1
|
Mur P, Bonifaci N, Díez-Villanueva A, Munté E, Alonso MH, Obón-Santacana M, Aiza G, Navarro M, Piñol V, Brunet J, Tomlinson I, Capellá G, Moreno V, Valle L. Non-Lynch Familial and Early-Onset Colorectal Cancer Explained by Accumulation of Low-Risk Genetic Variants. Cancers (Basel) 2021; 13:3857. [PMID: 34359758 PMCID: PMC8345397 DOI: 10.3390/cancers13153857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 01/07/2023] Open
Abstract
A large proportion of familial and/or early-onset cancer patients do not carry pathogenic variants in known cancer predisposing genes. We aimed to assess the contribution of previously validated low-risk colorectal cancer (CRC) alleles to familial/early-onset CRC (fCRC) and to serrated polyposis. We estimated the association of CRC with a 92-variant-based weighted polygenic risk score (wPRS) using 417 fCRC patients, 80 serrated polyposis patients, 1077 hospital-based incident CRC patients, and 1642 controls. The mean wPRS was significantly higher in fCRC than in controls or sporadic CRC patients. fCRC patients in the highest (20th) wPRS quantile were at four-fold greater CRC risk than those in the middle quantile (10th). Compared to low-wPRS fCRC, a higher number of high-wPRS fCRC patients had developed multiple primary CRCs, had CRC family history, and were diagnosed at age ≥50. No association with wPRS was observed for serrated polyposis. In conclusion, a relevant proportion of mismatch repair (MMR)-proficient fCRC cases might be explained by the accumulation of low-risk CRC alleles. Validation in independent cohorts and development of predictive models that include polygenic risk score (PRS) data and other CRC predisposing factors will determine the implementation of PRS into genetic testing and counselling in familial and early-onset CRC.
Collapse
Affiliation(s)
- Pilar Mur
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Nuria Bonifaci
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
| | - Anna Díez-Villanueva
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, IDIBELL, 08908 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Elisabet Munté
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
| | - Maria Henar Alonso
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, IDIBELL, 08908 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Mireia Obón-Santacana
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, IDIBELL, 08908 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Gemma Aiza
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
| | - Matilde Navarro
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Virginia Piñol
- Gastroenterology Unit, Hospital Universitario de Girona Dr Josep Trueta, 17007 Girona, Spain;
- School of Medicine, University of Girona, 17071 Girona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
- School of Medicine, University of Girona, 17071 Girona, Spain
- Catalan Institute of Oncology, IDIBGi, 17007 Girona, Spain
| | - Ian Tomlinson
- Edinburgh Cancer Research Centre, IGMM, University of Edinburgh, Edinburgh EH4 2XR, UK;
| | - Gabriel Capellá
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Victor Moreno
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, IDIBELL, 08908 Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Laura Valle
- Hereditary Cancer Program, Catalan Institute of Oncology, 08908 Barcelona, Spain; (P.M.); (N.B.); (E.M.); (G.A.); (M.N.); (J.B.); (G.C.)
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; (A.D.-V.); (M.H.A.); (M.O.-S.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28029 Madrid, Spain
| |
Collapse
|
3
|
Abstract
Colorectal serrated polyps are intermediate lesions in the serrated neoplastic pathway, which account for up to 30% of colorectal cancers. This pathway is biologically distinct from the adenoma-to-carcinoma sequence, with associated cancers exhibiting mutations in the BRAF oncogene, DNA promoter hypermethylation, and microsatellite instability. An evolving understanding of these unique lesions has led to the development of a more accurate classification, improved endoscopic identification, and tailored clinical management guidelines. This article reviews serrated polyps and serrated polyposis syndrome.
