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Habashy P, Lea V, Wilkinson K, Wang B, Wu XJ, Roberts TL, Ng W, Rutland T, Po JW, Becker T, Descallar J, Lee M, Mackenzie S, Gupta R, Cooper W, Lim S, Chua W, Lee CS. KRAS and BRAF Mutation Rates and Survival Outcomes in Colorectal Cancer in an Ethnically Diverse Patient Cohort. Int J Mol Sci 2023; 24:17509. [PMID: 38139338 PMCID: PMC10743527 DOI: 10.3390/ijms242417509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
KRAS and BRAF mutation rates in colorectal cancer (CRC) reported from various mono-ethnic studies vary amongst different ethnic groups. However, these differences in mutation rates may not be statistically significant or may be due to differences in environmental and/or laboratory factors across countries rather than racial genetic differences. Here, we compare the KRAS/BRAF mutation rates and survival outcomes in CRC between ethnic groups at a single institution. We also investigate the contributions of genetic, environmental, and laboratory factors to the variations in KRAS/BRAF mutation rates reported from different countries. Clinicopathological data from 453 ethnically diverse patients with CRC were retrospectively analyzed at Liverpool Hospital, NSW Australia (2014-2016). KRAS/BRAF mutations were detected using real-time PCR (Therascreen kits from Qiagen). Mismatch repair (MMR) status was determined using immunohistochemical staining. Four ethnic groups were analyzed: Caucasian, Middle Eastern, Asian, and South American. Overall survival data were available for 406 patients. There was no significant difference in KRAS mutation rates between Caucasians (41.1%), Middle Easterners (47.9%), Asians (44.8%), and South Americans (25%) (p = 0.34). BRAF mutation rates differed significantly between races (p = 0.025), with Caucasians having the highest rates (13.5%) and Middle Easterners the lowest (0%). A secondary analysis in which Caucasians were divided into three subgroups showed that ethnic grouping correlated significantly with KRAS mutation rate (p = 0.009), with central and eastern Europeans having the highest rates (58.3%). There were no significant differences in overall survival (OS) or disease-free survival (DFS) between the four races. The similarity in KRAS mutation rates across races raises the possibility that the differences in KRAS mutation rates reported from various countries may either not be statistically significant or may be due to environmental and/or laboratory factors rather than underlying racial genetic differences. In contrast, we verified that BRAF mutation rates differ significantly between races, suggesting racial genetic differences may be responsible for the discrepant BRAF mutation rates reported from different countries.
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Affiliation(s)
- Paul Habashy
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
| | - Vivienne Lea
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Kate Wilkinson
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Bin Wang
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Xiao-Juan Wu
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Tara Laurine Roberts
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Weng Ng
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Tristan Rutland
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Joseph William Po
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- Surgical Innovations Unit, Department of Surgery, Westmead Hospital, Sydney, NSW 2140, Australia
| | - Therese Becker
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
| | - Mark Lee
- Department of Radiation Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Scott Mackenzie
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Surgery, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Wendy Cooper
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Stephanie Lim
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- Department of Medical Oncology, Campbelltown Hospital, Sydney, NSW 2560, Australia
| | - Wei Chua
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Medical Oncology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
| | - Cheok Soon Lee
- Discipline of Pathology, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia; (P.H.); (T.R.)
- Liverpool Clinical School, Western Sydney University, Sydney, NSW 2170, Australia; (T.L.R.); (T.B.)
- Department of Anatomical Pathology, Liverpool Hospital, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 2170, Australia
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
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Hoseini B, Rahmatinejad Z, Goshayeshi L, Bergquist R, Golabpour A, Ghaffarzadegan K, Rahmatinejad F, Darrudi R, Eslami S. Colorectal Cancer in North-Eastern Iran: a retrospective, comparative study of early-onset and late-onset cases based on data from the Iranian hereditary colorectal cancer registry. BMC Cancer 2022; 22:48. [PMID: 34998373 PMCID: PMC8742430 DOI: 10.1186/s12885-021-09132-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/21/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. METHODS This retrospective study, carried out over a three-year follow-up period (2014-2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. RESULTS From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. CONCLUSION The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.
