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Jafari M, Laraqui A, Baba W, Benmokhtar S, Zaitouni SE, Ali AA, Bounaim A, Moujahid M, Tanz R, Mahfoud T, Sbitti Y, Annaz HE, Abi R, Tagajdid MR, Kochri SE, Lahlou IA, Hsaini HE, Belayachi L, Benjouad A, Ichou M, En-Nya A, Ennibi K. Prevalence and patterns of mutations in RAS/RAF/MEK/ERK/MAPK signaling pathway in colorectal cancer in North Africa. BMC Cancer 2022; 22:1142. [PMCID: PMC9639273 DOI: 10.1186/s12885-022-10235-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background Our review discuss (i) the findings from analyzed data that have examined KRAS, NRAS and BRAF mutations in patients with colorectal cancer (CRC) in North Africa and to compare its prevalence with that shown in other populations and (ii) the possible role of dietary and lifestyle factors with CRC risk. Methods Using electronic databases, a systematic literature search was performed for the KRAS, NRAS, and BRAF mutations in CRC patients from Morocco, Tunisia, Algeria and Lybia. Results Seventeen studies were identified through electronic searches with six studies conducted in Morocco, eight in Tunisia, two in Algeria, and one in Libya. A total of 1843 CRC patients were included 576 (31.3%) in Morocco, 641 (34.8%) in Tunisia, 592 (32.1%) in Algeria, and 34 (1.8%) in Libya. Overall, the average age of patients was 52.7 years old. Patients were predominantly male (56.6%). The mutation rates of KRAS, NRAS and BRAF were 46.4%, 3.2% and 3.5% of all patients, respectively. A broad range of reported KRAS mutation frequencies have been reported in North Africa countries. The KRAS mutation frequency was 23.9% to 51% in Morocco, 23.1% to 68.2% in Tunisia, 31.4% to 50% in Algeria, and 38.2% in Libya. The G12D was the most frequently identified KRAS exon 2 mutations (31.6%), followed by G12V (25.4%), G13D (15.5%), G12C (10.2%), G12A (6.9%), and G12S (6.4%). G12R, G13V, G13C and G13R are less than 5%. There are important differences among North Africa countries. In Morocco and Tunisia, there is a higher prevalence of G12D mutation in KRAS exon 2 (≈50%). The most frequently mutation type in KRAS exon 3 was Q61L (40%). A59T and Q61E mutations were also found. In KRAS exon 4, the most common mutation was A146T (50%), followed by K117N (33.3%), A146P (8.3%) and A146V (8.3%). Conclusion KRAS mutated CRC patients in North Africa have been identified with incidence closer to the European figures. Beside established anti-CRC treatment, better understanding of the causality of CRC can be established by combining epidemiology and genetic/epigenetic on CRC etiology. This approach may be able to significantly reduce the burden of CRC in North Africa.
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Affiliation(s)
- Meryem Jafari
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco ,grid.31143.340000 0001 2168 4024Laboratory of Biology of Human Pathologies, Department of Biology, Faculty of Sciences, Genomic Center of Human Pathologies, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelilah Laraqui
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Walid Baba
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco ,grid.31143.340000 0001 2168 4024Laboratory of Biology of Human Pathologies, Department of Biology, Faculty of Sciences, Genomic Center of Human Pathologies, Mohammed V University in Rabat, Rabat, Morocco
| | - Soukaina Benmokhtar
- grid.31143.340000 0001 2168 4024Laboratory of Biology of Human Pathologies, Department of Biology, Faculty of Sciences, Genomic Center of Human Pathologies, Mohammed V University in Rabat, Rabat, Morocco
| | - Sara El Zaitouni
- grid.31143.340000 0001 2168 4024Laboratory of Biology of Human Pathologies, Department of Biology, Faculty of Sciences, Genomic Center of Human Pathologies, Mohammed V University in Rabat, Rabat, Morocco
| | - Abdelmounaim Ait Ali
- grid.31143.340000 0001 2168 4024Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Ahmed Bounaim
- grid.31143.340000 0001 2168 4024Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Mountassir Moujahid
- grid.31143.340000 0001 2168 4024Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Rachid Tanz
- grid.31143.340000 0001 2168 4024Department of Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Tarik Mahfoud
- grid.31143.340000 0001 2168 4024Department of Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Yassir Sbitti
