Molecular differences between lymph nodes (LNs) and distant metastases (mets) in colorectal cancer (CRC).

Authors

Alberto Puccini

Alberto Puccini

USC Keck School of Medicine, Los Angeles, CA

Alberto Puccini , Joanne Xiu , Richard M. Goldberg , Axel Grothey , Anthony Frank Shields , Mohamed E. Salem , Andreas Seeber , Francesca Battaglin , Martin D. Berger , Wafik S. El-Deiry , Ryuma Tokunaga , Madiha Naseem , Wu Zhang , Sukeshi Patel Arora , Moh'd M. Khushman , Michael J. Hall , Philip Agop Philip , John Marshall , Wolfgang Michael Korn , Heinz-Josef Lenz

Organizations

USC Keck School of Medicine, Los Angeles, CA, Caris Life Sciences, Phoenix, AZ, West Virginia University Cancer Institute, Morgantown, WV, West Cancer Center, University of Tennessee, Germantown, TN, Karmanos Cancer Institute, Wayne State University, Detroit, MI, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, Department of Internal Medicine V (Hematology and Oncology), Innsbruck, Austria, Division of Medical Oncology, USC Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA, Fox Chase Cancer Center, Providence, RI, UT Health Science Center, San Antonio, TX, Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, Fox Chase Cancer Center, Philadelphia, PA, Karmanos Cancer Institute, Detroit, MI, Georgetown University, Washington, DC, University of California San Francisco, San Francisco, CA, University of Southern California, Los Angeles, CA

Research Funding

Other

Background: LNs mets are thought to occur before distant mets. However, lymphatic and distant mets arise from independent subclones of the primary tumor, suggesting that LNs are not essential intermediaries for distant mets. We aimed to comprehensively characterize the molecular profile of LN mets and to explore the differences between LN vs distant mets and primary tumors. Methods: Tumor samples from primary CRCs, LNs, and distant mets were analyzed using NGS (MiSeq on 47 genes, NextSeq on 592 genes), immunohistochemistry. Tumor mutational burden (TMB) was calculated based on somatic nonsynonymous missense mutations, and microsatellite instability (MSI) was evaluated by NGS of known MSI loci. Results: In total, 11871 tumors samples were examined, comprising primaries (N = 5862), distant (N = 5605) and LNs mets (N = 404). The most frequently mutated genes in LNs were TP53 (72%), APC (61%), KRAS (39%), ARID1A (20%), and PIK3CA (12%). LNs showed a higher mean TMB (13 mut/MB) vs distant mets (9, P < .0001). TMB-high (17mut/MB) was more frequent in primaries and LNs vs distant mets (9.5% and 8.8% vs 4.2%, P < .001 and P = .001, respectively), as well as MSI-H (8.8% and 6.9% vs 3.7%, P < .001 and P = .017, respectively). TMB-high is significantly higher in LNs vs distant mets and primaries (P < .0001), independent of MSI-H status. Analyzing distant mets by location, LNs showed higher TMB compared to lung, liver and peritoneum mets (P < .0001). Overall, LNs showed significantly different rates of mutations in APC, KRAS, PI3KCA, KDM6A, and BRIP1 (P < .01 for all comparisons) vs primaries; while presenting a distinct molecular profile compared to distant mets (TP53 72 vs 67%; KRAS 39 vs 50%; RNF43 7 vs 4%; ATM 5 vs 3%; KDM6A 4 vs 1%; BRCA2 4 vs 2%; MSH6 3 vs 2%; PTCH1 4 vs 1%; BRCA1 2 vs 1%; GNAS 2 vs 5%; P < .05 for all comparisons). Our cohort of 30 paired samples confirmed the molecular heterogeneity between primaries, LNs, and distant mets. Conclusions: This is the largest study to investigate the molecular differences between LNs mets, distant mets and primary tumors in CRC patients. Our data support the hypothesis that lymphatic and distants mets harbor different mutation profiles which suggests that they may arise from distinct subclones.

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Abstract Details

Meeting

2019 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Developmental Therapeutics and Tumor Biology (Nonimmuno)

Track

Developmental Therapeutics—Molecularly Targeted Agents and Tumor Biology

Sub Track

Tissue-Based Biomarkers

Citation

J Clin Oncol 37, 2019 (suppl; abstr 3130)

DOI

10.1200/JCO.2019.37.15_suppl.3130

Abstract #

3130

Poster Bd #

122

Abstract Disclosures