Abstract
Background & aimsHigh-risk features of colonic polyps are based on size, number, and pathologic characteristics. Surveillance colonoscopy is often recommended according to these findings. This study aimed to determine whether the molecular characteristics of polyps might provide information about the risk of metachronous advanced neoplasia.MethodologyWe retrospectively included 308 patients with colonic polyps. A total of 995 polyps were collected and tested for somatic BRAF and KRAS mutations. Patients were classified into 3 subgroups, based on the polyp mutational profile at baseline, as follows: non-mutated polyps (Wild-type), at least one BRAF-mutated polyp, or at least one KRAS-mutated polyp. At surveillance, advanced adenomas were defined as adenomas ≥ 10 mm and/or with high grade dysplasia or a villous component. In contrast, advanced serrated polyps were defined as serrated polyps ≥ 10 mm in any location, located proximal to the splenic flexure with any size or with dysplasia.ResultsAt baseline, 289 patients could be classified as wild-type (62.3%), BRAF mutated (14.9%), or KRAS mutated (22.8%). In the univariate analysis, KRAS mutations were associated with the development of metachronous advanced polyps (OR: 2.36, 95% CI: 1.22–4.58; P = 0.011), and specifically, advanced adenomas (OR: 2.42, 95% CI: 1.13–5.21; P = 0.023). The multivariate analysis, adjusted for age and sex, also showed associations with the development of metachronous advanced polyps (OR: 2.27, 95% CI: 1.15–4.46) and advanced adenomas (OR: 2.23, 95% CI: 1.02–4.85).ConclusionsOur results suggested that somatic KRAS mutations in polyps represent a potential molecular marker for the risk of developing advanced neoplasia.
Highlights
Colorectal cancer (CRC) is a heterogeneous group of diseases that can develop through distinct pathways involving different genetic and epigenetic changes [1]
KRAS mutations were associated with the development of metachronous advanced polyps (OR: 2.36, 95% confidence interval (CI): 1.22–4.58; P = 0.011), and advanced adenomas (OR: 2.42, 95% confidence intervals (95% CI): 1.13–5.21; P = 0.023)
KRAS and BRAF mutations and risk of metachronous neoplasia association declares no conflict of interest)
Summary
Colorectal cancer (CRC) is a heterogeneous group of diseases that can develop through distinct pathways involving different genetic and epigenetic changes [1]. Colonoscopy is considered the main method for detecting and removing precursor lesions, through screening and surveillance for CRC [6]. Surveillance colonoscopy is often recommended according to the characteristics of polyps, mainly the size and number, determined at a baseline colonoscopy [7]. The number of strategies for screening could increase, due to emerging technologies in molecular marker applications [8,9], to date, no molecular information has been useful in predicting whether new lesions will be detected at follow-up. High-risk features of colonic polyps are based on size, number, and pathologic characteristics. This study aimed to determine whether the molecular characteristics of polyps might provide information about the risk of metachronous advanced neoplasia
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