- grid.31143.340000 0001 2168 4024Department of Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Hicham El Annaz
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Rachid Abi
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Mohamed Rida Tagajdid
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Safae El Kochri
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Idriss Amine Lahlou
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Houda El Hsaini
- grid.463678.80000 0004 5896 7337International Faculty of Dental Medicine, College of Health Sciences, International University in Rabat, Rabat, Morocco
| | - Lamiae Belayachi
- grid.463678.80000 0004 5896 7337International Faculty of Dental Medicine, College of Health Sciences, International University in Rabat, Rabat, Morocco
| | - Abdelaziz Benjouad
- grid.463678.80000 0004 5896 7337International Faculty of Dental Medicine, College of Health Sciences, International University in Rabat, Rabat, Morocco
| | - Mohammed Ichou
- grid.31143.340000 0001 2168 4024Department of Medical Oncology, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
| | - Amina En-Nya
- grid.31143.340000 0001 2168 4024Laboratory of Biology of Human Pathologies, Department of Biology, Faculty of Sciences, Genomic Center of Human Pathologies, Mohammed V University in Rabat, Rabat, Morocco
| | - Khalid Ennibi
- grid.31143.340000 0001 2168 4024Sequencing Unit, Laboratory of Virology, Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco ,grid.31143.340000 0001 2168 4024Center of Virology, Infectious and Tropical Diseases, Faculty of Medicine and Pharmacy, Mohammed V Military Teaching Hospital, Mohammed V University in Rabat, Rabat, Morocco
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Patankar M, Eskelinen S, Tuomisto A, Mäkinen MJ, Karttunen TJ. KRAS and BRAF mutations induce anoikis resistance and characteristic 3D phenotypes in Caco‑2 cells. Mol Med Rep 2019; 20:4634-4644. [PMID: 31545494 PMCID: PMC6797985 DOI: 10.3892/mmr.2019.10693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022] Open
Abstract
In a number of types of cancer, anoikis, a form of apoptosis induced by loss of extracellular matrix (ECM) attachment, is disturbed. Anoikis resistance is essential in the formation of metastases. A recent study identified carcinoma cell subpopulations surviving without ECM contact in pathological specimens of colorectal cancer. The occurrence of these subpopulations indicated anoikis resistance. In the present study, it is demonstrated that KRAS and BRAF mutations induce anoikis resistance in colon cancer (Caco-2) cells. In 3D cultures, Caco-2 cells transfected with mutated KRAS or BRAF formed multicellular structures analogous to anoikis-resistant subpopulations in actual carcinomas, and serve as an in vitro model for anoikis resistance. Caco-2 cell lines were constructed, with KRAS or BRAF mutations, using retroviral delivery. The current study investigated anoikis resistance using an Annexin V apoptosis test from suspension cultures. 3D in vitro cultures, which were generated in collagen-matrigel mixtures, were assessed using confocal microscopy. 3D cultures embedded in paraffin were analyzed using conventional histopathology. In suspension cultures, Caco-2 cells with KRAS or BRAF mutations indicated a significantly lower proportion of Annexin positivity than the native Caco-2 cells, indicating that these mutations induce anoikis resistance in Caco-2 cells. 3D cultures displayed native Caco-2 cells forming polarized cysts with a single layer thick epithelium, whereas Caco-2 cells with KRAS or BRAF mutations formed partially filled cystic structures or solid round structures where only the outermost layer was in contact with the ECM. Additionally, KRAS mutations induced reversed polarity to Caco-2 cells along with the emergence of solid growth. The present study demonstrated that KRAS and BRAF mutations induce anoikis resistance in Caco-2 colorectal cancer cells. The growth patterns generated from the KRAS and BRAF mutated cells in 3D cultures revealed a resemblance to the putative anoikis-resistant subpopulations in actual carcinomas, including micropapillary structures and solid tumor cell islands. Additionally, KRAS mutation induced the emergence of inverted polarity. In conclusion, 3D cultures with modified Caco-2 cells serve as a valid in vitro model for anoikis resistance and inverted polarity.
