The low prevalence of colonic serrated adenocarcinoma with high KRAS mutational status at Cipto Mangunkusumo Hospital, Indonesia

Abstract

Background: Serrated adenocarcinoma (SA), a subtype of colorectal carcinoma, and the KRAS mutation, a strong marker for the patient’s response to anti-epidermal growth factor receptor therapy, have a clinical importance because of its progressive nature and tendency for chemoresistance. The purposes of this study were to (1) determine the prevalence of SA, (2) evaluate the histomorphological characteristics of SA and classical adenocarcinoma based on its prognostic factors, (3) determine the prevalence of the KRAS mutation in SA cases, and (4) identify the main characteristics of SA cases and classical adenocarcinoma with a KRAS mutation.Methods: This study was conducted by reviewing hematoxylin-eosin-stained slides of colorectal carcinoma (CRC) cases from January 2013 to July 2015 at the Department of Anatomical Pathology Cipto Mangunkusumo General Hospital. The final diagnosis of SA was based on the Tuppurainen et al criteria and the KRAS mutation was evaluated using real-time polymerase chain reaction.Results: Among the 117 adenocarcinoma cases, there were 41 unequivocal SA, 11 equivocal SA, and 65 classical adenocarcinoma. The prevalence rates of unequivocal and equivocal SA among all CRC cases were 7.7% and 2.1%, respectively. There were 11 (28.2%) cases of wild-type KRAS and 28 (71.7%) cases of mutated KRAS among all unequivocal SA cases. Tumor budding (TB) was the predominant prognostic factor.Conclusion: The prevalence of SA among all CRC cases was 7.7%. The KRAS mutation was found in almost three-quarters of all SA cases.

High Probability of Lynch Syndrome Among Colorectal Cancer Patients Is Associated With Higher Occurrence of KRAS and PIK3CA Mutations

“…This was much higher than what was reported in the Asia-Pacific (37-52%) and Western populations (32-49%) [ 36 - 49 ]. Nevertheless, our data are in line with a previous study in Indonesia, showing that KRAS mutation was found in 71.8% of serrated adenocarcinoma (SA), which is intriguingly higher than the generally reported incidence of 40% [ 50 - 52 ]. Another study, based on next-generation sequencing (NGS) analysis, showed that KRAS mutation occurred in 63.6% of 22 Indonesian patients with mostly advanced CRC [ 53 ].…”

High Probability of Lynch Syndrome among colorectal cancer patients in Indonesia is associated with higher occurrence of KRAS and PIK3CA mutations

“…This was much higher than what was reported in the Asia-Pacific (37-52%) and Western populations (32-49%) [25–38]. Nevertheless, our data is in line with a previous study in Indonesia, showing that KRAS mutation was found in 71.8% of serrated adenocarcinoma (SA), which is intriguingly higher than the generally reported incidence of 40% [39–41]. Another study, based on NGS (Next Generation Sequencing) analysis, showed that KRAS mutation occurred in 63.6% of 22 Indonesian patients with mostly advanced CRC [42].…”

Molecular Pattern and Clinical Implications of KRAS/NRAS and BRAF Mutations in Colorectal Cancer

“…While the rate of RAS mutations was higher in our study, the incidence of BRAF mutations was comparable. The highest KRAS mutation rate in the literature was reported by Rahadiani et al [31] as 71.8% and the lowest rate was reported by Bakarman et al as 12.5% [32]. In our study, the KRAS mutation rate was 47.2%.…”