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Eikenboom EL, Moen S, van Leerdam ME, Papageorgiou G, Doukas M, Tanis PJ, Dekker E, Wagner A, Spaander MCW. Metachronous colorectal cancer risk according to Lynch syndrome pathogenic variant after extensive versus partial colectomy in the Netherlands: a retrospective cohort study. Lancet Gastroenterol Hepatol 2023; 8:1106-1117. [PMID: 37865103 DOI: 10.1016/s2468-1253(23)00228-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Extensive colectomy (subtotal or total colectomy) is often advised for carriers of Lynch syndrome with colorectal cancer. However, the risk of metachronous colorectal cancer might differ by Lynch syndrome variant, meaning that partial colectomy, which has better functional outcomes, might be adequate for some patients with low-risk variants. We aimed to assess the risk of metachronous colorectal cancer after partial colectomy and extensive colectomy in carriers of Lynch syndrome with different pathogenic variants. METHODS For this retrospective cohort study, carriers of Lynch syndrome with colorectal cancer in the Netherlands were identified by linkage of the Dutch Foundation for the Detection of Hereditary Tumors (StOET) database and the Dutch Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) database. Data on demographics, Lynch syndrome variants, colorectal cancers, surgery types, mortality, and surveillance colonoscopies were extracted. Data on colorectal cancer and surveillance colonoscopies were updated until Feb 28, 2022. Data on survival status was updated until Feb 7, 2022. MLH1, MSH2, and EPCAM were classified as high-risk variants and MSH6 and PMS2 as low-risk variants. Patients for whom the type of surgery was unknown were excluded. Cox regression time-to-event analyses were done to assess the risk of metachronous colorectal cancer in four subgroups based on pathogenic variant (high-risk vs low-risk variants) and the extent of surgery (extensive colectomy vs partial colectomy). Sex, age at the time of primary colorectal cancer, primary colorectal cancer stage, performance of surveillance colonoscopies, adherence to the surveillance guidelines, and time period of primary colorectal cancer diagnosis were added to the model as possible confounders. Metachronous colorectal cancer was defined as colorectal cancer diagnosed more than 6 months after the primary colorectal cancer. Patients were censored at time of death or assembly of the database. FINDINGS Of 1908 carriers of Lynch syndrome registered in StOET, 532 with a history of colorectal cancer were identified after linkage with PALGA. Five carriers were excluded because of an unknown surgery type, leaving 527 in our sample (mean age at primary colorectal cancer 48·7 years [SD 12·1]; 274 [52%] male and 253 [48%] female). 121 (23%) patients developed metachronous colorectal cancer (median time from primary colorectal cancer to metachronous colorectal cancer 11·0 years [IQR 2·1-17·8]). Metachronous colorectal cancer occurred in 12 (12%) of 97 patients with high-risk variants and extensive colectomy, in 85 (32%) of 267 patients with high-risk variants and partial colectomy, in zero (0%) of 11 patients with low-risk variants and extensive colectomy, and in 24 (16%) of 152 patients with low-risk variants and partial colectomy. Partial colectomy was associated with a higher risk of metachronous colorectal cancer than extensive colectomy in the high-risk variant group (hazard ratio 1·97, 95% CI 1·04-3·73; p=0·039). The risk of metachronous colorectal cancer did not differ between carriers of low-risk variants who had partial colectomy and those of high-risk variants who had extensive colectomy (1·14, 0·55-2·36; p=0·72). INTERPRETATION The risk of metachronous colorectal cancer after partial colectomy in carriers of low-risk variants is similar to the risk after extensive colectomy in carriers of high-risk variants. This finding suggests that partial colectomy followed by endoscopic surveillance is an appropriate management approach to treat colorectal cancer in carriers of low-risk Lynch syndrome variants. FUNDING None.
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Affiliation(s)
- Ellis L Eikenboom
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Clinical Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands; Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Michail Doukas
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Pieter J Tanis
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands.
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Ismail FQ, Öberg S, Wozniak AB, Oggesen BT, Rosenberg J. Variation in the length of terminal ileum specimen in right hemicolectomy: a descriptive study. ANZ J Surg 2022; 93:951-955. [PMID: 36368701 DOI: 10.1111/ans.18153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to clarify the length of the bowel specimen and to assess if the length was affected by certain characteristics. METHODS Eligible patients were adults who had undergone right hemicolectomy for cancer in caecum, appendix, ascending colon or transverse colon from September 2019 to September 2020 at Herlev Hospital, Denmark. Data were collected from medical records. The primary outcome was the length of the resected terminal ileum. Secondary outcomes were to assess if body mass index (BMI), surgical approach, and neoadjuvant chemotherapy affected the length of the terminal ileum specimen, and to report the length of the colon specimen subdivided on the cancer locations. RESULTS In total, 50 patients were included. The median age was 74 years (range 36-91), 30 patients (60%) were females, and BMI was median 26 (range 17-45). The variation in the length of terminal ileum specimen was median 5 cm (range 1-17). The explorative analyses showed significant positive correlation between the length of terminal ileum specimen and BMI (P = 0.050) but not surgical approach (P = 0.23) nor neoadjuvant chemotherapy (P = 0.51). The length of the colon specimen naturally differed according to the cancer location with a median length of 26 cm (range 14-90). CONCLUSION We found a variation in the length of the terminal ileum specimen without an apparent explanation for this variation. The colon specimen also varied naturally according to cancer location.
