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Garcia-Pelaez J, Barbosa-Matos R, Lobo S, Dias A, Garrido L, Castedo S, Sousa S, Pinheiro H, Sousa L, Monteiro R, Maqueda JJ, Fernandes S, Carneiro F, Pinto N, Lemos C, Pinto C, Teixeira MR, Aretz S, Bajalica-Lagercrantz S, Balmaña J, Blatnik A, Benusiglio PR, Blanluet M, Bours V, Brems H, Brunet J, Calistri D, Capellá G, Carrera S, Colas C, Dahan K, de Putter R, Desseignés C, Domínguez-Garrido E, Egas C, Evans DG, Feret D, Fewings E, Fitzgerald RC, Coulet F, Garcia-Barcina M, Genuardi M, Golmard L, Hackmann K, Hanson H, Holinski-Feder E, Hüneburg R, Krajc M, Lagerstedt-Robinson K, Lázaro C, Ligtenberg MJL, Martínez-Bouzas C, Merino S, Michils G, Novaković S, Patiño-García A, Ranzani GN, Schröck E, Silva I, Silveira C, Soto JL, Spier I, Steinke-Lange V, Tedaldi G, Tejada MI, Woodward ER, Tischkowitz M, Hoogerbrugge N, Oliveira C. Genotype-first approach to identify associations between CDH1 germline variants and cancer phenotypes: a multicentre study by the European Reference Network on Genetic Tumour Risk Syndromes. Lancet Oncol 2023; 24:91-106. [PMID: 36436516 PMCID: PMC9810541 DOI: 10.1016/s1470-2045(22)00643-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Truncating pathogenic or likely pathogenic variants of CDH1 cause hereditary diffuse gastric cancer (HDGC), a tumour risk syndrome that predisposes carrier individuals to diffuse gastric and lobular breast cancer. Rare CDH1 missense variants are often classified as variants of unknown significance. We conducted a genotype-phenotype analysis in families carrying rare CDH1 variants, comparing cancer spectrum in carriers of pathogenic or likely pathogenic variants (PV/LPV; analysed jointly) or missense variants of unknown significance, assessing the frequency of families with lobular breast cancer among PV/LPV carrier families, and testing the performance of lobular breast cancer-expanded criteria for CDH1 testing. METHODS This genotype-first study used retrospective diagnostic and clinical data from 854 carriers of 398 rare CDH1 variants and 1021 relatives, irrespective of HDGC clinical criteria, from 29 institutions in ten member-countries of the European Reference Network on Tumour Risk Syndromes (ERN GENTURIS). Data were collected from Oct 1, 2018, to Sept 20, 2022. Variants were classified by molecular type and clinical actionability with the American College of Medical Genetics and Association for Molecular Pathology CDH1 guidelines (version 2). Families were categorised by whether they fulfilled the 2015 and 2020 HDGC clinical criteria. Genotype-phenotype associations were analysed by Student's t test, Kruskal-Wallis, χ2, and multivariable logistic regression models. Performance of HDGC clinical criteria sets were assessed with an equivalence test and Youden index, and the areas under the receiver operating characteristic curves were compared by Z test. FINDINGS From 1971 phenotypes (contributed by 854 probands and 1021 relatives aged 1-93 years), 460 had gastric and breast cancer histology available. CDH1 truncating PV/LPVs occurred in 176 (21%) of 854 families and missense variants of unknown significance in 169 (20%) families. Multivariable logistic regression comparing phenotypes occurring in families carrying PV/LPVs or missense variants of unknown significance showed that lobular breast cancer had the greatest positive association with the presence of PV/LPVs (odds ratio 12·39 [95% CI 2·66-57·74], p=0·0014), followed by diffuse gastric cancer (8·00 [2·18-29·39], p=0·0017) and gastric cancer (7·81 [2·03-29·96], p=0·0027). 136 (77%) of 176 families carrying PV/LPVs fulfilled the 2015 HDGC criteria. Of the remaining 40 (23%) families, who did not fulfil the 2015 criteria, 11 fulfilled the 2020 HDGC criteria, and 18 had lobular breast cancer only or lobular breast cancer and gastric cancer, but did not meet the 2020 criteria. No specific CDH1 variant was found to predispose individuals specifically to lobular breast cancer, although 12 (7%) of 176 PV/LPV carrier families had lobular breast cancer only. Addition of three new lobular breast cancer-centred criteria improved testing sensitivity while retaining high specificity. The probability of finding CDH1 PV/LPVs in patients fulfilling the lobular breast cancer-expanded criteria, compared with the 2020 criteria, increased significantly (AUC 0·92 vs 0·88; Z score 3·54; p=0·0004). INTERPRETATION CDH1 PV/LPVs were positively associated with HDGC-related phenotypes (lobular breast cancer, diffuse gastric cancer, and gastric cancer), and no evidence for a positive association with these phenotypes was found for CDH1 missense variants of unknown significance. CDH1 PV/LPVs occurred often in families with lobular breast cancer who did not fulfil the 2020 HDGC criteria, supporting the expansion of lobular breast cancer-centred criteria. FUNDING European Reference Network on Genetic Tumour Risk Syndromes, European Regional Development Fund, Fundação para a Ciência e a Tecnologia (Portugal), Cancer Research UK, and European Union's Horizon 2020 research and innovation programme.