Collapse
Affiliation(s)
- Jean H Ashburn
- Department of Colorectal Surgery, Sanford R. Weiss, MD, Center for Inherited Colorectal Neoplasia, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thomas P Plesec
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Matthew F Kalady
- Department of Colorectal Surgery, Sanford R. Weiss, MD, Center for Inherited Colorectal Neoplasia, Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
4
|
He EY, Wyld L, Sloane MA, Canfell K, Ward RL. The molecular characteristics of colonic neoplasms in serrated polyposis: a systematic review and meta-analysis. J Pathol Clin Res 2016; 2:127-37. [PMID: 27499922 PMCID: PMC4958734 DOI: 10.1002/cjp2.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/17/2016] [Indexed: 01/08/2023]
Abstract
Serrated polyposis is a rare disorder characterised by the presence of multiple serrated polyps in the large intestine, and an increased personal and familial risk of colorectal cancer. Knowledge of the molecular characteristics of colonic lesions which develop in this syndrome is fragmented, making it difficult to understand the underlying genetic basis of this condition. We conducted a systematic review and meta-analysis of all studies which evaluated the molecular characteristics of colorectal neoplasms found in individuals with serrated polyposis. We identified 4561 potentially relevant studies, but due to a lack of consensus in the reporting of findings, only fourteen studies were able to be included in the meta-analysis. BRAF mutation was found in 73% (95% CI 65-80%) of serrated polyps, 0% (95% CI 0-3%) of conventional adenomas and 49% (95%CI 33-64%) of colorectal cancers. In contrast, KRAS mutation was present in 8% (95% CI 5-11%) of serrated polyps, 3% (95% CI 0-13%) of conventional adenomas and 6% (95% CI 0-13%) of colorectal cancers. Absence of MLH1 immunostaining was found in 3% (95% CI 0-10%) of serrated polyps and 53% (95% CI 36-71%) of colorectal cancers. Overall, microsatellite instability was found in 40% (95% CI 18-64%) of colorectal cancers arising in the setting of serrated polyposis. Our results indicate that diverse molecular pathways are likely to contribute to the increased predisposition for colorectal cancer in individuals with serrated polyposis. We also propose a set of minimum standards for the reporting of future research in serrated polyposis as this is a rare syndrome and collation of research findings from different centres will be essential to identify the molecular mechanisms involved in the pathogenesis of this condition.
Collapse
Affiliation(s)
- Emily Y He
- Prince of Wales Clinical School, University of New South Wales Sydney, Australia
| | - Lucy Wyld
- Prince of Wales Clinical School, University of New South Wales Sydney, Australia
| | - Mathew A Sloane
- Prince of Wales Clinical School, University of New South Wales Sydney, Australia
| | - Karen Canfell
- Prince of Wales Clinical School, University of New South WalesSydney, Australia; Cancer Council NSWSydney, Australia
| | - Robyn L Ward
- Prince of Wales Clinical School, University of New South WalesSydney, Australia; Office of the Deputy Vice-Chancellor (Research), University of QueenslandBrisbane, Australia
| |
Collapse
|
5
|
Jasperson KW, Kanth P, Kirchhoff AC, Huismann D, Gammon A, Kohlmann W, Burt RW, Samadder NJ. Serrated polyposis: colonic phenotype, extracolonic features, and familial risk in a large cohort. Dis Colon Rectum 2013; 56:1211-6. [PMID: 24104994 DOI: 10.1097/DCR.0b013e3182a11cca] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Serrated polyposis is a poorly understood and likely underdiagnosed condition. Little is known regarding the colorectal cancer risk, extracolonic phenotype, and cause of serrated polyposis. OBJECTIVE The aim of this study is to describe the clinical and family history features of a large cohort of individuals with serrated polyposis. DESIGN This is a retrospective cohort study from 2 prospectively collected registries. PATIENTS Patients meeting the updated 2010 World Health Organization criteria for serrated polyposis were included. MAIN OUTCOME MEASURES We report descriptive statistics for clinical and family history factors. RESULTS A total of 52 individuals met criteria for serrated polyposis. Of these, one had Lynch syndrome and was not included in the statistical analyses. Median age at serrated polyposis diagnosis was 51 years (range, 18-77). Twenty-four (47%) patients were male, and 25 (49%) had a history of smoking. Two hundred sixty-eight lower endoscopic procedures were performed; 42 (82%) patients had colorectal adenomas, 8 (16%) had a personal history of colorectal cancer (only 1 was diagnosed during follow-up), 12 (24%) had extracolonic tumors (4 had more than 1 primary tumor), and 19 (37%) reported a family history of colorectal cancer. Esophagogastroduodenoscopy in 30 individuals revealed only 1 (3%) with unexplained gastroduodenal polyps. No association was found between colorectal cancer diagnosis and sex, age at serrated polyposis diagnosis, extracolonic tumor, history of adenoma, or smoking status. LIMITATIONS This was a retrospective study with no comparison groups. CONCLUSIONS Gastroduodenal polyps are uncommon and likely not associated with serrated polyposis. Although extracolonic tumors were common in our cohort, it is still unclear whether these are associated with serrated polyposis. Our data, along with previous studies, support an association between serrated polyposis and smoking. Further work is still needed to clarify the effect of smoking on polyp development/progression in serrated polyposis.