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Affiliation(s)
- Madhura Patankar
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Sinikka Eskelinen
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Anne Tuomisto
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Markus J Mäkinen
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
| | - Tuomo J Karttunen
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, 90014 Oulu, Finland
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Molecular alterations and PD-L1 expression in non-ampullary duodenal adenocarcinoma: Associations among clinicopathological, immunophenotypic and molecular features. Sci Rep 2019; 9:10526. [PMID: 31324814 PMCID: PMC6642201 DOI: 10.1038/s41598-019-46167-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
Non-ampullary duodenal adenocarcinoma (NADC) is extremely rare. Little is known about its clinicopathological and molecular features or its management. Herein we retrospectively analyzed the cases of 32 NADC patients, focusing on microsatellite instability (MSI), genetic mutations, CpG island methylator phenotype (CIMP), and immunostaining including mucin phenotype and PD-L1 expression. The incidence of MSI, KRAS/BRAF/GNAS mutations and CIMP was 51.6%, 34.4%/3.1%/6.5% and 28.1%, respectively. PD-L1 expression was seen in 34.4% of patients. No significant associations between clinicopathological features and KRAS/BRAF/GNAS genetic mutations or CIMP were found. Histologically non-well-differentiated-type NADCs and those in the 1st portion of the duodenum were significantly associated with later stages (stages III–IV) (P = 0.006 and P = 0.003, respectively). Gastric-phenotype NADCs were frequently observed in the 1st portion and in late-stage patients; their cancer cells more frequently expressed PD-L1. Histologically, the non-well-differentiated type was an independent predictor of PD-L1 expression in cancer cells (OR 25.05, P = 0.04) and immune cells (OR 44.14, P = 0.02). Only late-stage disease (HR 12.23, P = 0.01) was a prognostic factor for worse overall survival in a Cox proportional hazards regression model. Our observation of high proportions of MSI and PD-L1 expression may prompt the consideration of immune checkpoint inhibitors as a new treatment option for NADCs.
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Matsuzaki J, Suzuki H, Shimoda M, Mori H, Fukuhara S, Miyoshi S, Masaoka T, Iwao Y, Kanai Y, Kanai T. Clinical and endoscopic findings to assist the early detection of duodenal adenoma and adenocarcinoma. United European Gastroenterol J 2018; 7:250-260. [PMID: 31080610 DOI: 10.1177/2050640618817689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sporadic nonampullary duodenal adenocarcinoma is a rare malignant neoplasm in which poor prognosis is often associated with delayed diagnosis. Objective A case-control study was designed to evaluate the clinical and endoscopic characteristics of patients with nonampullary duodenal epithelial tumours (NADETs). Methods Patients with NADETs were chronologically divided into a discovery and a validation sets. Two age- and sex-matched control individuals for each case in the discovery set were randomly selected from individuals without NADET. A prediction model for the presence of NADET, constructed in the discovery set, was evaluated in the validation set. Results In total, 368 adenomas, 81 adenocarcinomas, and 314 controls were analysed. Current smoking, Barrett oesophagus, fundic gland polyps, history of malignant disease, and absence of dyslipidaemia were independently associated with the presence of NADET. The combination of these five factors enabled significant discrimination for NADET in the bulb with a sensitivity of 0.81 in the validation set. We also showed that duodenal adenocarcinomas in the bulb had greater invasive potential than adenocarcinomas in the second portion. Conclusion The presence of a duodenal tumour in the bulb could be predicted by clinical and endoscopic findings, which helps improve the prognosis and quality of life of patients.
