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Walton Bernstedt S, Haxhijaj A, Jamizadeh N, Björk J, Andreasson A, Forsberg AM, Backman AS. Quality of endoscopic surveillance of Lynch syndrome patients in a Swedish cohort. Endosc Int Open 2024; 12:E854-E860. [PMID: 38966318 PMCID: PMC11223886 DOI: 10.1055/a-2339-7152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 04/06/2024] [Indexed: 07/06/2024] Open
Abstract
Background and study aims Risk factors for colorectal cancer (CRC) in Lynch syndrome (LS) include sex, age, smoking, high body mass index (BMI), surveillance interval length, and risk genotype. The Boston Bowel Preparation Scale (BBPS) produces a standardized bowel cleanliness rating. A low BBPS score might be a risk factor for missed early lesions. The aim of this study was to investigate the correlation between BBPS score and adenoma detection (with known risk factors for CRC) and surveillance interval with CRC detection in LS patients. Methods A retrospective cohort study including 366 LS patients with 1,887 colonoscopies under surveillance in Stockholm, Sweden from 1989 to 2021 was conducted. Associations were tested using linear and logistic regression. Results We found no association between BBPS score and number of adenomas detected. A low BBPS score was found to be associated with older age (regression coefficient (coeff) -0.015; 95% confidence interval [CI] -0.026 to -0.004; P = 0.007) and obesity (coeff = -0.48; 95% CI: -0.89 to -0.062; P = 0.024). A higher number of detected adenomas was associated with older age (coeff = 0.008; 95% CI 0.004 to 0.012; P < 0.001), male sex (coeff = 0.097; 95% CI 0.008 to 0.19; P = 0.033) and CRC (coeff = 0.28; 95% CI 0.061 to 0.50; P = 0.012). Surveillance interval length was not significant in CRC detection. Conclusions Bowel cleanliness was not associated with adenoma detection and was less likely achieved in patients who were older and had higher BMI. Adenoma detection was associated with older age and male sex. The results indicate the need for better adherence to guidelines and attention to older age groups, men, and patients with obesity.
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Affiliation(s)
- Sophie Walton Bernstedt
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Division of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Adrianna Haxhijaj
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Nigin Jamizadeh
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Jan Björk
- Division of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Hereditary Cancer, Medical Unit Breast Endocrine and Sarcoma Tumours, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Andreasson
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Anna M Forsberg
- Department of Medicine Solna, Karolinska Institute Clinical Epidemiology Division, Stockholm, Sweden
| | - Ann-Sofie Backman
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
- Gastroenterology Unit, Division of Medicine, Ersta Hospital, Stockholm, Sweden
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Salikhanov I, Heinimann K, Chappuis P, Buerki N, Graffeo R, Heinzelmann V, Rabaglio M, Taborelli M, Wieser S, Katapodi MC. Swiss cost-effectiveness analysis of universal screening for Lynch syndrome of patients with colorectal cancer followed by cascade genetic testing of relatives. J Med Genet 2021; 59:924-930. [PMID: 34782441 PMCID: PMC9411888 DOI: 10.1136/jmedgenet-2021-108062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022]
Abstract
Background We estimated the cost-effectiveness of universal DNA screening for Lynch syndrome (LS) among newly diagnosed patients with colorectal cancer (CRC) followed by cascade screening of relatives from the Swiss healthcare system perspective. Methods We integrated decision trees with Markov models to calculate incremental cost per quality-adjusted life-year saved by screening all patients with CRC (alternative strategy) compared with CRC tumour-based testing followed by DNA sequencing (current strategy). Results The alternative strategy has an incremental cost-effectiveness ratio of CHF65 058 compared with the current strategy, which is cost-effective according to Swiss standards. Based on annual incidence of CRC in Switzerland, universal DNA screening correctly identifies all 123 patients with CRC with LS, prevents 17 LS deaths and avoids 19 CRC cases, while the current strategy leads to 32 false negative results and 253 LS cases lost to follow-up. One way and probabilistic sensitivity analyses showed that universal DNA testing is cost-effective in around 80% of scenarios, and that the cost of DNA testing and the number of invited relatives per LS case determine the cost-effectiveness ratio. Conclusion Results can inform policymakers, healthcare providers and insurance companies about the costs and benefits associated with universal screening for LS and cascade genetic testing of relatives.
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Affiliation(s)
- Islam Salikhanov
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Karl Heinimann
- Institute for Medical Genetics and Pathology, University Hospital Basel, Basel, BS, Switzerland
| | - Pierre Chappuis
- Oncogenetics Unit, Division of Oncology, Division of Genetic Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Nicole Buerki
- Women's Clinic, Basel University Hospital, Basel, Switzerland
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | | | - Manuela Rabaglio
- Medical Oncology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Monica Taborelli
- Genetic Services, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Maria C Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Abancens M, Bustos V, Harvey H, McBryan J, Harvey BJ. Sexual Dimorphism in Colon Cancer. Front Oncol 2020; 10:607909. [PMID: 33363037 PMCID: PMC7759153 DOI: 10.3389/fonc.2020.607909] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
A higher incidence of colorectal cancer (CRC) is found in males compared to females. Young women (18-44 years) with CRC have a better survival outcome compared to men of the same age or compared to older women (over 50 years), indicating a global incidence of sexual dimorphism in CRC rates and survival. This suggests a protective role for the sex steroid hormone estrogen in CRC development. Key proliferative pathways in CRC tumorigenesis exhibit sexual dimorphism, which confer better survival in females through estrogen regulated genes and cell signaling. Estrogen regulates the activity of a class of Kv channels (KCNQ1:KCNE3), which control fundamental ion transport functions of the colon and epithelial mesenchymal transition through bi-directional interactions with the Wnt/β-catenin signalling pathway. Estrogen also modulates CRC proliferative responses in hypoxia via the novel membrane estrogen receptor GPER and HIF1A and VEGF signaling. Here we critically review recent clinical and molecular insights into sexual dimorphism of CRC biology modulated by the tumor microenvironment, estrogen, Wnt/β-catenin signalling, ion channels, and X-linked genes.
