Features of Childhood Colorectal Carcinomas and Frequency of K-ras Mutations
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Keywords:Childhood colorectal carcinoma, K-ras mutation
Objective: Colorectal carcinoma (CRC) is extremely rare in childhood and has a poor prognosis in young patients. The tumorigenesis of CRC in children and adolescents is still unclear and probably evolves through different stages. There are not enough studies about the rarity of K-ras mutations with childhood CRC. This study aimed to investigate the features and outcomes of childhood CRC as well as examine the frequency of K-ras mutations in CRC among children and adolescents.
Methods: The clinical and pathologic features, prognostic factors, and outcomes of CRC in 28 children and adolescents (ages 10 to 17 years) referred to the Pediatric Oncology Department of Hacettepe University Children’s Hospital between 1974 and 2010 were reviewed for this study. Paraffin-embedded tissues of 18 patients were available and these tissues were analyzed by using the “pyrosequencing” method to detect K-ras mutations.
Results: The median age of patients was 14 years and the male/female ratio was 2.5/1. At presentation, the most common symptoms were abdominal pain (57%) and weight loss (43%). The time between symptoms and diagnosis was 4 months. The most common sites of involvement were the rectum (43%) and sigmoid colon (25%). Mucinous adenocarcinoma was the most common histiotype (71%). At presentation, 89% of patients had metastatic disease, especially to the peritoneal surface (39%). Overall survival rates at 3 and 5 years were 10%. Distant stage (p=0.045), incomplete resection, and macroscopic tumor (p=0.000) were poor prognostic outcomes. A K-ras mutation was identified in three of the 18 patients (17%). The most common mutation of the patients was GGT→GAT at codon 12.
Conclusion: Childhood colorectal carcinomas occur in a shorter time than in adults, with different histiotypes and more likely different steps. It seems that K-ras mutation plays a role in this different biology of pediatric CRC. However, further studies are essential to investigate and understand the biology of childhood CRC.
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