Colorectal surveillance outcomes from an institutional longitudinal cohort of lynch syndrome carriers

Frontiers in Oncology

Oncology

Maureen E. Mork¹  Julie Moskowitz¹  Y. Nancy You²  Miguel A. Rodriguez-Bigas²  Patrick M. Lynch³  Selvi Thirumurthi³  Kyera Evans⁴  Jennifer L. Kinnison⁴  Charles M. Bowen⁴  Laura Reyes-Uribe⁴  Valerie O. Sepeda⁴  Diane M. Weber⁴  Eduardo Vilar⁵  Daniel Goyco⁶  Gabriel del Carmen⁷  Melissa W. Taggart⁸ 

[1] Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Clinical Cancer Genetics Program, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;Department of Medicine, Baylor College of Medicine, Houston, TX, United States;Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States;Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States;

关键词: lynch;    colorectal < cancer type;    surveillance;    colonoscopy;    premalignancies;   

DOI  :  10.3389/fonc.2023.1146825

 received in 2023-01-17, accepted in 2023-04-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveLynch Syndrome (LS) carriers have a significantly increased risk of developing colorectal cancer (CRC) during their lifetimes. Further stratification of this patient population may help in identifying additional risk factors that predispose to colorectal carcinogenesis. In most LS patients CRC may arise from adenomas, although an alternative non-polypoid carcinogenesis pathway has been proposed for PMS2 carriers. Using data from our institutional LS cohort, our aim was to describe our current colorectal screening outcomes with a focus on the incidence of adenomas in the context of different MMR genotypes and patient demographics such as gender, race, and ethnicity.DesignWe collected demographics, genetic, colonoscopy, and pathology results from a total of 163 LS carriers who obtained regular screening care at MD Anderson Cancer Center. Data were extracted from the electronic health records into a REDCap database for analysis. Logistic regressions were performed to measure the association between MMR variants and the likelihood of adenomas, advanced adenomas, and CRC. Then, we analyzed the cumulative incidences of these outcomes for the first 36 months following enrollment using Kaplan-Meier incidence curves, and Cox proportional hazard regressions.ResultsOn multivariate analysis, age (≥45 years old) was associated with an increased risk of developing adenomas (P=0.034). Patients with a prior or active cancer status were less likely to develop adenomas (P=0.015), despite of the lack of association between surgical history with this outcome (P=0.868). We found no statistically significant difference in likelihood of adenoma development between MLH1 and MSH2/EPCAM, MSH6, and PMS2 carriers. Moreover, we observed no statistically significant difference in the likelihood of advanced adenomas or CRC for any measured covariates. On Cox proportional hazard, compared to MLH1 carriers, the incidence of adenomas was highest among MSH2/EPCAM carriers during for the first 36-months of follow-up (P<0.001). We observed a non-statistically significant trend for Hispanics having a higher and earlier cumulative incidence of adenomas compared to non-Hispanics (P=0.073). No MMR carrier was more likely to develop advanced adenomas. No difference in the incidence of CRC by MMR gene (P=0.198).ConclusionScreening recommendations for CRC in LS patients should be based on specific MMR variants and should also be tailored to consider patient demographics.

【 授权许可】

Unknown   
Copyright © 2023 del Carmen, Reyes-Uribe, Goyco, Evans, Bowen, Kinnison, Sepeda, Weber, Moskowitz, Mork, Thirumurthi, Lynch, Rodriguez-Bigas, Taggart, You and Vilar