Molecular identification of <i>KRAS</i>, <i>BRAF</i>, and <i>PIK3CA</i> mutations in colorectal cancer patients from the Kurdistan region of Iraq.

Colorectal cancer (CRC) emerged due to genetic mutations that fuel tumor development and influence patient outcomes. This research investigates <i>KRAS</i>, <i>BRAF</i>, and <i>PIK3CA</i> mutations in Iraqi Kurdish patients to assess their biological relevance and impact on clinical outcomes. Clinical and pathological data were collected from 150 patients' medical profiles. DNA was extracted from FFPE samples for <i>KRAS</i>, <i>BRAF</i>, and <i>PIK3CA</i> mutation analysis. Variations in <i>KRAS</i> and <i>BRAF</i> 600/601 were identified by polymerase chain reaction (PCR) amplification followed by hybridization assays. Real-time PCR was utilized to detect <i>PIK3CA</i> mutations. Tumors were predominantly located in the colon (80%) and classified as adenocarcinomas (88%), with stage III being the most frequent (36%). Metastases were observed in 72.67% of cases, primarily in the liver (46.67%). <i>KRAS</i> mutations were identified in 37.33% of cases (mainly in codons 12 and 13), while <i>BRAF</i> V600E mutations occurred in 10.67%, and <i>PIK3CA</i> mutations were detected in 18.67%, with exon 9 alterations more common than those in exon 20. <i>KRAS</i> mutations were strongly associated with liver metastases (<i>p</i>=0.006), and <i>BRAF</i> mutations correlated with peritoneal metastases (<i>p</i>=0.0001). Co-mutations of <i>KRAS</i> and <i>PIK3CA</i> appeared in 7.33% of cases, while <i>BRAF</i> and <i>PIK3CA</i> co-mutations were rarer (1.3%). Our study underscores the complexity of CRC and the pivotal role of <i>KRAS</i>, <i>BRAF</i>, and <i>PIK3CA</i> variations in tumor progression and outcomes in Iraq's Kurdistan Region, highlighting the importance of molecular profiling in clinical care.