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Affiliation(s)
- Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Rahmatinejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Robert Bergquist
- Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
- Ingerod, SE-454 94, Brastad, Sweden
| | - Amin Golabpour
- School of Paramedical , Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kamran Ghaffarzadegan
- Pathology Department, Education and Research Department, Razavi Hospital, Mashhad, Iran
| | - Fatemeh Rahmatinejad
- Department of Health Information Technology, Faculty of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Darrudi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Saeid Eslami
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Zheng Y, Chen J, Zhang X, Xie L, Zhang Y, Sun Y. Sensitivity and polymorphism of Bethesda panel markers in Chinese population. Bull Cancer 2020; 107:1091-1097. [PMID: 32980144 DOI: 10.1016/j.bulcan.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/01/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aims to analyze sensitivities and polymorphisms of the Bethesda panel markers (BAT25, BAT26, D2S123, D5S346 and D17S250) for microsatellite instability testing in Chinese from Jiangsu Province and their clinical implication. METHODS MSI, sensitivity and polymorphism analysis in 541 colorectal cancer (CRC) patients were detected by fragment analysis. RESULTS Five hundred and twenty-five tissue samples and 541 blood samples of the 541 sample pairs were successfully amplified. Thirty-four (6.5%) cases were MSI-high (MSI-H) while 33 (6.3%) and 458 (87.2%) were MSI-low (MSI-L) and microsatellite stable (MSS), respectively. BAT26 (85.3%) exhibited the highest instability followed by BAT25 (82.4%), D2S123 (67.6%), D17S250 (64.7%) and D5S346 (50.0%) in MSI-H cases. The median ages of CRC patients with LS, MSI-H, MSI-L and MSS status were 38-43, 48, 60 and 63, respectively. 75.0%, 44.1%, 12.1% and 7.0% CRC cases were mucinous carcinomas in LS, MSI-H, MSI-L and MSS group, respectively. For D2S123, D17S250 and D5S346, heterozygosity was 80.8%, 74.1% and 57.7% and sizes of polymorphic variation range (PVR) were 207bp to 234bp, 140bp to 169bp and 109bp to 137bp, respectively. For D2S123 and D5S346, there was a bimodal distribution distinguishing the D17S250 from an indistinct trimodal or tetramodal distribution. CONCLUSION MSI-H cases showed earlier onset and higher proportion of mucinous carcinomas. Mononucleotide BAT26 and BAT25 exhibited higher sensitivity than dinucleotides D2S123, D17S250 and D5S346 in the Chinese population. The dinucleotide markers were highly polymorphic with high percent of heterozygosity, great variation in repeat length and non-normal distribution in Chinese population from Jiangsu Province.
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Affiliation(s)
- Yanying Zheng
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China
| | - Jie Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China
| | - Xiang Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China
| | - Ling Xie
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China
| | - Yifen Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China
| | - Yi Sun
- Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine), Department of Pathology, No.155 Hanzhong Road, 210029 Nanjing, China.
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Frequency of Mismatch Repair Protein (MMRP) Deficiency among Young Jordanians Diagnosed with Colorectal Carcinoma (CRC). Gastroenterol Res Pract 2020; 2020:5632984. [PMID: 32382267 PMCID: PMC7195647 DOI: 10.1155/2020/5632984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/22/2020] [Accepted: 03/28/2020] [Indexed: 12/30/2022] Open
Abstract
Purpose Microsatellite instability (MSI) caused by mismatch repair protein (MMRP) deficiency is detected in 15% of sporadic colorectal cancers (CRCs). Our aim is to investigate the frequency of MMRP deficiency in young CRC patients, using immunohistochemical analysis. Methods This study targeted cases of CRC at King Hussein Cancer Center from 2004 until 2012 in patients 45 years of age or younger at the time of diagnosis. Clinicopathological data was obtained from 155 patients' records. Immunohistochemistry for MLH1, MSH2, PMS2, and MSH6 proteins was performed on paraffin-embedded tissue containing carcinoma. Results The median age of patient at diagnosis was 38 years. A total of 29 (19%) cases showed deficient MMRP(dMMRP)expression. Loss of expression of PMS2 was seen in 17 cases, 12 cases of which showed loss of MLH1 expression. Loss of expression of MSH6 was seen in 10 cases, 9 of which showed loss of MSH2 expression. One case (3.4%) showed loss of all four MMR proteins, and another case (3.4%) showed loss of PMS2/MLH1 and MSH6. There was a significant association between abnormal MMR protein expression and tumor location proximal to splenic flexure (p value 0.000), pathologic features suggestive of microsatellite instability (p value 0.000), P53 negativity (p value 0.000), and stage (p value 0.02). Patients with dMMRP CRC appeared to have a significantly better overall survival compared to patients with proficient MMRP(pMMRP)(p value 0.02). Loss of MSH2/MSH6 was significantly associated with positive family history of cancer (p value = 0.020). Conclusions The prevalence of dMMRP tumors in this age group appears to be similar to international literature. dMMRP tumors tends to be associated with earlier stages and better outcomes compared to pMMRP cases. dMMRP can serve as a biomarker for better prognosis. These results are of value in directing the clinical management of young patients with CRC.