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Affiliation(s)
- Juntaro Matsuzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan.,Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Hidekazu Suzuki
- Fellowship Training Center, Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Mori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seiichiro Fukuhara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Sawako Miyoshi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuhiro Masaoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Iwao
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
| | - Yae Kanai
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Sikdar N, Saha G, Dutta A, Ghosh S, Shrikhande SV, Banerjee S. Genetic Alterations of Periampullary and Pancreatic Ductal Adenocarcinoma: An Overview. Curr Genomics 2018; 19:444-463. [PMID: 30258276 PMCID: PMC6128383 DOI: 10.2174/1389202919666180221160753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 02/06/2023] Open
Abstract
Pancreatic Ductal AdenoCarcinoma (PDAC) is one of the most lethal malignancies of all solid cancers. Precancerous lesions for PDAC include PanIN, IPMNs and MCNs. PDAC has a poor prognosis with a 5-year survival of approximately 6%. Whereas Periampulary AdenoCarcinoma (PAC) having four anatomic subtypes, pancreatic, Common Bile Duct (CBD), ampullary and duodenum shows relative better prognosis. The highest incidence of PDAC has been reported with black with respect to white population. Similarly, incidence rate of PAC also differs with different ethnic populations. Several lifestyle, environmental and occupational exposures including long-term diabetes, obesity, and smoking, have been linked to PDAC, however, for PAC the causal risk factors were poorly described. It is now clear that PDAC and PAC are a multi-stage process resulting from the accumulation of genomic alterations in the somatic DNA of normal cells as well as inherited mutations. Approximately 10% of PDAC have a familial inheritance. Germline mutations in CDKN2A, BRCA2, STK11, PALB2, PRSS1, etc., as well as certain syndromes have been well associated with predisposition to PDAC. KRAS, CDKN2A, TP53 and SMAD4 are the 4 "mountains" (high-frequency driver genes) which have been known to earliest somatic alterations for PDAC while relatively less frequent in PAC. Our understanding of the molecular carcinogenesis has improved in the last few years due to extensive research on PDAC which was not well explored in case of PAC. The genetic alterations that have been identified in PDAC and different subgroups of PAC are important implications for the development of genetic screening test, early diagnosis, and prognostic genetic markers. The present review will provide a brief overview of the incidence and prevalence of PDAC and PAC, mainly, increased risk in India, the several kinds of risk factors associated with the diseases as well as required genetic alterations for disease initiation and progression.
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Affiliation(s)
- Nilabja Sikdar
- Address correspondence to this author at the Human Genetics Unit, Indian Statistical Institute, 203, B.T. Road Kolkata 700108, India; Tel (1): +91-33
-25773240 (L); (2): +91-9830780397 (M); Fax: +91 33 35773049;, E-mail:
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Zhao P, Chen H, Wen D, Mou S, Zhang F, Zheng S. Personalized treatment based on mini patient-derived xenografts and WES/RNA sequencing in a patient with metastatic duodenal adenocarcinoma. Cancer Commun (Lond) 2018; 38:54. [PMID: 30139386 PMCID: PMC6108145 DOI: 10.1186/s40880-018-0323-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 08/14/2018] [Indexed: 01/07/2023] Open
Abstract
Background Treatment guidelines for a variety of cancers have been increasingly used in clinical practice, and have resulted in major improvement in patient outcomes. However, recommended regimens (even first-line treatments) are clearly not ideal for every patients. In the present study, we used mini patient-derived xenograft (mini-PDX) and next-generation sequencing to develop personalized treatment in a patient with metastatic duodenal adenocarcinoma. Methods Resected metachronous metastatic tumor tissues were implanted into SCID mice to determine the sensitivity to a variety of drug regimens. Mutation profiles were assessed using both DNA whole-exome sequencing (DNA–WES) and RNA sequencing. The results of the analyses were used to select optimal treatment for the patient with metastatic duodenal adenocarcinoma. Results Assessment with mini-PDX models took only 7 days. The results showed high sensitivity to S-1 plus cisplatin, gemcitabine plus cisplatin and everolimus alone. The patient received gemcitabine plus cisplatin initially, but the treatment was terminated due to toxicity. The patient was then switched to treatment with S-1 alone. The overall disease-free survival was 34 months. DNA–WES and RNA sequencing identified KRAS mutation (A146T), TP53 (C229Yfs*10) and RICTOR amplification in the metastatic duodenal adenocarcinoma. These findings provided further support to the results of the mini-PDX, and suggest mTOR inhibitors should be used if and when relapse eventually occurs in this patient. Conclusions Mini-PDX model combined with WES/RNA sequencing can rapidly assess drug sensitivity in cancer patients and reveal key genetic alterations. Further research on this technology for personalized therapy in patients with refractory malignant tumors is warranted. Electronic supplementary material The online version of this article (10.1186/s40880-018-0323-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peng Zhao
- Cancer Biotherapy Center, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, P. R. China
| | - Hui Chen
- Department of General Surgery, Zhejiang Hospital, Hangzhou, 310013, P. R. China
| | - Danyi Wen
- LIDE Biotech Co., Ltd, Shanghai, P. R. China
| | - Shuo Mou
- OrigiMed Co., Ltd, Shanghai, P. R. China
| | | | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, P. R. China. .,Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Hangzhou, China.
