Abstract
Alessandra Ulivieri1,2, Giuseppe Cardillo3, Liborio Manente1, Gregorino Paone4, Andrea Petricca Mancuso5, Leonardo Vigna5, Enrico Di Stasio6, Rita Gasbarra1, Salvatore Girlando7, Alvaro Leone1
1Anatomic Pathology Unit, San Camillo-Forlanini Hospitals, Rome, Italy
2Laboratory of Biomedical research “Fondazione Niccolò Cusano per la Ricerca Medico-Scientifica” Niccolò Cusano University of Rome, Rome, Italy
3Thoracic Surgery Unit, San Camillo-Forlanini Hospitals, Rome, Italy
4Department of Respiratory Diseases, San Camillo-Forlanini Hospitals, Rome, Italy
5Department of Medical Oncology, San Camillo-Forlanini Hospitals, Rome, Italy
6Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
7Anatomic Pathology Unit, S. Chiara Hospital, Trento, Italy
Correspondence to:
Alvaro Leone, e-mail: aleone@scamilloforlanini.rm.it
Keywords: Pathology, melanoma, pulmonary metastases, BRAF, NRAS, EGFR
Received: May 15, 2015 Accepted: June 20, 2015 Published: July 04, 2015
ABSTRACT
Background: Melanoma is highly curable in early stages but holds devastating consequences in advanced phases with a median survival of 6–10 months. Lungs are a common metastasis target, but despite this, limited data are available on the molecular status of pulmonary lesions.
Materials and Methods: 25 patients with surgically resected melanoma lung metastases were screened for BRAF, NRAS, CKIT and EGFR alterations. The results were correlated with time to lung metastasis (TLM), relapse-free survival after metastasectomy (RFS) and overall survival (OS).
Results: BRAF or NRAS were mutated in 52% and 20% of cases while CKIT was unaffected. Chromosome 7 polysomy was detected in 47% of cases with 17.5% showing EGFR amplification and concomitant BRAF mutation. NRAS mutated patients developed LM within 5 yrs from primary melanoma with larger lesions compared with BRAF (mean diameter 3.3 ± 2.2cm vs 1.9 ± 1.1cm, p = 0.2). NRAS was also associated with a shorter median RFS and OS after metastasectomy. Moreover, Cox regression analysis revealed that NRAS mutation was the only predictive factor of shorter survival from primary melanoma (p = 0.039, OR = 5.5 (1.1–27.6)).
Conclusions: Molecular characterization identifies advanced melanoma subgroups with distinct prognosis and therapeutic options. The presence of NRAS mutation was associated to a worse disease evolution.
