Anti-APC (C-terminal) monoclonal antibody, clone D-BQD 39.0

Background Selecting patients with colorectal cancer peritoneal metastases (CRC-PMs) for surgery is still a concern. Biological features have the potential to improve prognostic stratification, but their significance in this clinical setting is still unclear. We assessed the prognostic impact of primary side and KRAS/NRAS/BRAF/PIK3CA mutations in patients treated with either cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) or CRS alone. Methods We reviewed a prospective database of 152 CRC-PM patients selected to undergo perioperative systemic chemotherapy and CRS with or without HIPEC. Extensive mutational analysis of KRAS, NRAS, BRAF, and PIK3CA was performed by polymerase chain reaction (PCR). In 68 patients, Ion Torrent next-generation sequencing technology was used to characterize the hotspot regions of 50 genes. Results The primary tumor was right-sided in 61 patients (40.1%) and left-sided in 91 patients (59.9%). Right-sided primaries were associated with mutated KRAS (p = 0.01) and normal carcinoembryonic antigen (CEA;p = 0.03). KRAS was mutated in 71/152 patients (46.7%), NRAS in 7/152 patients (4.6%), BRAF in 10/152 patients (6.6%), PIK3CA in 17/78 patients (25.0%), TP53 in 37/68 patients (54.4%), APC in 25/68 patients (36.7%), SMAD4 in 13/68 patients (19.1%), and FBXW7 in 5/68 patients (7.4%). Median follow-up was 54.9 months and median survival from PM diagnosis was 45.1 months. The right-sided primary (hazard ratio [HR] 1.62, 95% confidence interval [CI] 0.43-0.89;p = 0.011), BRAF mutations (HR 2.21, 95% CI 1.05-4.63;p = 0.038), and Peritoneal Cancer Index (HR 1.47, 95% CI 1.03-2.10;p = 0.036) independently correlated with poorer survival, while APC mutations univariately correlated with better survival (p = 0.03). Conclusions BRAF mutations and right-sided primary are adverse prognostic factors that may be used to optimize therapeutic strategies. APC may be involved in CRC-PM development and progression.

The trophoblast cells that take part in placenta formation are characterized by different modes of multiplication of their genome that largely designates their eu- or aneuploidy level. The two main ways of genome multiplication are described in different degree: (a) endoreduplication that involves almost complete shutdown of mitosis and (b) reduced mitosis ('endomitosis') in which, by contrast, entry into mitosis and the passage of its initial stages is a prerequisite of genome multiplication. Endoreduplication observed in the trophoblast giant cells (TGC) in a range of mammalian species implies uncoupling of DNA replication from mitosis achieved by reduction of mitotic Cdk activity. The key role in the regulation of endoreduplication and endomitosis play activity of APC/C complex, geminin and E2F family. A programme of genome multiplication and cell cycle progression may include depolyploidization achieved by specific mitotic or non-mitotic (amitotic) division of the giant nucleus. In some mammalian species (Rodents), this process represents the final step of the giant cell lifespan that coincides with complete cessation of cell or genome reproduction. Meantime, in other species the process may take part in cell reproduction during lengthy pregnancy. The dynamics of fox and human polyploidization is similar by the possibility of a simultaneous increase in the proportion of endopolyploid and low-polyploid cells. Reduced mitoses, endoreduplication and depolyploidization appear to be an evolution strategy allowing to generate the functionally different trophoblast cell populations depending of the lifestyle of life of the animal species. Some placental pathologies may be accounted for disturbance of the programme of the cell/genome reproduction of the giant and low-ploid cell populations.