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Affiliation(s)
- Maria Abancens
- Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
| | - Viviana Bustos
- Departamento de Acuicultura y Recursos Agroalimentarios, Programa Fitogen, Universidad de Los Lagos, Osorno, Chile
| | - Harry Harvey
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Jean McBryan
- Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
| | - Brian J. Harvey
- Department of Molecular Medicine, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
- Centro de Estudios Cientificos CECs, Valdivia, Chile
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Li S, Qian D, Thompson BA, Gutierrez S, Wu S, Pesaran T, LaDuca H, Lu HM, Chao EC, Black MH. Tumour characteristics provide evidence for germline mismatch repair missense variant pathogenicity. J Med Genet 2019; 57:62-69. [PMID: 31391288 DOI: 10.1136/jmedgenet-2019-106096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/28/2019] [Accepted: 07/09/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pathogenic variants in mismatch repair (MMR) genes (MLH1, MSH2, MSH6 and PMS2) increase risk for Lynch syndrome and related cancers. We quantified tumour characteristics to assess variant pathogenicity for germline MMR genes. METHODS Among 4740 patients with cancer with microsatellite instability (MSI) and immunohistochemical (IHC) results, we tested MMR pathogenic variant association with MSI/IHC status, and estimated likelihood ratios which we used to compute a tumour characteristic likelihood ratio (TCLR) for each variant. Predictive performance of TCLR in combination with in silico predictors, and a multifactorial variant prediction (MVP) model that included allele frequency, co-occurrence, co-segregation, and clinical and family history information was assessed. RESULTS Compared with non-carriers, carriers of germline pathogenic/likely pathogenic (P/LP) variants were more likely to have abnormal MSI/IHC status (p<0.0001). Among 150 classified missense variants, 73.3% were accurately predicted with TCLR alone. Models leveraging in silico scores as prior probabilities accurately classified >76.7% variants. Adding TCLR as quantitative evidence in an MVP model (MVP +TCLR Pred) increased the proportion of accurately classified variants from 88.0% (MVP alone) to 98.0% and generated optimal performance statistics among all models tested. Importantly, MVP +TCLR Pred resulted in the high yield of predicted classifications for missense variants of unknown significance (VUS); among 193 VUS, 62.7% were predicted as P/PL or benign/likely benign (B/LB) when assessed according to American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines. CONCLUSION Our study demonstrates that when used separately or in conjunction with other evidence, tumour characteristics provide evidence for germline MMR missense variant assessment, which may have important implications for genetic testing and clinical management.
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Affiliation(s)
- Shuwei Li
- Bioinformatics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Dajun Qian
- Bioinformatics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Bryony A Thompson
- Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Clinical Pathology, University of Melbourne, Parkville, Victoria, Australia
| | | | - Sitao Wu
- Bioinformatics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Tina Pesaran
- Clinical Diagnostics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Holly LaDuca
- Clinical Diagnostics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Hsiao-Mei Lu
- Bioinformatics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Elizabeth C Chao
- Clinical Diagnostics, Ambry Genetics Corp, Aliso Viejo, California, USA
| | - Mary Helen Black
- Bioinformatics, Ambry Genetics Corp, Aliso Viejo, California, USA
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Sun J, Dong M, Xiao X. Efficacy, functional outcome and post-operative complications of total abdominal colectomy with ileorectal anastomosis vs. segmental colectomy in hereditary non-polyposis colorectal cancer. Exp Ther Med 2018; 16:1603-1612. [PMID: 30186378 PMCID: PMC6122142 DOI: 10.3892/etm.2018.6380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/16/2018] [Indexed: 01/07/2023] Open
Abstract
The primary objective of the present study was to compare the choice of colectomy, i.e. total vs. segmental colectomy, in cases of hereditary non-polyposis colorectal cancer (HNPCC/lynch syndrome), and to assess the efficacy, oncological safety, functional outcome and post-operative complications of total abdominal colectomy with ileorectal anastomosis vs. segmental colectomy in HNPCC. A total of 289 patients who fulfilled the Amsterdam I and II criteria for HNPCC were included in the present study. The criteria for confirmation of the diagnosis were five micro-satellite markers, namely BAT25, BAT26, D2s123, d5S346 and D17S250. Group 1 included those patients who received their diagnosis in the years 2011–2013 and those in group 2 had been diagnosed in the years 2014–2016. The cohort had been subjected to two different types of surgery: i) Standard and extended surgery including total colectomy with ileal pouch anal anastomosis and subtotal colectomy and ii) segmental resection of the colon. Analysis of patient data indicated that in group 1, the extended resection was performed more frequently than in group 2 (68 vs. 34% of cases) and accordingly, segmental resection was less frequent (32 vs. 66%; P<0.001). In conclusion, the extensive rather than the segmental resection has been commonly performed several years ago, but at present, the surgical method of choice in cases of lynch syndrome is segmental resection. Trial registry no. QU/MR2011/CRC5, dated 21 March 2011.
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Affiliation(s)
- Jie Sun
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan 250012, P.R. China.,Department of General Surgery, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong 264200, P.R. China
| | - Mingjie Dong
- Department of General Surgery, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong 264200, P.R. China
| | - Xiaoping Xiao
- Department of General Surgery, Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai, Shandong 264200, P.R. China
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