Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer

Rebecca A. Barnetson, Albert Tenesa, Susan M. Farrington, Iain D. Nicholl, Roseanne Cetnarskyj, Mary E. Porteous, Harry Campbell, Malcolm G. Dunlop (Lead / Corresponding author)

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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.

Original languageEnglish
Pages (from-to)2751-2763
Number of pages13
JournalNew England Journal of Medicine
Volume354
Issue number26
DOIs
Publication statusPublished - 29 Jun 2006

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DNA Mismatch Repair
Colonic Neoplasms
Mutation
Survival
Genes
Colorectal Neoplasms
Germ-Line Mutation
Hereditary Nonpolyposis Colorectal Neoplasms
Microsatellite Instability
Disease Management
DNA Repair
Logistic Models
Genotype
Staining and Labeling
Population
Neoplasms

Cite this

Barnetson, R. A., Tenesa, A., Farrington, S. M., Nicholl, I. D., Cetnarskyj, R., Porteous, M. E., ... Dunlop, M. G. (2006). Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer. New England Journal of Medicine, 354(26), 2751-2763. https://doi.org/10.1056/NEJMoa053493
Barnetson, Rebecca A. ; Tenesa, Albert ; Farrington, Susan M. ; Nicholl, Iain D. ; Cetnarskyj, Roseanne ; Porteous, Mary E. ; Campbell, Harry ; Dunlop, Malcolm G. / Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer. In: New England Journal of Medicine. 2006 ; Vol. 354, No. 26. pp. 2751-2763.
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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.",
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Barnetson, RA, Tenesa, A, Farrington, SM, Nicholl, ID, Cetnarskyj, R, Porteous, ME, Campbell, H & Dunlop, MG 2006, 'Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer', New England Journal of Medicine, vol. 354, no. 26, pp. 2751-2763. https://doi.org/10.1056/NEJMoa053493

Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer. / Barnetson, Rebecca A.; Tenesa, Albert; Farrington, Susan M.; Nicholl, Iain D.; Cetnarskyj, Roseanne; Porteous, Mary E.; Campbell, Harry; Dunlop, Malcolm G. (Lead / Corresponding author).

In: New England Journal of Medicine, Vol. 354, No. 26, 29.06.2006, p. 2751-2763.

Research output: Contribution to journalArticle

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T1 - Identification and survival of carriers of mutations in DNA mismatch-repair genes in colon cancer

AU - Barnetson, Rebecca A.

AU - Tenesa, Albert

AU - Farrington, Susan M.

AU - Nicholl, Iain D.

AU - Cetnarskyj, Roseanne

AU - Porteous, Mary E.

AU - Campbell, Harry

AU - Dunlop, Malcolm G.

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N2 - 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.

AB - 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.

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