Stachler Matthew D, Rinehart Elizabeth, Lindeman Neal, Odze Robert, Srivastava Amitabh
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Hum Pathol. 2015 Apr;46(4):507-13. doi: 10.1016/j.humpath.2015.01.005. Epub 2015 Jan 14.
Routine tumor genotyping enables identification of concurrent mutations in tumors and reveals low-frequency mutations that may be associated with a particular tumor phenotype. We genotyped 311 colorectal carcinomas (CRCs) for 471 mutation hot spots in 41 cancer-associated genes. At least 1 mutation was present in 239 (77%) of 311 tumors. Two concurrent mutations were identified in 89 (29%) tumors, 3 mutations in 24 (8%), 4 mutations in 6 (2%), and 5 mutations in 1 tumor. KRAS mutations were most frequent and identified in 132 (42%) tumors, followed by APC in 79 (25%) and TP53 in 64 (21%) tumors. Mutations in PIK3CA, BRAF, CTNNB1, and NRAS were identified in 41, 27, 11, and 9 cases, respectively. Rare mutations not typically associated with CRC included AKT1 (4), AKT2 (1), IDH1 (1), KIT (1), MAP2K1 (1), PTEN (2), and GNAS (6). GNAS mutations in CRC correlated with a mucinous phenotype and were present in 20% of all mucinous adenocarcinomas evaluated in this study. Among CRCs with a PIK3CA mutation, 77% showed concurrent mutations in other cancer-associated genes, and 4% of CRC did not neatly fit into either the chromosomal instability pathway or CpG island methylator phenotype/microsatellite instability pathway, suggesting overlapping mutational profile in some tumors. Our findings indicate that routine tumor genotyping is helpful in identifying low-frequency mutations, such as GNAS, that may correlate with a specific morphological phenotype and also reveal multiplicity of concurrent mutations in a significant proportion of CRC that may have significant implications for clinical trial design and personalized therapy.
常规肿瘤基因分型能够识别肿瘤中的并发突变,并揭示可能与特定肿瘤表型相关的低频突变。我们对311例结直肠癌(CRC)的41个癌症相关基因中的471个突变热点进行了基因分型。311例肿瘤中有239例(77%)至少存在1个突变。在89例(29%)肿瘤中鉴定出2个并发突变,24例(8%)中有3个突变,6例(2%)中有4个突变,1例肿瘤中有5个突变。KRAS突变最为常见,在132例(42%)肿瘤中被鉴定出来,其次是APC突变,有79例(25%),TP53突变有64例(21%)。PIK3CA、BRAF、CTNNB1和NRAS突变分别在41、27、11和9例中被鉴定出来。通常与CRC不相关的罕见突变包括AKT1(4例)、AKT2(1例)、IDH1(1例)、KIT(1例)、MAP2K1(1例)、PTEN(2例)和GNAS(6例)。CRC中的GNAS突变与黏液样表型相关,在本研究评估的所有黏液腺癌中占20%。在具有PIK3CA突变的CRC中,77%显示出其他癌症相关基因的并发突变,4%的CRC不完全符合染色体不稳定途径或CpG岛甲基化表型/微卫星不稳定途径,这表明一些肿瘤中存在重叠的突变谱。我们的研究结果表明,常规肿瘤基因分型有助于识别可能与特定形态学表型相关的低频突变,如GNAS,并且还揭示了相当一部分CRC中并发突变的多样性,这可能对临床试验设计和个性化治疗具有重要意义。