Young age and a positive family history of colorectal cancer are complementary selection criteria for the identification of Lynch syndrome

作者：Manders P; Spruijt L; Kets C M; Willems H W; Bodmer D; Hebeda K M; Nagtegaal I D; van Krieken J H J M; Ligtenberg M J L; Hoogerbrugge N^*

来源：European Journal of Cancer, 2011, 47(9): 1407-1413.

DOI：10.1016/j.ejca.2010.12.024

• Colorectal cancer
• HNPCC
• Lynch syndrome
• MSI testing
• Bethesda criteria
• Family history

Families at high risk for Lynch syndrome can effectively be recognised by microsatellite instability (MSI) testing. The aim of the present study is to compare the effectiveness of a MSI test for the identification of Lynch syndrome in patients selected by a pathologist mainly based on young age at diagnosis (MSI-testing-indicated-by-a-Pathologist; MIPA), with that of patients selected by a clinical geneticist mainly based on family history (MSI-testing-indicated-by-Family-History; MIFH).
Patients with a Lynch syndrome associated tumour were selected using MIPA (n = 362) or MIFH (n = 887). Germline DNA mutation testing was performed in 171 out of 215 patients (80%) with a MSI positive tumour.
MSI was tested positive in 20% of the MIPA-group group compared to 16% in the MIFH-group (P = 0.291). In 91 of 171 patients with MSI positive tumours tested for germline mutations were identified as Lynch syndrome patients: 42% in the MIPA-group and 56% in the MIFH-group (P = 0.066). Colorectal cancer (CRC) or endometrial cancer (EC) presenting at an age below 50 years would have led to the diagnosis of Lynch syndrome in 89% of these families (CRC below 50 years: 88% and EC below 50 years: 12%). Families detected by MIPA were characterised more often by extracolonic Lynch syndrome associated malignancies, especially EC (P < 0.001).
Our results indicate that recognition of Lynch syndrome by CRC or EC below 50 years is as effective as a positive family history. Families from patients selected by individual criteria more often harbour extracolonic Lynch syndrome associated malignancies.

• 出版日期2011-6