Clinical-pathological Profile of Colorectal Adenocarcinomas with APC, PIK3CA and SMAD4 Mutations in Uganda | Chapter 13 | Medical Research and Its Applications Vol. 5

Introduction: APC gene mutations are an important initiator in tumorigenesis and have been detected in many colorectal cancers (CRC). There is conflicting evidence regarding the association between clinicopathological features of CRC and PIK3CA mutations. A promising prognostic factor of CRC and an important molecule to understand the progression and tumorigenesis of CRC is the SMAD family member 4 (SMAD4). The frequency rates of APC, PIK3CA, and SMAD4 mutations in CRC differ among populations. The objective of this study was to determine the mutation frequencies and determine their association with certain clinicopathological features in Ugandan patients.

Methodology: A cross-sectional study between 2008 to 2021 involving four hospitals in central Uganda and the Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University. The demographics, stage, grade, LVI status and histopathological subtype were obtained for each CRC participant. The CRC tumours were evaluated using next-generation sequencing (NGS). The pathological mutation rates of APC, PIK3CA and SMAD4 were recorded, along with clinicopathological features. The chi-square test and Fischer’s exact test were used to determine the association between clinicopathological features and mutation status.

Results: Out of 127 CRC participants, the mutation rates were APC: 77(60.6%), PIK3CA: 37(29.1%) and SMAD4: 68(53.5%). A loss of APC was found in 70.2% of female participants compared to 29.8% of female participants with the presence of APC (p=0.047). There were 57% positive APC tumours that were lymphovascular invasion (LVI) positive compared to 42.9% negative APC tumours that were LVI positive (p=0.015). With increasing T-stage, more CRC participants were PIK3CA negative (p=0.018). There was no association between the stage, grade, status, and tumour topography with APC, PIK3CA and SMAD4 mutation status.

Conclusions: In Uganda, the frequency of APC mutations is similar, however, the frequencies of PIK3CA and SMAD4 mutations were higher than that reported in the Western world. APC mutations were associated with a positive LVI status. However, APC, PIK3CA, and SMAD4 mutations were not associated with most clinicopathological parameters.

 

Author(s)details:-

 

Richard Wismayer
Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda and Department of Surgery, Faculty of Health Sciences, Equator University for Science and Technology, Masaka, Uganda and Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

Rosie Mathews
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.

 

Celina Whalley
Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

 

Julius Kiwanuka
Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Fredrick Elishama Kakembo
Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and African Centre of Excellence in Bioinformatics and Data Intensive Sciences, Infectious Diseases Institute, Makerere University, Kampala, Uganda.

 

Steve Thorn
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

Henry Wabinga
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.

 

Michael Odida
Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda and Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda.

 

Ian Tomlinson
Institute of Genetics and Cancer, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK and Department of Oncology, University of Oxford, Oxford, UK.

 

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