FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 354:2751-2763 June 29, 2006 Number 26 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Boland, C. R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The identification of mutations in germ-line DNA mismatch-repair genes at the time of diagnosis of colorectal cancer is important in the management of the disease.

Methods Without preselection and regardless of family history, we recruited 870 patients under the age of 55 years soon after they received a diagnosis of colorectal cancer. We studied these patients for germ-line mutations in the DNA mismatch-repair genes MLH1, MSH2, and MSH6 and developed a two-stage model by multivariate logistic regression for the prediction of the presence of mutations in these genes. Stage 1 of the model incorporated only clinical variables; stage 2 comprised analysis of the tumor by immunohistochemical staining and tests for microsatellite instability. The model was validated in an independent population of patients. We analyzed 2938 patient-years of follow-up to determine whether genotype influenced survival.

Results There were 38 mutations among the 870 participants (4 percent): 15 mutations in MLH1, 16 in MSH2, and 7 in MSH6. Carrier frequencies in men (6 percent) and women (3 percent) differed significantly (P<0.04). The addition of immunohistochemical analysis in stage 2 of the model had a sensitivity of 62 percent and a positive predictive value of 80 percent. There were 35 mutations in the validation series of 155 patients (23 percent): 19 mutations in MLH1, 13 in MSH2, and 3 in MSH6. The performance of the model was robust among a wide range of cutoff probabilities and was superior to that of the Bethesda and Amsterdam criteria for hereditary nonpolyposis colorectal cancer. Survival among carriers was not significantly different from that among noncarriers.

Conclusions We devised and validated a method of identifying patients with colorectal cancer who are carriers of mutations in DNA repair genes. Survival was similar among carriers and noncarriers.

Source Information

From the Colon Cancer Genetics Group, School of Molecular and Clinical Medicine (R.A.B., A.T., S.M.F., H.C., M.G.D.), and the Public Health Sciences (H.C.), University of Edinburgh; and the Medical Research Council Human Genetics Unit (R.A.B., A.T., S.M.F., H.C., M.G.D.) and the Clinical Genetics Department (R.C., M.E.P.), Western General Hospital — all in Edinburgh; and the Research Institute in Healthcare Science, School of Applied Sciences, University of Wolverhampton, Wolverhampton, United Kingdom (I.D.N.).

Address reprint requests to Dr. Dunlop at the Medical Research Council Human Genetics Unit, Western General Hospital, University of Edinburgh, Crewe Road, Edinburgh EH4 2XU, United Kingdom, or at malcolm.dunlop{at}hgu.mrc.ac.uk.

Full Text of this Article

This article has been cited by other articles:

• Kurnat-Thoma, E. L. (2008). Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome): Molecular Pathogenesis and Clinical Approaches to Diagnosis and Management for Nurses. Biol Res Nurs 9: 185-199 [Abstract]  
• Lynch, P. M. (2007). New Issues in Genetic Counseling of Hereditary Colon Cancer. Clin. Cancer Res. 13: 6857s-6861s [Abstract] [Full Text]  
• Young, L. C., Keuling, A. M., Lai, R., Nation, P. N., Tron, V. A., Andrew, S. E. (2007). The associated contributions of p53 and the DNA mismatch repair protein Msh6 to spontaneous tumorigenesis. Carcinogenesis 28: 2131-2138 [Abstract] [Full Text]  
• Lynch, H. T., Boland, C. R., Rodriguez-Bigas, M. A., Amos, C., Lynch, J. F., Lynch, P. M. (2007). Who Should Be Sent for Genetic Testing in Hereditary Colorectal Cancer Syndromes?. JCO 25: 3534-3542 [Abstract] [Full Text]  
• Malesci, A., Laghi, L., Bianchi, P., Delconte, G., Randolph, A., Torri, V., Carnaghi, C., Doci, R., Rosati, R., Montorsi, M., Roncalli, M., Gennari, L., Santoro, A. (2007). Reduced Likelihood of Metastases in Patients with Microsatellite-Unstable Colorectal Cancer. Clin. Cancer Res. 13: 3831-3839 [Abstract] [Full Text]  
• Vasen, H F A, Moslein, G, Alonso, A, Bernstein, I, Bertario, L, Blanco, I, Burn, J, Capella, G, Engel, C, Frayling, I, Friedl, W, Hes, F J, Hodgson, S, Mecklin, J-P, Moller, P, Nagengast, F, Parc, Y, Renkonen-Sinisalo, L, Sampson, J R, Stormorken, A, Wijnen, J (2007). Guidelines for the clinical management of Lynch syndrome (hereditary non-polyposis cancer). J. Med. Genet. 44: 353-362 [Abstract] [Full Text]  
• Mead, L. J., Jenkins, M. A., Young, J., Royce, S. G., Smith, L., St. John, D. J. B., Macrae, F., Giles, G. G., Hopper, J. L., Southey, M. C. (2007). Microsatellite Instability Markers for Identifying Early-Onset Colorectal Cancers Caused by Germ-Line Mutations in DNA Mismatch Repair Genes. Clin. Cancer Res. 13: 2865-2869 [Abstract] [Full Text]  
• Cahill, D. P., Levine, K. K., Betensky, R. A., Codd, P. J., Romany, C. A., Reavie, L. B., Batchelor, T. T., Futreal, P. A., Stratton, M. R., Curry, W. T., Iafrate, A. J., Louis, D. N. (2007). Loss of the Mismatch Repair Protein MSH6 in Human Glioblastomas Is Associated with Tumor Progression during Temozolomide Treatment. Clin. Cancer Res. 13: 2038-2045 [Abstract] [Full Text]  
• Boland, C. R. (2007). Clinical Uses of Microsatellite Instability Testing in Colorectal Cancer: An Ongoing Challenge. JCO 25: 754-756 [Full Text]  
• Lynch, H. T., Lynch, J. F., Lynch, P. M. (2007). Toward a Consensus in Molecular Diagnosis of Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome). JNCI J Natl Cancer Inst 99: 261-263 [Full Text]  
• Aaltonen, L., Johns, L., Jarvinen, H., Mecklin, J.-P., Houlston, R. (2007). Explaining the Familial Colorectal Cancer Risk Associated with Mismatch Repair (MMR)-Deficient and MMR-Stable Tumors. Clin. Cancer Res. 13: 356-361 [Abstract] [Full Text]  
• Balmana, J., Stockwell, D. H., Steyerberg, E. W., Stoffel, E. M., Deffenbaugh, A. M., Reid, J. E., Ward, B., Scholl, T., Hendrickson, B., Tazelaar, J., Burbidge, L. A., Syngal, S. (2006). Prediction of MLH1 and MSH2 mutations in Lynch syndrome.. JAMA 296: 1469-1478 [Abstract] [Full Text]  
• Ford, J. M., Whittemore, A. S. (2006). Predicting and preventing hereditary colorectal cancer.. JAMA 296: 1521-1523 [Full Text]  
• (2006). Better Identification of HNPCC Gene Carriers. JWatch Gastroenterology 2006: 3-3 [Full Text]  
• Boland, C. R. (2006). Decoding hereditary colorectal cancer.. NEJM 354: 2815-2817 [Full Text]