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Chandrasegaram MD, Gill AJ, Samra J, Price T, Chen J, Fawcett J, Merrett ND. Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer. World J Gastrointest Oncol 2017; 9:407-415. [PMID: 29085567 PMCID: PMC5648984 DOI: 10.4251/wjgo.v9.i10.407] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/26/2017] [Accepted: 08/16/2017] [Indexed: 02/05/2023] Open
Abstract
Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion. This has led to variation in the reported proportions of resected periampullary cancers. Pancreatic cancer is the most common cancer resected with a pancreaticoduodenectomy followed by ampullary (16%-50%), bile duct (5%-39%), and duodenal cancer (3%-17%). Patients with resected duodenal and ampullary cancers have a better reported median survival (29-47 mo and 22-54 mo) compared to pancreatic cancer (13-19 mo). The poorer survival with pancreatic cancer relates to differences in tumour characteristics such as a higher incidence of nodal, neural and vascular invasion. While small ampullary cancers can present early with biliary obstruction, pancreatic cancers need to reach a certain size before biliary obstruction ensues. This larger size at presentation contributes to a higher incidence of resection margin involvement in pancreatic cancer. Ampullary cancers can be subdivided into intestinal or pancreatobiliary subtype cancers with histomolecular staining. This avoids relying on histomorphology alone, as even some poorly differentiated cancers preserve the histomolecular profile of their mucosa of origin. Histomolecular profiling is superior to anatomic location in prognosticating survival. Ampullary cancers of intestinal subtype and duodenal cancers are similar in their intestinal origin and form a logical clinical and therapeutic subgroup of periampullary cancers. They respond to 5-FU based chemotherapeutic regimens such as capecitabine-oxaliplatin. Unlike pancreatic cancers, KRAS mutation occurs in only approximately a third of ampullary and duodenal cancers. Future clinical trials should group ampullary cancers of intestinal origin and duodenal cancers together given their similarities and their response to fluoropyrimidine therapy in combination with oxaliplatin. The addition of anti-epidermal growth factor receptor therapy in this group warrants study.
