Genomic landscape and its prognostic significance in stage III colorectal cancer: JCOG1506A1, an ancillary of JCOG0910

Large‐scale genomic sequencing of colorectal cancers has been reported mainly for Western populations. Differences by stage and ethnicity in the genomic landscape and their prognostic impact remain poorly understood. We investigated 534 Japanese stage III colorectal cancer samples from the Phase III trial, JCOG0910. Targeted‐capture sequencing of 171 potentially colorectal cancer‐associated genes was performed, and somatic single‐nucleotide variants and insertion–deletions were determined. Hypermutated tumors were defined as tumors with MSIsensor score >7 and ultra‐mutated tumors with POLE mutations. Genes with alterations associated with relapse‐free survival were analyzed using multivariable Cox regression models. In all patients (184 right‐sided, 350 left‐sided), mutation frequencies were TP53, 75.3%; APC, 75.1%; KRAS, 43.6%; PIK3CA, 19.7%; FBXW7, 18.5%; SOX9, 11.8%; COL6A3, 8.2%; NOTCH3, 4.5%; NRAS, 4.1%; and RNF43, 3.7%. Thirty‐one tumors were hypermutated (5.8%; 14.1% right‐sided, 1.4% left‐sided). Modest associations were observed: poorer relapse‐free survival was seen with mutant KRAS (hazard ratio 1.66; p = 0.011) and mutant RNF43 (2.17; p = 0.055), whereas better relapse‐free survival was seen with mutant COL6A3 (0.35; p = 0.040) and mutant NOTCH3 (0.18; p = 0.093). Relapse‐free survival tended to be better for hypermutated tumors (0.53; p = 0.229). In conclusion, the overall spectrum of mutations in our Japanese stage III colorectal cancer cohort was similar to that in Western populations, but the frequencies of mutation for TP53, SOX9, and FBXW7 were higher, and the proportion of hypermutated tumors was lower. Multiple gene mutations appeared to impact relapse‐free survival, suggesting that tumor genomic profiling can support precision medicine for colorectal cancer.