Casellas
- Hospital General Universitario de Alicante Hospital, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - José Luís Soto
- Hospital General Universitario de Elche, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Pedro Zapater
- Hospital General Universitario de Alicante/ Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Rodrigo Jover
- Alicante University General Hospital, Alicante, Spain
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