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Colorectal cancer in Saudi Arabia as the proof-of-principle model for implementing strategies of predictive, preventive, and personalized medicine in healthcare. EPMA J 2019; 11:119-131. [PMID: 32140189 DOI: 10.1007/s13167-019-00186-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) is the most commonly diagnosed cancer among Saudi males and ranks third in females with up to 73% of cases diagnosed at late stage. This review provides an analysis of CRC situation in the Kingdom of Saudi Arabia (KSA) from healthcare perspective. A PUBMED (1986-2018) search was done to identify publications focusing on CRC in KSA. Due to reports of increased CRC incidence among young age group (< 50), and given the young population of KSA, the disease may burden the national healthcare system in the next decades. Environmental factors attributed to increasing incidence rates of CRC include red meat consumption, sedentary lifestyle, and increased calorie intake. Despite substantial investment in healthcare, attention to predictive diagnostics and targeted prevention is lacking. There is a need to develop national screening guidelines based on evidence that supports a reduction in incidence and mortality of CRC when screening is implemented. Future approaches are discussed based on multi-level diagnostics, risk assessment, and population screening programs focused on the needs of young populations that among others present the contents of the advanced approach by predictive, preventive, and personalized medicine. Recommendations are provided that could help to develop policies at regional and national levels. Countries with demographics and lifestyle similar to KSA may gain insights from this review to shape their policies and procedures.
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Ghorbanoghli Z, Jabari C, Sweidan W, Hammoudeh W, Cortas G, Sharara AI, Abedrabbo A, Hourani I, Mahjoubi B, Majidzadeh K, Tözün N, Ziada-Bouchaar H, Hamoudi W, Diab O, Khorshid HRK, Lynch H, Vasen H. A new hereditary colorectal cancer network in the Middle East and eastern mediterranean countries to improve care for high-risk families. Fam Cancer 2019; 17:209-212. [PMID: 28685475 PMCID: PMC5893664 DOI: 10.1007/s10689-017-0018-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colorectal cancer (CRC) has a very high incidence in the western world. Data from registries in the Middle East showed that the incidence of CRC is relatively low in these countries. However, these data also showed that CRC incidence has increased substantially over the past three decades and that a high proportion of cases are diagnosed at an early age (<50 years). In view of these findings, more attention should be paid to prevention. Because of the often limited financial resources, focused screening of individuals with hereditary CRC, in particular those with Lynch syndrome, appears to be the most cost-effective strategy. During recent meetings of the Palestinian Society of Gastroenterology and the Mediterranean Task force for Cancer Control (MTCC) in Jericho, and the Patient’s Friends Society of Jerusalem in Hebron the issue of hereditary CRC in the Middle East was discussed and the idea was conceived to establish a network on hereditary colorectal cancer (HCCN-ME) with the goal of improving care for high-risk groups in the Middle East and (Eastern) Mediterranean Countries.
