优化常规 KRAS 基因突变聚合酶链反应检测程序,以合理选择转移性结直肠癌的一线靶向个体化治疗。
Optimization of routine KRAS mutation PCR-based testing procedure for rational individualized first-line-targeted therapy selection in metastatic colorectal cancer.
机构信息
Service de Biopathologie, Centre Alexis Vautrin 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France ; CNRS, UMR 7039 CRAN Nancy, France ; Université de Lorraine Nancy, France.
出版信息
Cancer Med. 2013 Feb;2(1):11-20. doi: 10.1002/cam4.47. Epub 2013 Feb 3.
KRAS mutation detection represents a crucial issue in metastatic colorectal cancer (mCRC). The optimization of KRAS mutation detection delay enabling rational prescription of first-line treatment in mCRC including anti-EGFR-targeted therapy requires robust and rapid molecular biology techniques. Routine analysis of mutations in codons 12 and 13 on 674 paraffin-embedded tissue specimens of mCRC has been performed for KRAS mutations detection using three molecular biology techniques, that is, high-resolution melting (HRM), polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP), and allelic discrimination PCR (TaqMan PCR). Discordant cases were assessed with COBAS 4800 KRAS CE-IVD assay. Among the 674 tumor specimens, 1.5% (10/674) had excessive DNA degradation and could not be analyzed. KRAS mutations were detected in 38.0% (256/674) of the analysable specimens (82.4% in codon 12 and 17.6% in codon 13). Among 613 specimens in whom all three techniques were used, 12 (2.0%) cases of discordance between the three techniques were observed. 83.3% (10/12) of the discordances were due to PCR-RFLP as confirmed by COBAS 4800 retrospective analysis. The three techniques were statistically comparable (κ > 0.9; P < 0.001). From these results, optimization of the routine procedure consisted of proceeding to systematic KRAS detection using HRM and TaqMan and PCR-RFLP in case of discordance and allowed significant decrease in delays. The results showed an excellent correlation between the three techniques. Using HRM and TaqMan warrants high-quality and rapid-routine KRAS mutation detection in paraffin-embedded tumor specimens. The new procedure allowed a significant decrease in delays for reporting results, enabling rational prescription of first-line-targeted therapy in mCRC.
KRAS 基因突变检测在转移性结直肠癌(mCRC)中至关重要。为了优化 KRAS 基因突变检测的延迟时间,从而在 mCRC 中合理选择一线治疗方案,包括抗 EGFR 靶向治疗,需要使用稳健、快速的分子生物学技术。我们使用三种分子生物学技术(高分辨率熔解曲线分析、聚合酶链反应限制片段长度多态性分析和等位基因特异性 PCR 分析)对 mCRC 中 674 例石蜡包埋组织标本中 12 号和 13 号密码子的突变进行了常规分析,以检测 KRAS 基因突变。对于不一致的病例,我们采用了 COBAS 4800 KRAS CE-IVD 检测方法进行评估。在 674 例肿瘤标本中,有 1.5%(10/674)标本存在严重的 DNA 降解,无法进行分析。在可分析的 674 例标本中,有 38.0%(256/674)检测到 KRAS 基因突变(12 号密码子 82.4%,13 号密码子 17.6%)。在所有三种技术都用于 613 例标本的情况下,三种技术之间存在 12 例(2.0%)不一致的情况。通过 COBAS 4800 回顾性分析,发现 10 例(83.3%)不一致的情况是由于 PCR-RFLP 造成的。三种技术在统计学上具有可比性(κ>0.9;P<0.001)。基于这些结果,我们对常规检测流程进行了优化,即使用 HRM 和 TaqMan 进行系统的 KRAS 检测,如果出现不一致的情况,再采用 PCR-RFLP 进行检测,这使得检测时间显著缩短。结果表明,三种技术之间具有极好的相关性。使用 HRM 和 TaqMan 可以保证在石蜡包埋肿瘤标本中进行高质量、快速的 KRAS 基因突变检测。新的检测流程可以显著缩短报告结果的时间,从而在 mCRC 中合理选择一线靶向治疗方案。
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