Early-stage serrated adenocarcinomas are divided into several molecularly distinct subtypes

PLoS One. 2019 Feb 20;14(2):e0211477. doi: 10.1371/journal.pone.0211477. eCollection 2019.

Abstract

Serrated adenocarcinoma (SAC) is considered the end stage of the serrated neoplasia pathway. Although SAC prognosis is not widely recognized, the serrated pathway-associated subtype consistently exhibits unfavorable prognosis in genetic studies. Herein, we classified molecularly distinct subtypes of serrated adenocarcinomas and clarified their associated clinicopathological characteristics and genetic changes. We examined 38 early-stage colorectal SACs. Of these, 24 were classified into three molecularly distinct groups by colon cancer subtyping (CCS). The clinicopathological characteristics, Ki 67 labeling index (LI), and SAC epithelial serration were assessed. The DNA from carcinomas and normal tissue/adenoma was extracted by laser microdissection and sequenced by next-generation sequencing, and mutation numbers and patterns of a 15-oncogene panel were determined. The CCS groups included CCS1 (CDX2+, HTR2B-, FRMD6-, ZEB1-, and microsatellite instable-low [MSI-L]/microsatellite stable [MSS]; 14 cases), CCS2 (microsatellite instable-high [MSI-H], 5 cases), and CCS3 (CDX2-, HTR2B+, FRMD6+, ZEB1+, and MSI-L/MSS; 5 cases). Invasive cancer was significantly more frequent in CCS3 than in CCS1 (5/5 versus 3/14, respectively). Ki67 LI and epithelial serration were higher in CCS3 than in CCS1 (83.0 ± 5.8 versus 65.4 ± 4.0 and 5/5 versus 3/14, respectively; p = 0.031 and 0.0048). CCS2 showed the highest mutation number, whereas KRAS and BRAF mutation numbers were higher in CCS3 than in CCS1. Early-stage SACs were classified into three molecularly distinct subtypes with different clinicopathological and genetic characteristics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / genetics
  • Adenocarcinoma / pathology*
  • Aged
  • CDX2 Transcription Factor / genetics
  • Colorectal Neoplasms / genetics
  • Colorectal Neoplasms / pathology*
  • Cytoskeletal Proteins / genetics
  • Female
  • Humans
  • Male
  • Membrane Proteins / genetics
  • Microsatellite Instability
  • Neoplasm Staging
  • Phenotype
  • Pilot Projects
  • Prognosis
  • Receptor, Serotonin, 5-HT2B / genetics
  • Zinc Finger E-box-Binding Homeobox 1 / genetics

Substances

  • CDX2 Transcription Factor
  • CDX2 protein, human
  • Cytoskeletal Proteins
  • FRMD6 protein, human
  • HTR2B protein, human
  • Membrane Proteins
  • Receptor, Serotonin, 5-HT2B
  • ZEB1 protein, human
  • Zinc Finger E-box-Binding Homeobox 1

Grants and funding

Y.U. have financial relationships to disclose. Next-generation sequencing was carried out at the Analysis Center of Life Science, Hiroshima University (https://www.hiroshima-u.ac.jp). Reagents for a portion of targeted enrichment and next-generation sequencing were provided by Illumina (https://jp.illumina.com/?gclid=EAIaIQobChMIrsDXhrfp3AIVkLaWCh3UxggfEAAYASAAEgJY-vD_BwE). This work was supported by JSPS KAKENHI (grant no. 17K09476), (https://www.jsps.go.jp/english/e-grants/index.html) and Tuchiya Memorial Medical Promotion Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.