Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Int J Cancer. 2015 Mar 15;136(6):E559-68. doi: 10.1002/ijc.29149. Epub 2014 Aug 30.
Germline mutation testing in patients with colorectal cancer (CRC) is offered only to a subset of patients with a clinical presentation or tumor histology suggestive of familial CRC syndromes, probably underestimating familial CRC predisposition. The aim of our study was to determine whether unbiased screening of newly diagnosed CRC cases with next generation sequencing (NGS) increases the overall detection rate of germline mutations. We analyzed 152 consecutive CRC patients for germline mutations in 18 CRC-associated genes using NGS. All patients were also evaluated for Bethesda criteria and all tumors were investigated for microsatellite instability, immunohistochemistry for mismatch repair proteins and the BRAF*V600E somatic mutation. NGS based sequencing identified 27 variants in 9 genes in 23 out of 152 patients studied (18%). Three of them were already reported as pathogenic and 12 were class 3 germline variants with an uncertain prediction of pathogenicity. Only 1 of these patients fulfilled Bethesda criteria and had a microsatellite instable tumor and an MLH1 germline mutation. The others would have been missed with current approaches: 2 with a MSH6 premature termination mutation and 12 uncertain, potentially pathogenic class 3 variants in APC, MLH1, MSH2, MSH6, MSH3 and MLH3. The higher NGS mutation detection rate compared with current testing strategies based on clinicopathological criteria is probably due to the large genetic heterogeneity and overlapping clinical presentation of the various CRC syndromes. It can also identify apparently nonpenetrant germline mutations complicating the clinical management of the patients and their families.
对结直肠癌(CRC)患者进行种系突变检测仅提供给具有家族性 CRC 综合征临床表型或肿瘤组织学表现的一部分患者,这可能低估了家族性 CRC 的易感性。我们的研究目的是确定新一代测序(NGS)是否对新诊断的 CRC 病例进行无偏筛选,从而提高种系突变的总体检测率。我们使用 NGS 分析了 152 例连续的 CRC 患者的 18 个 CRC 相关基因中的种系突变。所有患者还进行了贝塞斯达标准评估,所有肿瘤均进行了微卫星不稳定性、错配修复蛋白免疫组化和 BRAF*V600E 体细胞突变检测。基于 NGS 的测序在 152 例研究患者中的 9 个基因中确定了 27 个变异,其中 23 例(18%)患者存在变异。其中 3 个已被报道为致病性,12 个为 3 级种系变异,其致病性预测不确定。这些患者中只有 1 例符合贝塞斯达标准,且存在微卫星不稳定肿瘤和 MLH1 种系突变。其他患者将被当前方法所遗漏:2 例 MSH6 提前终止突变和 12 例 APC、MLH1、MSH2、MSH6、MSH3 和 MLH3 中不确定、潜在致病性的 3 级种系变异。与基于临床病理标准的当前检测策略相比,NGS 突变检测率较高,这可能是由于各种 CRC 综合征的遗传异质性较大且临床表现重叠。它还可以识别出明显非穿透性的种系突变,从而使患者及其家属的临床管理复杂化。
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