Abstract
Background
Multiple gastric cancers at the same time (synchronous) or recurrence after 1 year (metachronous) are frequently encountered. Since their genetic profiles were not well elucidated, we molecularly subtyped the genetic events of synchronous and metachronous early-stage gastric cancers.
Methods
We studied mismatch repair (MMR) genes in 84 tumors from 31 patients (15 synchronous and 16 metachronous) by immunohistochemistry. We performed microsatellite instability analysis and targeted sequencing of 58 significantly mutated genes (SMGs) in 35 tumors from thirteen patients. Genomic data from TCGA were used for comparisons with advanced-stage cancers.
Results
Among the 31 patients, at least one deficient-MMR (dMMR) tumor was observed in eight (26%). Of eight patients, seven showed a mixture of proficient-MMR (pMMR) and dMMR tumors. The one case with only dMMR had six recurrent tumors within 2 years. To further subtype, we sequenced 58 SMGs in 35 samples (25 pMMR and 10 dMMR) from thirteen patients. In 35 samples, 163 mutations were identified, but none matched in almost cases, strongly indicating different clonal origins, whether synchronous or metachronous occurrences. Of the 25 pMMR cases, 1 belonged to Epstein–Barr virus (EBV), 24 belonged to chromosomal instability (CIN) subtypes. Of the thirteen cases, repetitive CIN, a mixture of CIN and MSI, a mixture of CIN and EBV, and repetitive MSI were observed in nine (70%), two (15%), one (8%) and one (8%), respectively.
Conclusions
Despite multiple tumors occurring in the same patient simultaneously or several years apart, clonal origin was totally different. ‘Switching’ or ‘mixing’ of dMMR and pMMR, EBV or CIN occurred, which had clinical relevance with regard to immunotherapy.
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Abbreviations
- MMR:
-
Mismatch repair
- SMGs:
-
Significantly mutated genes
- dMMR:
-
Deficient-MMR
- pMMR:
-
Proficient-MMR
- EBV:
-
Epstein–Barr virus
- EBER:
-
Epstein–Barr virus encoded small mRNA’s
- MSI:
-
Microsatellite instability
- CIN:
-
Chromosomal instability
- ESD:
-
Endoscopic submucosal dissection
- TCGA:
-
The Cancer Genome Atlas
- ICGC:
-
International Cancer Genome Consortium
- IHC:
-
Immunohistochemistry
- FFPE:
-
Formalin-fixed paraffin-embedded
- COSMIC:
-
Catalog of Somatic Mutations in Cancer
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Acknowledgements
This study was supported by a Grant-in-Aid for Genome Research Project from Yamanashi Prefecture (to M.O. and Y.H.), The Japan Society for the Promotion of Science (JSPS) KAKENHI Early-Career Scientists (Grant Number JP18K16292 to Y.H.), Research Grant for Young Scholars (to Y.H.), The YASUDA Medical Foundation (to Y.H.) and The Uehara Memorial Foundation (to Y.H.). We thank all medical and ancillary hospital staff and the patients for consenting to participate. We also thank Kanoko Sano, Saki Hiraga, Shunsuke Watanabe, and Eri Ishii for technical support. Finally, we thank James P. Mahaffey, Ph.D., from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.
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535_2019_1547_MOESM2_ESM.pdf
Supplemental Figure 1. Relationship between mutated genes and variant allele fractions. Average of variant allele fractions and the number of mutations were plotted (PDF 9 kb)
535_2019_1547_MOESM3_ESM.pdf
Epstein–Barr virus (EBV) infection status was determined by in situ hybridization targeting EBV encoded small mRNA’s (EBER). Representative images for hematoxylin-eosin staining and EBER in situ hybridization performed in EBV-positive (T1 in Case #3) and EBV-negative (T1 in Case #16) gastric cancer tissues. Scale bar: 100 μm (PDF 205 kb)
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Takaoka, S., Hirotsu, Y., Ohyama, H. et al. Molecular subtype switching in early-stage gastric cancers with multiple occurrences. J Gastroenterol 54, 674–686 (2019). https://doi.org/10.1007/s00535-019-01547-z
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DOI: https://doi.org/10.1007/s00535-019-01547-z