Collapse
|
6
|
Lucci-Cordisco E, Risio M, Venesio T, Genuardi M. The growing complexity of the intestinal polyposis syndromes. Am J Med Genet A 2013; 161A:2777-87. [PMID: 24124059 DOI: 10.1002/ajmg.a.36253] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/05/2013] [Indexed: 12/12/2022]
Abstract
Familial adenomatous polyposis has been the first form of inherited intestinal polyposis to be recognized. For a long time it has been considered the main polyposis syndrome, associated with an easily recognizable phenotype, with a marginal role attributed to a few very rare hamartomatous conditions. More recently, it has been gradually demonstrated that the intestinal polyposes encompass a range of conditions within a wide spectrum of disease severity, polyp histology, and extraintestinal manifestations. A growing number of genes and phenotypes has been identified, and heterogeneity of somatic molecular pathways underlying epithelial transformation in different syndromes and associated tumors has been documented. Increasing knowledge on the molecular bases and more widespread use of genetic tests has shown phenotypic overlaps between conditions that were previously considered distinct, highlighting diagnostic difficulties. With the advent of next generation sequencing, the diagnosis and the classification of these syndromes will be progressively based more on genetic testing results. However, the phenotypic variability documented among patients with mutations in the same genes cannot be fully explained by different expressivity, indicating a role for as yet unknown modifying factors. Until the latter will be identified, the management of patients with polyposis syndromes should be guided by both clinical and genetic findings.
Collapse
Affiliation(s)
- Emanuela Lucci-Cordisco
- Institute of Medical Genetics, "A. Gemelli" School of Medicine, Catholic University, Rome, Italy
| | | | | | | |
Collapse
|
7
|
Win AK, Walters RJ, Buchanan DD, Jenkins MA, Sweet K, Frankel WL, de la Chapelle A, McKeone DM, Walsh MD, Clendenning M, Pearson SA, Pavluk E, Nagler B, Hopper JL, Gattas MR, Goldblatt J, George J, Suthers GK, Phillips KD, Woodall S, Arnold J, Tucker K, Field M, Greening S, Gallinger S, Aronson M, Perrier R, Woods MO, Green JS, Walker N, Rosty C, Parry S, Young JP. Cancer risks for relatives of patients with serrated polyposis. Am J Gastroenterol 2012; 107:770-8. [PMID: 22525305 DOI: 10.1038/ajg.2012.52] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Serrated polyposis (hyperplastic polyposis) is characterized by multiple polyps with serrated architecture in the colorectum. Although patients with serrated polyposis are known to be at increased risk of colorectal cancer (CRC) and possibly extracolonic cancers, cancer risk for their relatives has not been widely explored. The aim of this study was to estimate the risks of CRC and extracolonic cancers for relatives of patients with serrated polyposis. METHODS A cohort of the 1,639 first- and second-degree relatives of 100 index patients with serrated polyposis recruited regardless of a family history of polyps or cancer from genetic clinics in Australia, New Zealand, Canada, and the USA, were retrospectively analyzed to estimate the country-, age-, and sex-specific standardized incidence ratios (SIRs) for relatives compared with the general population. RESULTS A total of 102 CRCs were observed in first- and second-relatives (SIR 2.25, 95% confidence interval (CI) 1.75-2.93; P<0.001), with 54 in first-degree relatives (SIR 5.16, 95% CI 3.70-7.30; P<0.001) and 48 in second-degree relatives (SIR 1.38, 95% CI 1.01-1.91; P=0.04). Six pancreatic cancers were observed in first-degree relatives (SIR 3.64, 95% CI 1.70-9.21; P=0.003). There was no statistical evidence of increased risk for cancer of the stomach, brain, breast, or prostate. CONCLUSIONS Our finding that relatives of serrated polyposis patients are at significantly increased risk of colorectal and pancreatic cancer adds to the accumulating evidence that serrated polyposis has an inherited component.
Collapse
|