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Comparison of Prediction Models for Lynch Syndrome Among Individuals With Colorectal Cancer.

Authors :
Kastrinos, Fay
Ojha, Rohit P.
Leenen, Celine
Alvero, Carmelita
Mercado, Rowena C.
Balmaña, Judith
Valenzuela, Irene
Balaguer, Francesc
Green, Roger
Lindor, Noralane M.
Thibodeau, Stephen N.
Newcomb, Polly
Aung Ko Win
Jenkins, Mark
Buchanan, Daniel D.
Bertario, Lucio
Sala, Paola
Hampel, Heather
Syngal, Sapna
Steyerberg, Ewout W.
Source :
JNCI: Journal of the National Cancer Institute; Feb2016, Vol. 108 Issue 2, p1-9, 9p, 5 Charts, 3 Graphs
Publication Year :
2016

Abstract

<bold>Background: </bold>Recent guidelines recommend the Lynch Syndrome prediction models MMRPredict, MMRPro, and PREMM1,2,6 for the identification of MMR gene mutation carriers. We compared the predictive performance and clinical usefulness of these prediction models to identify mutation carriers.<bold>Methods: </bold>Pedigree data from CRC patients in 11 North American, European, and Australian cohorts (6 clinic- and 5 population-based sites) were used to calculate predicted probabilities of pathogenic MLH1, MSH2, or MSH6 gene mutations by each model and gene-specific predictions by MMRPro and PREMM1,2,6. We examined discrimination with area under the receiver operating characteristic curve (AUC), calibration with observed to expected (O/E) ratio, and clinical usefulness using decision curve analysis to select patients for further evaluation. All statistical tests were two-sided.<bold>Results: </bold>Mutations were detected in 539 of 2304 (23%) individuals from the clinic-based cohorts (237 MLH1, 251 MSH2, 51 MSH6) and 150 of 3451 (4.4%) individuals from the population-based cohorts (47 MLH1, 71 MSH2, 32 MSH6). Discrimination was similar for clinic- and population-based cohorts: AUCs of 0.76 vs 0.77 for MMRPredict, 0.82 vs 0.85 for MMRPro, and 0.85 vs 0.88 for PREMM1,2,6. For clinic- and population-based cohorts, O/E deviated from 1 for MMRPredict (0.38 and 0.31, respectively) and MMRPro (0.62 and 0.36) but were more satisfactory for PREMM1,2,6 (1.0 and 0.70). MMRPro or PREMM1,2,6 predictions were clinically useful at thresholds of 5% or greater and in particular at greater than 15%.<bold>Conclusions: </bold>MMRPro and PREMM1,2,6 can well be used to select CRC patients from genetics clinics or population-based settings for tumor and/or germline testing at a 5% or higher risk. If no MMR deficiency is detected and risk exceeds 15%, we suggest considering additional genetic etiologies for the cause of cancer in the family. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00278874
Volume :
108
Issue :
2
Database :
Complementary Index
Journal :
JNCI: Journal of the National Cancer Institute
Publication Type :
Academic Journal
Accession number :
113310200
Full Text :
https://doi.org/10.1093/jnci/djv308