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Affiliation(s)
- Zeinab Ghorbanoghli
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre & Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
| | - Carol Jabari
- Patient's Friends Society, Jerusalem, Palestine
- Hebron University, Hebron, Palestine
| | - Walid Sweidan
- Department of Gastroenterology, Makased Islamic Charitable Hospital, Jerusalem, Palestine
| | - Wail Hammoudeh
- Department of Internal Medicine, Arabcare Hospital, Ramallah, Palestine
| | - George Cortas
- Department of Gastroenterology, St. George Hospital Medical Center, University of Balamand Medical School, Beirut, Lebanon
| | - Ala I Sharara
- Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amal Abedrabbo
- Department of Pediatrics, Makased Islamic Charitable Hospital, Jerusalem, Palestine
| | - Ijad Hourani
- Department of Surgery, Agusta Victoria Hospital, Jerusalem, Palestine
| | - Bahareh Mahjoubi
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Nurdan Tözün
- Department of Internal Medicine and Gastroenterology, University of Acibadem, Acibadem Kozyatagi Hospital, Istanbul, Turkey
| | - Hadia Ziada-Bouchaar
- Laboratory of Biology and Molecular Genetics, Faculty of Medicine, University 3, Constantine, Algeria
| | - Waseem Hamoudi
- Department of Gastroenterology, The Royal Hospital, Amman, Jordan
| | - Osama Diab
- Department of Internal Medicine, Creighton University, Omaha, USA
| | | | - Henry Lynch
- Creighton's Hereditary Cancer Center, Creighton University, Omaha, USA
| | - Hans Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
- Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands.
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Goshayeshi L, Ghaffarzadegan K, Khooei A, Esmaeilzadeh A, Rahmani Khorram M, Mosannen Mozaffari H, Kiani B, Hoseini B. Prevalence and clinicopathological characteristics of mismatch repair-deficient colorectal carcinoma in early onset cases as compared with late-onset cases: a retrospective cross-sectional study in Northeastern Iran. BMJ Open 2018; 8:e023102. [PMID: 30166308 PMCID: PMC6119423 DOI: 10.1136/bmjopen-2018-023102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Lynch syndrome (LS), a genetically inherited autosomal disorder, increases the incidence of colorectal carcinoma (CRC). We aimed to perform a universal strategy to assess the prevalence and clinicopathological characteristics of early onset CRCs at high risk of LS versus late-onset ones in the Iranian population. SETTING A local population-based study from Northeastern Iran. PARTICIPANTS 321 consecutive CRCs and pathology specimen screened between 2013 and 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Retrospectively, information regarding the clinical criteria was obtained by interviewing the patients with CRC or, their families. Pathologists tested tumours with immunohistochemistry (IHC) staining of four mismatch repair (MMR) proteins (MLH1, MSH2, MSH6 and PMS2). Tumours with absent IHC staining of MLH1 were tested for BRAF mutations to exclude sporadic CRCs. Prevalence of early onset CRCs at high risk of LS and familial CRC type X were assessed as primary and secondary outcome measures, respectively. RESULTS Of 321 CRCs (13/123 (10.57%), early onset vs 21/198 (10.6%) late-onset) were detected to be MMR-deficient (dMMR). Nine early onset cases and 14 late-onset ones with a loss of MLH1 underwent testing for the BRAF mutation, none of the early onset and four (2.02%) late-onset were recognised as sporadic. The difference in the outcome of IHC-analysis between early and late-onset CRCs at high risk of LS was not statistically significant (p=0.34). Majority of the suspected LS tumours from early onset patients had arisen in distal part (8/11 (72.72%) vs 8/14 (57.14%)), all of which were occurred in the rectum or sigmoid. CONCLUSION Clinically, these findings suggest that in case of limitation for BRAF testing, the practitioner in Iran may consider managing early onset dMMR cases like LS until access to BRAF testing becomes available to them, before germline testing to accurately diagnose LS.
