1. Is tumor testing efficiency for Lynch syndrome different in rectal and colon cancer?
- Author
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Marabelli M, Gandini S, Rafaniello PR, Calvello M, Tolva G, Feroce I, Lazzeroni M, Marino E, Dal Molin M, Trovato C, Guerrieri-Gonzaga A, Petz WL, Barberis M, Bertario L, and Bonanni B
- Subjects
- Adult, Aged, Aged, 80 and over, Colonic Neoplasms diagnosis, Colorectal Neoplasms, Hereditary Nonpolyposis genetics, Colorectal Neoplasms, Hereditary Nonpolyposis pathology, DNA Methylation genetics, Female, Genetic Testing methods, Humans, Immunohistochemistry, Logistic Models, Male, Microsatellite Instability, Middle Aged, Multivariate Analysis, MutL Protein Homolog 1 genetics, Mutation, Proto-Oncogene Proteins B-raf genetics, Rectal Neoplasms diagnosis, Colonic Neoplasms genetics, Colorectal Neoplasms, Hereditary Nonpolyposis diagnosis, DNA Mismatch Repair genetics, Early Detection of Cancer methods, Rectal Neoplasms genetics
- Abstract
Background: Tumor testing utility in Lynch syndrome (LS) diagnosis is established., Aims: Analyze the differences between tumor testing efficiency in rectal (RC) and colon cancer (CC)., Methods: We performed immunohistochemistry (IHC) for MisMatch Repair (MMR) proteins (IHC-MMR) and MicroSatellite Instability analysis (MSI) on 482 unselected primary tumors: 320 CCs and 162 RCs. Samples had proficient-IHC, deficient-IHC or borderline-IHC ("patchy" expression). MSI-H borderline-IHC tumors were considered as likely MMR-deficient. Germline testing was offered to MMR-deficient patients without BRAF mutation or MLH1 promoter hypermetilation (MLH1-Hy)., Results: We identified 51/482 (10.6%) MMR-defective tumors. Multivariable analysis demonstrated a significant correlation between tumor testing results with histotype, lymph-node involvement and tumor location. In particular, RC showed a lower MMR-deficiency rate than CC (p<0.0001). Interestingly, MLH1 loss was detected in 0% RCs and 76.1% CCs, with 80% of them showing BRAF mutation/MLH1-Hy. A germline variant was detected in 12 out of 18 patients (mutation detection rate of 66.7%)., Conclusion: Tumor testing results showed molecular differences between CCs and RCs, in terms of MMR proteins expression, and presence of BRAF mutation/MLH1-Hy. MSH6 variants were the most frequent ones (50%). Although young age at diagnosis was associated with mutation detection (p = 0.045), 33.3% of LS patients were >50 years., Competing Interests: Conflict of interest None declared., (Copyright © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2020
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