TY - JOUR

T1 - Urinary Tract Cancer in Lynch Syndrome; Increased Risk in Carriers of MSH2 Mutations

AU - Joost, Patrick

AU - Therkildsen, Christina

AU - Dominguez-Valentin, Mev

AU - Jönsson, Mats

AU - Nilbert, Mef

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/12

Y1 - 2015/12

N2 - OBJECTIVE: To evaluate the risk of urothelial cancer in the upper urinary tract and the bladder, determine the contribution from the different mismatch-repair genes, and define clinical characteristics of urothelial cancer in Lynch syndrome.MATERIALS AND METHODS: The national hereditary nonpolyposis colorectal cancer registry was used to identify all 288 Lynch syndrome families in Denmark. Urothelial cancers that developed in mutation carriers and in their first-degree relatives were identified, mismatch-repair status was assessed, clinicopathologic variables were defined, and cumulative lifetime risks were determined.RESULTS: In total, 48 cancers of the ureter, 34 cancers of the renal pelvis, and 54 urinary bladder cancers developed at a mean age of 61 (24-89) years. The tumors were typically of high grade, showed loss of mismatch-repair protein expression in 90% of the tumors and microsatellite instability in 23% of the tumors. Mutations in MSH2 were overrepresented (73%), and MSH2 mutation carriers were at a significantly increased risk of developing urinary tract cancer compared with individuals with mutations in MLH1 or MSH6.CONCLUSION: Cancers of the upper urinary tract and the urinary bladder are included in the Lynch syndrome tumor spectrum. Urothelial cancers are predominantly linked to MSH2 mutations, which suggest that surveillance should be targeted at individuals with mutations herein.

AB - OBJECTIVE: To evaluate the risk of urothelial cancer in the upper urinary tract and the bladder, determine the contribution from the different mismatch-repair genes, and define clinical characteristics of urothelial cancer in Lynch syndrome.MATERIALS AND METHODS: The national hereditary nonpolyposis colorectal cancer registry was used to identify all 288 Lynch syndrome families in Denmark. Urothelial cancers that developed in mutation carriers and in their first-degree relatives were identified, mismatch-repair status was assessed, clinicopathologic variables were defined, and cumulative lifetime risks were determined.RESULTS: In total, 48 cancers of the ureter, 34 cancers of the renal pelvis, and 54 urinary bladder cancers developed at a mean age of 61 (24-89) years. The tumors were typically of high grade, showed loss of mismatch-repair protein expression in 90% of the tumors and microsatellite instability in 23% of the tumors. Mutations in MSH2 were overrepresented (73%), and MSH2 mutation carriers were at a significantly increased risk of developing urinary tract cancer compared with individuals with mutations in MLH1 or MSH6.CONCLUSION: Cancers of the upper urinary tract and the urinary bladder are included in the Lynch syndrome tumor spectrum. Urothelial cancers are predominantly linked to MSH2 mutations, which suggest that surveillance should be targeted at individuals with mutations herein.

KW - Adaptor Proteins, Signal Transducing

KW - Adenosine Triphosphatases

KW - Aged

KW - Aged, 80 and over

KW - Animals

KW - Arabidopsis Proteins

KW - Carcinoma, Transitional Cell

KW - Colorectal Neoplasms, Hereditary Nonpolyposis

KW - DNA Repair Enzymes

KW - DNA-Binding Proteins

KW - Denmark

KW - Female

KW - Genetic Predisposition to Disease

KW - Humans

KW - Male

KW - Middle Aged

KW - MutS Homolog 2 Protein

KW - Neoplasms, Multiple Primary

KW - Neoplasms, Second Primary

KW - Nuclear Proteins

KW - Pedigree

KW - Risk Factors

KW - Urologic Neoplasms

U2 - 10.1016/j.urology.2015.08.018

DO - 10.1016/j.urology.2015.08.018

M3 - Journal article

C2 - 26385421

VL - 86

SP - 1212

EP - 1217

JO - Urology

JF - Urology

SN - 0090-4295

IS - 6

ER -