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Affiliation(s)
- Manju D Chandrasegaram
- the Prince Charles Hospital, Brisbane, Queensland 4032, Australia
- School of Medicine, University of Queensland, Queensland 4006, Australia
| | - Anthony J Gill
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - Jas Samra
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales 2065, Australia
| | - Tim Price
- Queen Elizabeth Hospital, Adelaide, South Australia 5011, Australia
- University of Adelaide, South Australia 5005, Australia
| | - John Chen
- Flinders Medical Centre, Adelaide, South Australia 5042, Australia
- Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Jonathan Fawcett
- School of Medicine, University of Queensland, Queensland 4006, Australia
- Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | - Neil D Merrett
- Department of Upper GI Surgery, Bankstown Hospital, Sydney, New South Wales 2200, Australia
- Discipline of Surgery, Western Sydney University, Sydney, New South Wales 2560, Australia
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Tewari M, Swain JR, Dixit VK, Shukla HS. Molecular Aberrations in Periampullary Carcinoma. Indian J Surg Oncol 2017; 8:348-356. [DOI: 10.1007/s13193-017-0645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 03/15/2017] [Indexed: 11/29/2022] Open
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Methylation of MGMT Is Associated with Poor Prognosis in Patients with Stage III Duodenal Adenocarcinoma. PLoS One 2016; 11:e0162929. [PMID: 27643594 PMCID: PMC5028050 DOI: 10.1371/journal.pone.0162929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND O6-methylguanine-DNA methyltransferase (MGMT) methylation status has not been extensively investigated in duodenal adenocarcinoma (DA). The aim of this study was to evaluate the MGMT methylation status and examine its possible prognostic value in patients with stage III DA. METHODS Demographics, tumor characteristics and survival were available for 64 patients with stage III DA. MGMT methylation was detected by using MethyLight. A Cox proportional hazard model was built to predict survival, adjusted for clinicopathological characteristics and tumor molecular features, including the CpG island methylator phenotype (CIMP), microsatellite instability (MSI), and KRAS mutations. RESULTS MGMT methylation was detected in 17 of 64 (26.6%) patients, and was not correlated with sex, age, tumor differentiation, CIMP, MSI, or KRAS mutations. MGMT methylation was the only one factor associated with both overall survival (OS) and disease-free survival (DFS) on both univariate and multivariate analyses. In patients treated with surgery alone, MGMT-methylated group had worse OS and DFS when compared with MGMT-unmethylated group. However, in patients treated with chemotherapy/radiotherapy, outcomes became comparable between the two groups. CONCLUSIONS Our results demonstrate MGMT methylation is a reliable and independent prognostic factor in DAs. Methylation of MGMT is associated with poor prognosis in patients with stage III DAs.
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Jun SY, Kim M, Jin Gu M, Kyung Bae Y, Chang HK, Sun Jung E, Jang KT, Kim J, Yu E, Woon Eom D, Hong SM. Clinicopathologic and prognostic associations of KRAS and BRAF mutations in small intestinal adenocarcinoma. Mod Pathol 2016; 29:402-15. [PMID: 26892442 DOI: 10.1038/modpathol.2016.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/07/2015] [Accepted: 01/07/2016] [Indexed: 02/07/2023]
Abstract
Activating KRAS and/or BRAF mutations have been identified as predictors of resistance to anti-epidermal growth factor receptor (EGFR) chemotherapy in colorectal cancer. But the status of KRAS and BRAF mutations and their clinicopathologic and prognostic significance has not been extensively evaluated in small intestinal adenocarcinomas. In this work, the KRAS and BRAF genes in 190 surgically resected small intestinal adenocarcinoma cases were sequenced and their association with various clinicopathologic variables, including survival of the patients, was analyzed. KRAS or BRAF mutations were observed in 63 (33%) cases. Sixty-one cases had KRAS mutations and 2 had BRAF mutations and the two types of mutation were mutually exclusive. The majority of KRAS mutations were G>A transition (43/61 cases, 71%) or p.G12D (31/61 cases, 51%). The patients with mutant KRAS tended to have higher pT classifications (P=0.034) and more frequent pancreatic invasion (P=0.020) than those with wild-type KRAS. Multivariate logistic regression analysis showed that certain mutated KRAS subtypes (G>A transitions and G12D mutations) were significantly correlated with higher pT classification (P=0.015 and 0.004, respectively) than wild-type KRAS and other KRAS mutations. The patients with KRAS or BRAF mutation had a tendency to shorter overall survival than those with wild-type KRAS and BRAF (P=0.148), but subgroup analysis demonstrated the patients with KRAS mutations showed worse survival (median, 46.0 months; P=0.046) than those with wild-type KRAS (85.4 months) in lower pT classification (pT1-pT3) group. In summary, KRAS and, infrequently, BRAF mutations are observed in a subset of small intestinal adenocarcinomas, and are associated with higher pT classification and more frequent pancreatic invasion. KRAS mutation is a poor prognostic predictor in patients with lower pT classification tumors. Anti-EGFR targeted therapy could be applied to about two-thirds of small intestinal adenocarcinoma patients, namely those with wild-type KRAS and BRAF if they have metastatic disease, similar to colorectal cancer patients.
