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PREMM5 distinguishes sporadic from Lynch syndrome-associated MMR-deficient/MSI-high colorectal cancer.
- Source :
- Familial Cancer; Oct2023, Vol. 22 Issue 4, p459-465, 7p
- Publication Year :
- 2023
-
Abstract
- Current algorithms for diagnosing Lynch syndrome (LS) include multistep molecular tumor tests to distinguish LS-associated from sporadic colorectal cancer (CRC), which add cost and complexity to the evaluation. We hypothesized that PREMM5, a clinical LS prediction tool, could be an alternative approach to screen for LS, thereby lessening the need for specialized molecular diagnostics. We reviewed a consecutively ascertained institutional cohort of 1058 CRC patients on whom pathologic and clinical data were available, including prior LS germline testing. Data from MMR-D/MSI-H CRC patients were reviewed and PREMM5 scores were calculated for each individual. Using a PREMM5 score cutoff ≥ 2.5% to characterize the need for germline testing, we determined the rate of pathogenic/likely pathogenic germline variants (PGVs) in LS genes in patients with PREMM5 scores ≥ 2.5% versus < 2.5%. Sensitivity and negative predictive values (NPV) of PREMM5 were calculated for all MMR-D/MSI-H CRC patients, and those with MLH1-deficient CRC. MMR IHC and/or MSI results were available on 572/1058 cases. We identified 74/572 (12.9%) cases as MMR-D/MSI-H, of which 28/74 (37.8%) harbored a LS PGV. 11/49 (22.4%) patients with MLH1-deficient CRC harbored a LS PGV. PREMM5 had 100% sensitivity (95% CI: 87.7–100 for any MMR-D/MSI-H; 95% CI: 71.5–100 for MLH1-deficient CRC) and 100% NPV (95% CI: 83.2–100 for any MMR-D/MSI-H; 95% CI: 82.4–100 for MLH1-deficient CRC) for identifying LS PGVs in these cohorts. PREMM5 accurately distinguishes LS- from non-LS-associated MMR-D/MSI-H CRC without additional somatic molecular testing. These findings are particularly relevant for limited-resource settings where advanced molecular diagnostics may be unavailable. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 13899600
- Volume :
- 22
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Familial Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 172445039
- Full Text :
- https://doi.org/10.1007/s10689-023-00345-0