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Affiliation(s)
- Ladan Goshayeshi
- Gastroentrology and Hepatology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamran Ghaffarzadegan
- Pathology Department, Education and Research Department, Razavi Hospital, Mashhad, Iran
| | - Alireza Khooei
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Esmaeilzadeh
- Gastroentrology and Hepatology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Gastroenterology and Hepatology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Rahmani Khorram
- Medical Student, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hooman Mosannen Mozaffari
- Gastroentrology and Hepatology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Gastroenterology and Hepatology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Kiani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
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Ibrahim T, Saer-Ghorra C, Trak-Smayra V, Nadiri S, Yazbeck C, Baz M, Kattan JG. Molecular characteristics of colorectal cancer in a Middle Eastern population in a single institution. Ann Saudi Med 2018; 38:251-259. [PMID: 30078023 PMCID: PMC6086673 DOI: 10.5144/0256-4947.2018.251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The few studies of the molecular biology of colorectal cancer (CRC) in Middle Eastern populations have included only small samples of patients. OBJECTIVE Evaluate the frequency and prognostic effect of RAS, BRAF, PIK3CA, PTEN, and EGFR somatic mutations as well as mismatch repair (MMR) deficiency in Lebanese Middle Eastern patients. DESIGN Retrospective single-center descriptive study. SETTING Lebanese Middle Eastern patients in a tertiary medical cen.ter. METHODS We included all patients diagnosed with CRC between January 2010 and December 2015, in whom RAS mutational status and the expression of MLH1 and MSH2 proteins were available. MAIN OUTCOME MEASURES Genetic mutations detected by direct sequencing while MMR protein expression was evaluated by immunohistochemistry. SAMPLE SIZE 645 patients. RESULTS RAS, BRAF, EGFR, PI3KCA, and PTEN mutation rates were 38.5%,12.9%, 0%, 11.1% and 0% respectively. The MMR deficiency rate was 20.6%. No factor was associated with RAS mutation whereas MMR-deficient tumors were less likely to be metastatic at diagnosis. Among patients with wild-type RAS females fared better than males (median overall survival [OS]=1734 vs 1079 days respectively, P=.015) even after adjustment for confounding factors by Cox regression analy.sis. This finding was not reproduced in the RAS-mutated group. The median OS of patients with MMR-deficient tumors was not reached, while the median OS was 2475 days in patients who had maintained expression of both MLH1 and MSH2. CONCLUSION The RAS mutation rate was similar to Western and East Asian countries, but not for the BRAF mutation and MMR deficiency. We also found a prognostic effect for sex in the RAS wild-type group, a finding worthy of further exploration. LIMITATIONS Retrospective, single center and small sample size. Expression of MSH6 and PMS2 not analyzed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Tony Ibrahim
- Tony Ibrahim, Deparment of Medical Oncology,, Gustave Roussy, 114 Rue Edouard Valliant,, Villejulf 94800, France, T: 075 504 4905, , ORCID: http://orcid.org/0000-0001-9728-8554
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Alqahtani M, Edwards C, Buzzacott N, Carpenter K, Alsaleh K, Alsheikh A, Abozeed W, Mashhour M, Almousa A, Housawi Y, Al Hawwaj S, Iacopetta B. Screening for Lynch syndrome in young Saudi colorectal cancer patients using microsatellite instability testing and next generation sequencing. Fam Cancer 2017. [PMID: 28643016 DOI: 10.1007/s10689-017-0015-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Individuals with Lynch syndrome (LS) have germline variants in DNA mismatch repair (MMR) genes that confer a greatly increased risk of colorectal cancer (CRC), often at a young age. Identification of these individuals has been shown to increase their survival through improved surveillance. We previously identified 33 high risk cases for LS in the Saudi population by screening for microsatellite instability (MSI) in the tumor DNA of 284 young CRC patients. The aim of the present study was to identify MMR gene variants in this cohort of patients. Peripheral blood DNA was obtained from 13 individuals who were at high risk of LS due to positive MSI status and young age (<60 years at diagnosis). Next generation sequencing, Sanger sequencing and Multiplex Ligation-dependent Probe Amplification were used to screen for germline variants in the MLH1, MSH2, MSH6 and PMS2 MMR genes. These were cross-referenced against several variant databases, including the International Society for Gastrointestinal Hereditary Tumors Incorporated database. Variants with pathogenic or likely pathogenic significance were identified in 8 of the 13 high risk cases (62%), comprising 4 in MLH1 and 4 in MSH2. All carriers had a positive family history for CRC or endometrial cancer. Next generation sequencing is an effective strategy for identifying young CRC patients who are at high risk of LS because of positive MSI status. We estimate that 7% of CRC patients aged <60 years in Saudi Arabia are due to LS, potentially involving around 50 new cases per year.
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Affiliation(s)
- Masood Alqahtani
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Caitlin Edwards
- Department of Diagnostic Genomics, PathWest, Nedlands, Australia
| | | | - Karen Carpenter
- Department of Diagnostic Genomics, PathWest, Nedlands, Australia
| | - Khalid Alsaleh
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik Alsheikh
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Abozeed
- College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Clinical Oncology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Miral Mashhour
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Afnan Almousa
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Yousef Housawi
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Shareefa Al Hawwaj
- Department of Pathology and Laboratory Medicine, Department of Genetics, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Barry Iacopetta
- Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.
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