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Vol 57(2023) N 1 p. 61-73; DOI 10.1134/S0026893323010041 Full Text

A.M. Danishevich1*, N.I. Pospehova2, A.M. Stroganova2, D.A. Golovina2, M.P. Nikulin2, A.E. Kalinin2, S.E. Nikolaev1, I.S. Stilidi2, L.N. Lyubchenko3,4

Landscape of KRAS, BRAF, and PIK3CA Mutations and Clinical Features of EBV-Associated and Microsatellite Unstable Gastric Cancer

1Loginov Moscow Clinical Research and Practical Center, Moscow Health Department, Moscow, 111123 Russia
2Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, Moscow, 115478 Russia
3National Medical Research Center of Radiology, Ministry of Health of the Russian Federation, Moscow, 125284 Russia
4Lopatkin Institute of Urology and Interventional Radiology, National Medical Research Center of Radiology, Ministry of Health of the Russian Federation, Moscow, 105425 Russia

*danisham7@gmail.com
Received - 2022-06-07; Revised - 2022-07-11; Accepted - 2022-07-26

Personalization of gastric cancer (GC) treatment is an urgent problem because of the clinical heterogeneity and aggressive course of the disease. Four GC subtypes were isolated based on molecular characteristics by The Cancer Genome Atlas researchers in 2014: Epstein-Barr virus positive (EBV+), microsatellite unstable (MSI), chromosomally unstable (CIN), and genomically stable (GS). There is no unified method to detect the CIN and GS subtypes today, while MSI and EBV status assessments are used routinely and are of great clinical importance. A total of 159 GC samples were tested for MSI, EBV DNA, and somatic mutations in codons 12-13 (exon 2), 61 (exon 3), and 146 (exon 4) of the KRAS gene; codons 597-601 (exon 15) of the BRAF gene; and codons 542-546 (exon 9), 1047-1049 (exon 20) of the PIK3CA gene. EBV+ GC was detected in 8.2% of samples; and MSI, in 13.2%. MSI and EBV+ were found to be mutually exclusive. The mean ages at GC manifestation were 54.8 and 62.1 years in patients with EBV+ and MSI GCs, respectively. EBV+ GC affected men in 92.3% of cases, 76.2% of the patients were older than 50 years of age. Diffuse and intestinal adenocarcinomas were diagnosed in 6 (46.2%) and 5 (38.5%) EBV+ cases, respectively. MSI GC equally affected men (n = 10, 47.6%) and women (n = 11, 52.4%). The intestinal histological type was the most prevalent (71.4%); the lesser curvature was affected in 28.6% of the cases. The E545K variant of PIK3CA was observed in one EBV+ GC case. A combination of clinically significant variants of KRAS and PIK3CA was found in all MSI cases. The BRAF V600E mutation, which is specific to MSI colorectal cancer, was not detected. The EBV+ subtype was associated with better prognosis. The five-year survival rates were 100.0 and 54.7% for MSI and EBV+ GCs, respectively.

gastric cancer, molecular classification, Epstein-Barr virus, microsatellite unstable, KRAS, BRAF, PIK3CA



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