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Affiliation(s)
- Sun-Young Jun
- Department of Pathology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Misung Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Mi Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Kyung Bae
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hee-Kyung Chang
- Department of Pathology, Kosin University College of Medicine, Busan, Republic of Korea
| | - Eun Sun Jung
- Department of Pathology, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunsil Yu
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Woon Eom
- Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Abstract
OBJECTIVES Periampullary cancers (PACs) include the following 4 traditional anatomic subtypes: pancreatic, ampullary, biliary, or duodenal cancers. This review was performed to highlight recent advances in the genomic and molecular understanding of each PAC subtype and the advances in chemotherapeutic and molecular trials in these cancer subtypes. RESULTS Recent advances have highlighted differences in the genomic and molecular features within each PAC subtype. Ampullary cancers can now be further defined accurately into their intestinal and pancreatobiliary subtypes using histomolecular profiling. K-ras mutation, which occurs in most pancreatic cancers, is found to occur less frequently in ampullary (42%-52%), biliary (22%-23%), and duodenal cancers (32%-35%), suggesting crucial differences in targetable mutations in these cancer subtypes.Ampullary cancers of intestinal subtype and duodenal cancers seem to share similarities with colorectal cancer, given that they respond to similar chemotherapeutic regimens. This has potential implications for clinical trials and treatment selection, where PACs are often considered together. CONCLUSIONS Future trials should be designed in view of our increased understanding of the different anatomic and histomolecularly profiled subtypes of PAC cancers, which respects their individual molecular characteristics, phenotype, and response to treatment.
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12
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Aparicio T, Svrcek M, Zaanan A, Beohou E, Laforest A, Afchain P, Mitry E, Taieb J, Di Fiore F, Gornet JM, Thirot-Bidault A, Sobhani I, Malka D, Lecomte T, Locher C, Bonnetain F, Laurent-Puig P. Small bowel adenocarcinoma phenotyping, a clinicobiological prognostic study. Br J Cancer 2013; 109:3057-66. [PMID: 24196786 PMCID: PMC3859950 DOI: 10.1038/bjc.2013.677] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare tumour with a poor prognosis. Molecular biology data on SBA carcinogenesis are lacking. METHODS Expression of HER2, β-catenin, p53 and mismatch repair (MMR) protein was assessed by immunohistochemistry. KRAS, V600E BRAF mutations and microsatellite instability were investigated. RESULTS We obtained samples from 63 SBA patients (tumour stages: I-II: 30%; III: 35%; IV: 32%; locally advanced: 3%). HER2 overexpression (3+) was observed in 2 out of 62 patients, overexpression of p53 in 26 out of 62, abnormal expression of β-catenin in 12 out of 61, KRAS mutation in 21 out of 49, BRAF V600E mutation in 1 out of 40 patients, MMR deficiency (dMMR) in 14 out of 61 and was consistent with Lynch syndrome in 9 out of 14 patients. All of the dMMR tumours were in the duodenum or jejunum and only one was stage IV. Median overall survival (OS) was 36.6 months (95% CI, 26.9-72.2). For all patients, in univariate analysis, stages I-II (P<0.001), WHO PS 0-1 (P=0.01) and dMMR phenotype (P=0.02) were significantly associated with longer OS. In multivariate analysis, disease stage (P=0.01) and WHO PS 0-1 (P=0.001) independently predicted longer OS. For stage IV patients, median OS was 20.5 months (95% CI: 14.6; 36.6 months). In multivariate analysis, WHO PS 0-1 (P=0.0001) and mutated KRAS status (P=0.02) independently predicted longer OS. CONCLUSION This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations. The seemingly higher frequency of dMMR than in CRC may be explained by the higher frequency of Lynch syndrome in SBA patients. A dMMR phenotype was significantly associated with a non-metastatic tumour (P=0.02). A trend for a good prognosis and a duodenum or jejunum primary site was associated with dMMR.
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Affiliation(s)
- T Aparicio
- Gastroenterology and Digestive Oncology, APHP, Hôpitaux Universitaires de Seine Saint Denis, Avicenne Hospital, University Paris 13, Paris Sorbonne Cité, 125 rue de Stalingrad, Bobigny 93000, France
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