息肉中Kras突变的常规晚期结直肠瘤的预测
Prediction of metachronous advanced colorectal neoplasia by KRAS mutation in polyps
影响因子:6.70000
分区:医学2区 / 胃肠肝病学3区
发表日期:2024 Nov
作者:
Alejandro Martínez-Roca, Joaquín Cubiella, Anabel García-Heredia, David Guill-Berbegal, Sandra Baile-Maxía, Carolina Mangas-Sanjuán, Noelia Sala-Miquel, Lucía Madero-Velazquez, Cristina Alenda, Pedro Zapater, Clara González-Núñez, Agueda Iglesias-Gómez, Laura Codesido-Prado, Astrid Díez-Martín, Michal F Kaminski, Rune Erichsen, Hans-Olov Adami, Monika Ferlitsch, María Pellisé, Øyvind Holme, Evelien Dekker, Michael Bretthauer, Rodrigo Jover,
摘要
分子标记物在去除的果仁中的潜力仍然不确定。我们的目的是评估体细胞突变在KRAS在KRAS中的作用，在高危腺瘤患者的息肉中预测3年内晚期息肉或结直肠癌（CRC）的风险，总计518名患者。所包括的患者的腺瘤≥10mM，高度发育不良，绒毛成分或基线时多≥3个腺瘤，并计划在3年±6个月时进行监视结肠镜检查。从这些患者收集的1189个息肉进行了体细胞KRAS突变。在监视时，将晚期病变定义为腺瘤，大小≥10mm。高度发育不良或绒毛成分，锯齿状息肉≥10mm或发育不良或CRC。基线，81例患者（15.6％）在至少一个息肉中患有KRAS突变。 KRAS突变息肉的患者患有更频繁的绒毛组织学病变，尺寸≥20mm。在对年龄和性别进行调整的多变量分析中，仅年龄（OR]，1.06; 95％置信区间[CI]，1.02-1.09; P <0.001），≥5腺瘤（OR，3.92; 3.92; 95％CI，1.96-7.82），1.96-7.82）和KR stras stut 3.-kr Sutation（Or，2.5％）; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％; 95％》;与监视时的晚期病变的发展有关。您的结果表明，在具有高风险腺瘤的患者中，KRAS中存在体细胞突变是发展晚期息肉的独立危险因素。
Abstract
The potential of molecular markers in the removed polys as reliable predictors of metachronous lesions is still uncertain.Our aim was to evaluate the role of somatic mutations in KRAS in polyps of patients with high-risk adenomas to predict the risk of advanced polyps or colorectal cancer (CRC) within 3 years.A total of 518 patients were prospectively enrolled. The included patients had adenomas ≥10 mm, high-grade dysplasia, villous component or ≥3 more adenomas at baseline and were scheduled to undergo surveillance colonoscopy at 3 years ± 6 months. Somatic KRAS mutation was performed on 1189 polyps collected from these patients. At surveillance, advanced lesions were defined as adenomas with a size of ≥10 mm. High-grade dysplasia or villous component, serrated polyps ≥10 mm or with dysplasia or CRC.At baseline, 81 patients (15.6%) had KRAS mutations in at least one polyp. Patients with KRAS mutated polyps had more frequent villous histological lesions and size ≥20 mm. In the multivariate analysis, adjusted for age and sex, only age (odds ratios [OR], 1.06; 95% confidence interval [CI], 1.02-1.09; p < 0.001), ≥5 adenomas (OR, 3.92; 95% CI, 1.96-7.82), and KRAS mutation (OR, 2.54; 95% CI, 1.48-4.34; p < 0.01) were independently associated with the development of advanced lesions at surveillance.Our results show that, in patients with high-risk adenomas, the presence of somatic mutations in KRAS is an independent risk factor for the development of advanced metachronous polyps.