Analysis of K-ras, BRAF, and PIK3CA mutations in laterally-spreading tumors of the colorectum

Background and Aims: Laterally‐spreading tumors (LST) are a newly‐recognized category of colorectal neoplasia, and are defined as lesions larger than 10 mm in diameter and extending circumferentially rather than vertically. However, genetic features of this new category of tumors are not fully elucidated. The aim of this study was to evaluate genetic alterations in LST. Methods: We examined K‐ras, BRAF, and phosphoinositide‐3‐kinase catalytic‐α polypeptide (PIK3CA) mutations in 101 LST, including 68 LST‐granular type (LST‐G) and 33 LST‐non‐granular type by direct sequencing. As controls, we examined these gene mutations in 66 protruded colon adenomas (10 mm or larger) and 44 advanced colon cancers. Results: K‐ras, BRAF, and PIK3CA mutations were observed in 59 (58%), zero (0%), and three (3%) LST, respectively. LST‐G morphology in the right‐sided colon was significantly correlated with the existence of K‐ras mutations, whereas a size of 20 mm or larger was the only predictor of mutations in the left‐sided colorectum. The frequency of K‐ras mutations in LST was particularly marked in the left‐sided colorectum compared to protruded adenomas or advanced cancers (LST vs protruded adenomas, P < 0.001; LST vs advanced cancers, P = 0.002), whereas in the right‐sided colon, K‐ras mutations were equally frequent. PIK3CA mutations were not familiar in either LST (3%) or advanced cancers (9%). Conclusions: K‐ras mutations were involved in colorectal LST in different manners according to tumor location.