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Affiliation(s)
- Fatima Qays Ismail
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
- The Late‐complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
| | - Stina Öberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
| | - Anita Bilde Wozniak
- The Late‐complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
| | - Birthe Thing Oggesen
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
- The Late‐complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
- The Late‐complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital University of Copenhagen Herlev Denmark
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Survival outcomes associated with Lynch syndrome colorectal cancer and metachronous rate after subtotal/total versus segmental colectomy: Meta-analysis. Surgery 2022; 172:1315-1322. [PMID: 36031446 DOI: 10.1016/j.surg.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/01/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lynch syndrome is associated with the most common form of heritable bowel cancer. There remains limited level 1 evidence on survival outcomes and rate of metachronous tumor associated with Lynch syndrome colorectal cancer. METHODS A systematic literature search of original studies was performed on Ovid searching MEDLINE, Embase, Cochrane Database of Systematic Reviews, American College of Physicians ACP Journal Club, Database of Abstracts of Reviews of Effects DARE, and Clinical Trials databases from inception of database to February 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. The data were pooled using a random-effects model. All of the P values were 2-tailed, and statistical analysis was performed using RevMan v. 5.3 Cochrane Collaboration. RESULTS From 1,942 studies, 15 studies met the inclusion criteria and were included for qualitative and quantitative synthesis. The five-year overall survival was 89.5% (82.0-94.1%), P < .01; I2 = 89%. The ten-year overall survival was 80.5% (68.7-88.6%), P < .01; I2 = 81%. The fifteen-year overall survival was 70% (33.7%-91.5%), P < .01; I2 = 93%. Univariate meta-regression analysis showed no statistically significant difference in 5-year overall survival by sex, age, MLH1, MSH2, MSH6, nor tumor location (right versus left colon). The metachronous tumor rate was 12% to 33% with a follow-up period of up to 15 years, significantly lower in patients who underwent subtotal/total colectomy (0-6%). CONCLUSION The overall survival of patients with colorectal cancer with Lynch syndrome was approximately 90% at 5 years, 80% at 10 years, and 70% at 15 years. The metachronous tumor rate was approximately 10% to 30% at up to 15 years, significantly improved by subtotal/total colectomy.
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Maura CC, Eleonora B, Andreina O, Ivan B, Marta P, Stefano S, Marco V, Teresa RM, Massimo M, Laura C, Manuela G, Andrea M, Licia R, Daniele M, Patrizia P, Paolo V. Management of Dietary Habits and Diarrhea in Fap Individuals: A Mediterranean Low-Inflammatory Dietary Intervention. Nutrients 2021; 13:nu13113988. [PMID: 34836243 PMCID: PMC8623170 DOI: 10.3390/nu13113988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: A total colectomy and a frequent life-long endoscopic surveillance are guaranteed to patients with Familial Adenomatous Polyposis (FAP) to reduce their risk of duodenal and rectal stump cancers. However, after surgery, individuals with FAP suffer from an increased number of diarrheal discharges that force them to dietary restrictions. A non-randomized pilot study was conducted to assess whether a three-month low-inflammatory Mediterranean dietary intervention reduces gastro-intestinal markers of inflammation in FAP individuals. The aim of the present work is to evaluate the participant’s adherence to the proposed dietary recommendations and the change in their number of diarrheal discharges. Methods: 26 FAP individuals aged >18 years, who underwent a total colectomy with ileo-rectal anastomosis and were involved in the surveillance program at the Fondazione IRCCS Istituto Nazionale Tumori of Milan, were included in the present analysis. Results: FAP individuals significantly reduced the Not recommended foods (p-value: 0.002) and increased the consumption of the Recommended ones (p-value: 0.075). The adherence to the proposed dietary recommendations was accompanied by a significant decrease in the number of diarrheal discharges (p-value: 0.008). Conclusions: This study suggests that adhering to a low-inflammatory Mediterranean diet has a potential protective effect on the number of diarrheal discharges in FAP individuals.
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Affiliation(s)
- Ciniselli Chiara Maura
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCSS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (P.M.); (V.P.)
| | - Bruno Eleonora
- Unit of Epidemiology and Prevention, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.E.); (O.A.); (B.I.)
| | - Oliverio Andreina
- Unit of Epidemiology and Prevention, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.E.); (O.A.); (B.I.)
| | - Baldassari Ivan
- Unit of Epidemiology and Prevention, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.E.); (O.A.); (B.I.)
| | - Pastori Marta
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCSS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (P.M.); (V.P.)
| | - Signoroni Stefano
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.M.); (R.M.T.)
| | - Vitellaro Marco
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.M.); (R.M.T.)
| | - Ricci Maria Teresa
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.S.); (V.M.); (R.M.T.)
| | - Milione Massimo
- First Pathology Division, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (M.M.); (C.L.)
| | - Cattaneo Laura
- First Pathology Division, Department of Diagnostic Pathology and Laboratory, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (M.M.); (C.L.)
| | - Gariboldi Manuela
- Unit of Genetic Epidemiology and Pharmacogenomics, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Mancini Andrea
- Unit of Diagnostic and Therapeutic Endoscopy, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Rivoltini Licia
- Unit of Immunotherapy of Human Tumors, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Morelli Daniele
- Laboratory Medicine Division, Department of Diagnostic Pathology, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Pasanisi Patrizia
- Unit of Epidemiology and Prevention, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.E.); (O.A.); (B.I.)
