학술논문
Cancer risk and survival in path_MMRcarriers by gene and gender up to 75 years of age: a report from the Prospective Lynch Syndrome Database
Document Type
Article
Author
Møller, Pål; Seppala, Toni T; Bernstein, Inge; Holinski-Feder, Elke; Sala, Paulo; Gareth Evans, D; Lindblom, Annika; Macrae, Finlay; Blanco, Ignacio; Sijmons, Rolf H; Jeffries, Jacqueline; Vasen, Hans F A; Burn, John; Nakken, Sigve; Hovig, Eivind; Rødland, Einar Andreas; Tharmaratnam, Kukatharmini; de Vos tot Nederveen Cappel, Wouter H; Hill, James; Wijnen, Juul T; Jenkins, Mark A; Green, Kate; Lalloo, Fiona; Sunde, Lone; Mints, Miriam; Bertario, Lucio; Pineda, Marta; Navarro, Matilde; Morak, Monika; Renkonen-Sinisalo, Laura; Valentin, Mev Dominguez; Frayling, Ian M; Plazzer, John-Paul; Pylvanainen, Kirsi; Genuardi, Maurizio; Mecklin, Jukka-Pekka; Moeslein, Gabriela; Sampson, Julian R; Capella, Gabriel
Source
Gut; 2018, Vol. 67 Issue: 7 p1306-1316, 11p
Subject
Language
ISSN
00175749; 14683288
Abstract
BackgroundMost patients with path_MMRgene variants (Lynch syndrome (LS)) now survive both their first and subsequent cancers, resulting in a growing number of older patients with LS for whom limited information exists with respect to cancer risk and survival.Objective and designThis observational, international, multicentre study aimed to determine prospectively observed incidences of cancers and survival in path_MMRcarriers up to 75 years of age.Results3119 patients were followed for a total of 24 475 years. Cumulative incidences at 75 years (risks) for colorectal cancer were 46%, 43% and 15% in path_MLH1, path_MSH2and path_MSH6carriers; for endometrial cancer 43%, 57% and 46%; for ovarian cancer 10%, 17% and 13%; for upper gastrointestinal (gastric, duodenal, bile duct or pancreatic) cancers 21%, 10% and 7%; for urinary tract cancers 8%, 25% and 11%; for prostate cancer 17%, 32% and 18%; and for brain tumours 1%, 5% and 1%, respectively. Ovarian cancer occurred mainly premenopausally. By contrast, upper gastrointestinal, urinary tract and prostate cancers occurred predominantly at older ages. Overall 5-year survival for prostate cancer was 100%, urinary bladder 93%, ureter 85%, duodenum 67%, stomach 61%, bile duct 29%, brain 22% and pancreas 0%. Path_PMS2carriers had lower risk for cancer.ConclusionCarriers of different path_MMRvariants exhibit distinct patterns of cancer risk and survival as they age. Risk estimates for counselling and planning of surveillance and treatment should be tailored to each patient’s age, gender and path_MMRvariant. We have updated our open-access website www.lscarisk.org to facilitate this.