Oncotarget

Research Papers:

Local recurrences at the anastomotic area are clonally related to the primary tumor in sporadic colorectal carcinoma

Efsevia Vakiani _, Ronak H. Shah, Michael F. Berger, Alvin P. Makohon-Moore, Johannes G. Reiter, Irina Ostrovnaya, Marc A. Attiyeh, Andrea Cercek, Jinru Shia, Christine A. Iacobuzio-Donahue, David B. Solit and Martin R. Weiser

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Oncotarget. 2017; 8:42487-42494. https://doi.org/10.18632/oncotarget.17200

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Abstract

Efsevia Vakiani1, Ronak H. Shah2, Michael F. Berger1,2, Alvin P. Makohon-Moore3, Johannes G. Reiter4, Irina Ostrovnaya5, Marc A. Attiyeh3, Andrea Cercek6, Jinru Shia1, Christine A. Iacobuzio-Donahue1,3, David B. Solit2 and Martin R. Weiser7

1Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

2Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

3The David Rubenstein Pancreatic Cancer Research Center, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA

4Program for Evolutionary Dynamics, Harvard University, Cambridge, MA, 02138, USA

5Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

6Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

7Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA

Correspondence to:

Efsevia Vakiani, email: vakianie@mskcc.org

Keywords: next-generation sequencing, colorectal cancer, anastomotic recurrence

Received: October 25, 2016     Accepted: April 07, 2017     Published: April 18, 2017

ABSTRACT

Purpose: Anastomotic recurrences (AR) occur in 2–10% of colorectal carcinoma cases after resection of primary tumor (PT). Currently, there are no molecular data investigating their genetic profile and multiple theories exist about their pathogenesis. The aim of our study was to compare the genomic profile of AR to that of the patients’ corresponding matched PT and, when available, to a distant metastasis (DM).

Experimental Design: Thirty-six tumors from 14 patients were genotyped using a capture-based, next-generation assay to define the mutational status of 341 cancer-associated genes. All patients had R0 resection of their PT and AR occurred 1.1−7.0 years following PT resection. A DM or a second AR was analyzed in 8 patients. All tumors were microsatellite stable except in one patient with Lynch syndrome.

Results: A total of 254 somatic mutations were detected including 138 mutations in the microsatellite stable (MSS) cases. The most commonly mutated genes were APC, KRAS, TP53, PIK3CA, ATM and PIK3R1. In all patients with MSS tumors the AR and PT shared between 50−100% of mutations, including mutations in key driver genes, consistent with these tumors being clonally related. Genetic events private to DM were not detected in AR and phylogenetic analysis showed that ARs were more closely related to PT than DM. In the Lynch syndrome patient the PT and AR showed distinct somatic mutations consistent with independent primaries.

Conclusions: ARs are clonally related to PT in sporadic colorectal carcinomas and do not appear to represent seeding of the anastomotic site by distant metastases.


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