KRAS exon 2 mutations in mucinous ovarian carcinoma: an exploratory study of low prevalence and grade association in Azerbaijan

Background: Ovarian cancer represents a leading cause of global morbidity and mortality among gynecological malignancies. Kirsten rat sarcoma (KRAS) gene mutations, particularly in Exon 2, play a significant role in the development of mucinous ovarian carcinoma (MOC); however, studies investigating this mutation in specific populations remain limited. This exploratory study aimed to investigate the prevalence of KRAS Exon 2 mutations and their clinicopathological correlates in MOC patients from Azerbaijan. Methods: This cross-sectional exploratory study involved 25 patients with mucinous ovarian carcinoma who had available paraffin blocks and met the inclusion criteria. KRAS mutations were detected using polymerase chain reaction (PCR) and sequencing techniques. Comprehensive clinicopathological data, including bilaterality, age, cancer stage, histological grading, growth pattern, and tumor markers, were systematically analyzed using the Chi-square test and Fisher’s exact test for categorical variables, and t-tests or nonparametric equivalents for continuous variables. Results: A total of 25 participants met the inclusion criteria. KRAS Exon 2 mutations were detected in 12% of patients. Power analysis revealed that the current sample size could detect large effect sizes (Cohen’s w ≥ 0.55) with 80% power. No significant associations were found between bilaterality (p = 0.565), age (p = 0.089), cancer stage (p = 0.518), and KRAS mutations. However, a statistically significant association was observed between histological grading and KRAS mutations (p = 0.038), specifically with Grade 3 tumors showing a higher mutation frequency. Mutations were more frequent in patients with an expansile growth pattern (67% vs. 33%) and elevated tumor markers, though these associations did not reach statistical significance. Conclusions: This exploratory study demonstrates that KRAS Exon 2 mutations are significantly associated with a higher histological grade in MOC, suggesting their potential role as prognostic biomarkers and therapeutic targets. The 12% mutation rate is lower than global averages, indicating possible population-specific genetic variations. Larger multicenter studies are needed to validate these findings.

Mucinous ovarian carcinoma; KRAS mutations; Exon 2; Histological grading; Prognostic biomarker; Azerbaijan

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