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Affiliation(s)
- José Garcia-Pelaez
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Rita Barbosa-Matos
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Silvana Lobo
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Alexandre Dias
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Luzia Garrido
- Centro Hospitalar Universitário São João, Porto, Portugal
| | - Sérgio Castedo
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Centro Hospitalar Universitário São João, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal,European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS), Porto, Portugal
| | - Sónia Sousa
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Hugo Pinheiro
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Serviço de Medicina Interna, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Liliana Sousa
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Rita Monteiro
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Joaquin J Maqueda
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Bioinf2Bio, Porto, Portugal
| | - Susana Fernandes
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
| | - Fátima Carneiro
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Centro Hospitalar Universitário São João, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal,European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS), Porto, Portugal
| | - Nádia Pinto
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Center of Mathematics, University of Porto, Porto, Portugal,Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Carolina Lemos
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal,Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal,Institute for Molecular and Cell Biology, University of Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Carla Pinto
- Department of Laboratory Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal
| | - Manuel R Teixeira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal,Department of Laboratory Genetics, Portuguese Oncology Institute of Porto, Porto, Portugal,Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal,European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS), Porto, Portugal
| | - Stefan Aretz
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany,ERN GENTURIS, Bonn, Germany
| | - Svetlana Bajalica-Lagercrantz
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Genetics, Cancer Genetic Unit, Karolinska University Hospital Solna, Stockholm, Sweden,Cancer Theme, Karolinska University Hospital Solna, Stockholm, Sweden,ERN GENTURIS, Stockholm, Sweden
| | - Judith Balmaña
- Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain,ERN GENTURIS, Barcelona, Spain
| | - Ana Blatnik
- Department of Clinical Cancer Genetics, Institute of Oncology Ljubljana, Ljubljana, Slovenia,ERN GENTURIS, Ljubljana, Slovenia
| | - Patrick R Benusiglio
- Medical Genetics Department, Pitié-Salpêtrière Hospital, AP-HP and Sorbonne University, Paris, France
| | - Maud Blanluet
- Service de Génétique Oncologique, Institut Curie, Paris, France
| | - Vincent Bours
- Laboratory of Human Genetics, GIGA Institute, University of Liège, Liège, Belgium,Center of Genetics, University Hospital, Liège, Belgium,ERN GENTURIS, Liège, Belgium
| | - Hilde Brems
- Department of Human Genetics, University of Leuven, Leuven, Belgium
| | - Joan Brunet
- Hereditary Cancer Programme, Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research and Girona Biomedical Research Institute, Barcelona-Girona, Spain,ERN GENTURIS, Barcelona, Spain
| | - Daniele Calistri
- Laboratorio di Bioscienze, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Gabriel Capellá
- Hereditary Cancer Program, Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research, Barcelona, Spain,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain,ERN GENTURIS, Barcelona, Spain
| | - Sergio Carrera
- Oncology Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - Chrystelle Colas
- Service de Génétique Oncologique, Institut Curie, Paris, France,ERN GENTURIS, Paris, France
| | - Karin Dahan
- Center of Human Genetics, IPG, Gosselies, Belgium
| | - Robin de Putter
- Clinical Genetics Department, University Hospital of Ghent, Ghent, Belgium,ERN GENTURIS, Ghent, Belgium
| | - Camille Desseignés
- Medical Genetics Department, Pitié-Salpêtrière Hospital, AP-HP and Sorbonne University, Paris, France