- Correspondence: ; Tel.: +39-02-2390-3513
| | - Verderio Paolo
- Bioinformatics and Biostatistics Unit, Department of Applied Research and Technological Development, Fondazione IRCSS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (C.C.M.); (P.M.); (V.P.)
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Dueñas N, Navarro M, Teulé À, Solanes A, Salinas M, Iglesias S, Munté E, Ponce J, Guardiola J, Kreisler E, Carballas E, Cuadrado M, Matias-Guiu X, de la Ossa N, Lop J, Lázaro C, Capellá G, Pineda M, Brunet J. Assessing Effectiveness of Colonic and Gynecological Risk Reducing Surgery in Lynch Syndrome Individuals. Cancers (Basel) 2020; 12:E3419. [PMID: 33218006 PMCID: PMC7698735 DOI: 10.3390/cancers12113419] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Colorectal (CRC) and endometrial cancer (EC) are the most common types of cancer in Lynch syndrome (LS). Risk reducing surgeries (RRS) might impact cancer incidence and mortality. Our objectives were to evaluate cumulative incidences of CRC, gynecological cancer and all-cause mortality after RRS in LS individuals. METHODS Retrospective analysis of 976 LS carriers from a single-institution registry. Primary endpoints were cumulative incidence at 75 years of cancer (metachronous CRC in 425 individuals; EC and ovarian cancer (OC) in 531 individuals) and all-cause mortality cumulative incidence, comparing extended (ES) vs. segmental surgery (SS) in the CRC cohort and risk reducing gynecological surgery (RRGS) vs. surveillance in the gynecological cohort. RESULTS Cumulative incidence at 75 years of metachronous CRC was 12.5% vs. 44.7% (p = 0.04) and all-cause mortality cumulative incidence was 38.6% vs. 55.3% (p = 0.31), for ES and SS, respectively. Cumulative, incidence at 75 years was 11.2% vs. 46.3% for EC (p = 0.001) and 0% vs. 12.7% for OC (p N/A) and all-cause mortality cumulative incidence was 0% vs. 52.7% (p N/A), for RRGS vs. surveillance, respectively. CONCLUSIONS RRS in LS reduces the incidence of metachronous CRC and gynecological neoplasms, also indicating a reduction in all-cause mortality cumulative incidence in females undergoing RRGS.
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Affiliation(s)
- Nuria Dueñas
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Matilde Navarro
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology, Badalona, 089016 Barcelona, Spain;
| | - Àlex Teulé
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
| | - Ares Solanes
- Hereditary Cancer Program, Catalan Institute of Oncology, Badalona, 089016 Barcelona, Spain;
| | - Mònica Salinas
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Sílvia Iglesias
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Elisabet Munté
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
| | - Jordi Ponce
- Department of Gynecology, Bellvitge University Hospital, 08908 Hospitalet de Llobregat, 089016 Barcelona, Spain;
| | - Jordi Guardiola
- Department of Gastroenterology, Bellvitge University Hospital, Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Esther Kreisler
- Department of General Surgery, Bellvitge University Hospital, Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Elvira Carballas
- Department of Gynecology, Trias i Pujol University Hospital, Badalona, 089016 Barcelona, Spain;
| | - Marta Cuadrado
- Department of General Surgery, Trias i Pujol University Hospital, Badalona, 089016 Barcelona, Spain;
| | - Xavier Matias-Guiu
- Department of Pathology, Bellvitge University Hospital, Hospitalet de Llobregat, 08908 Barcelona, Spain;
| | - Napoleón de la Ossa
- Department of Pathology, Trias i Pujol University Hospital, Badalona, 089016 Barcelona, Spain;
- Department of Pathology, Hospital General de Catalunya—Grupo Quironsalud, 08203 Barcelona, Spain
| | - Joan Lop
- Department of Pathology, Hospital del Mar Institute for Medical Research, 08003 Barcelona, Spain;
| | - Conxi Lázaro
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Gabriel Capellá
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Marta Pineda
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology-IDIBELL, ONCOBELL, Hospitalet de Llobregat, 08908 Barcelona, Spain; (N.D.); (M.N.); (À.T.); (M.S.); (S.I.); (E.M.); (C.L.); (G.C.); (M.P.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto Salud Carlos III, 28029 Madrid, Spain
- Hereditary Cancer Program, Catalan Institute of Oncology-IDBIGI, 17007 Girona, Spain
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