| | | | - Conceição Egas
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - D Gareth Evans
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK,Manchester Centre for Genomic Medicine, Manchester, UK
| | - Damien Feret
- Center of Human Genetics, IPG, Gosselies, Belgium
| | - Eleanor Fewings
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | | | - Florence Coulet
- Medical Genetics Department, Pitié-Salpêtrière Hospital, AP-HP and Sorbonne University, Paris, France
| | - María Garcia-Barcina
- Genetics Unit, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - Maurizio Genuardi
- Sezione di Medicina Genomica, Dipartimento di Scienze della Vita e Salute Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy,UOC Genetica Medica, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy,ERN GENTURIS, Rome, Italy
| | - Lisa Golmard
- Service de Génétique Oncologique, Institut Curie, Paris, France
| | - Karl Hackmann
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany,National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg, Germany,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany,German Cancer Consortium, Dresden, Germany
| | - Helen Hanson
- SouthWest Thames Regional Genetics Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany,Medizinisch Genetisches Zentrum, Munich, Germany,ERN GENTURIS, Munich, Germany
| | - Robert Hüneburg
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany,ERN GENTURIS, Bonn, Germany
| | - Mateja Krajc
- Department of Clinical Cancer Genetics, Institute of Oncology Ljubljana, Ljubljana, Slovenia,ERN GENTURIS, Ljubljana, Slovenia
| | - Kristina Lagerstedt-Robinson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Genetics, Cancer Genetic Unit, Karolinska University Hospital Solna, Stockholm, Sweden,ERN GENTURIS, Stockholm, Sweden
| | - Conxi Lázaro
- Hereditary Cancer Program, Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research, Barcelona, Spain,Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain,ERN GENTURIS, Barcelona, Spain
| | - Marjolijn J L Ligtenberg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands,Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands,ERN GENTURIS, Nijmegen, Netherlands
| | - Cristina Martínez-Bouzas
- Genetics Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - Sonia Merino
- Genetics Unit, Biocruces Bizkaia Health Research Institute, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | | | - Srdjan Novaković
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ana Patiño-García
- Unidad de Medicina Genómica y Pediatría, Clínica Universidad de Navarra, Programa de Tumores Sólidos, Centro de Investigación Médica Aplicada, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain
| | | | - Evelin Schröck
- Institute for Clinical Genetics, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany,National Center for Tumor Diseases, Dresden, Germany: German Cancer Research Center, Heidelberg, Germany,Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany,German Cancer Consortium, Dresden, Germany,Max Planck Institute of Molecular Cell Biology and Genetics, Dresden, Germany,ERN GENTURIS, Dresden, Germany
| | - Inês Silva
- GenoMed—Diagnósticos de Medicina Molecular, Lisbon, Portugal
| | | | - José L Soto
- Molecular Genetics Laboratory, Elche University Hospital, Elche, Spain
| | - Isabel Spier
- Institute of Human Genetics, Medical Faculty, University of Bonn, Bonn, Germany,National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany,ERN GENTURIS, Bonn, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany,Medizinisch Genetisches Zentrum, Munich, Germany,ERN GENTURIS, Munich, Germany
| | - Gianluca Tedaldi
- Laboratorio di Bioscienze, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - María-Isabel Tejada
- Genetics Service, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Cruces-Barakaldo, Bizkaia, Spain
| | - Emma R Woodward
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK,Manchester Centre for Genomic Medicine, Manchester, UK
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, Netherlands,Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherlands,ERN GENTURIS, Nijmegen, Netherlands
| | - Carla Oliveira
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal; Porto Comprehensive Cancer Center Raquel Seruca, Porto, Portugal; European Reference Network on Genetic Tumour Risk Syndromes (ERN GENTURIS), Porto, Portugal.
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