DOI QR코드

DOI QR Code

Epidemioclinical Feature of Early-Onset Colorectal Cancer at-Risk for Lynch Syndrome in Central Iran

  • Zeinalian, Mehrdad (Cellular and Molecular Research Center, Shahrekord University of Medical Sciences) ;
  • Hashemzadeh-Chaleshtori, Morteza (Cellular and Molecular Research Center, Shahrekord University of Medical Sciences) ;
  • Akbarpour, Mohammad Javad (Poursina Hakim Research Center, Isfahan University of Medical Sciences) ;
  • Emami, Mohammad Hassan (Cellular and Molecular Research Center, Isfahan University of Medical Sciences)
  • Published : 2015.06.26

Abstract

Background: Colorectal cancer (CRC) is becoming one of the most complicated challenges of human health, particularly in developing countries like Iran. In this paper, we try to characterize CRC cases diagnosed < age 50 at-risk for Lynch syndrome within central Iran. Materials and Methods: We designed a descriptive retrospective study to screen all registered CRC patients within 2000-2013 in Poursina Hakim Research Center (PHRC), a referral gastroenterology clinic in central Iran, based on being early-onset (age at diagnosis ${\leq}50years$) and Amsterdam II criteria. We calculated frequencies and percentages by SPSS 19 software to describe clinical and family history characteristics of patients with early-onset CRC. Results: Overall 1,659 CRC patients were included in our study of which 413 (24.9%) were ${\leq}50years$ at diagnosis. Of 219/413 successful calls 67 persons (30.6%) were reported deceased. Family history was positive for 72/219 probands (32.9%) and 53 families (24.2%) were identified as familial colorectal cancer (FCC), with a history of at-least three affected members with any type of cancer in the family, of which 85% fulfilled the Amsterdam II Criteria as hereditary non-polyposis colorectal cancer (HNPCC) families (45/219 or 20.5%). Finally, 14 families were excluded due to proband tumor tissues being unavailable or unwillingness for incorporation. The most common HNPCC-associated extracolonic-cancer among both males and females of the families was stomach, at respectively 31.8 and 32.7 percent. The most common tumor locations among the 31 probands were rectum (32.3%), sigmoid (29.0%), and ascending colon (12.9%). Conclusions: Given the high prevalence of FCC (~1/4 of early-onset Iranian CRC patients), it is necessary to establish a comprehensive cancer genetic counseling and systematic screening program for early detection and to improve cancer prognosis among high risk families.

Keywords

Colorectal cancer;epidemioclinical feature;lynch syndrome;central Iran

References

  1. American Cancer Society (2013). Cancer Facts and Figures. Atlanta, Ga: American Cancer Society. Available online. Last accessed October 24, 2013.
  2. Ansari R, Mahdavinia M, Sadjadi A, et al (2006). Incidence and age distribution of colorectal cancer in Iran: results of apopulation-based cancer registry. Cancer Lett, 240, 143-147. https://doi.org/10.1016/j.canlet.2005.09.004
  3. Bansidhar BJ (2012). Extracolonic manifestations of lynch syndrome. Clin Colon Rectal Surg, 25, 103-10. https://doi.org/10.1055/s-0032-1313781
  4. Bavi PP, Abubaker JA, Jehan ZD, et al (2008). Colorectal carcinomas from Middle East. Molecular and tissue microarray analysis of genomic instability pathways. Saudi Med J, 29, 75-80.
  5. Bener A (2011). Colon cancer in rapidly developing countries: review of the lifestyle, dietary, consanguinity and hereditary risk factors. Oncol Rev, 5, 5-11. https://doi.org/10.4081/oncol.2011.5
  6. Brennan P, Hainaut P, Boffetta P (2011). Genetics of lung-cancer susceptibility. Lancet oncol, 12, 399-408. https://doi.org/10.1016/S1470-2045(10)70126-1
  7. Burt R (2007). Inheritance of Colorectal Cancer. Drug Discov Today Dis, 4, 293-300. https://doi.org/10.1016/j.ddmec.2008.05.004
  8. Bush WS, Haines J (2010). Overview of linkage analysis in complex traits. Curr Protoc Hum Genet, 1, 1-18.
  9. Cappell MS (2008). Pathophysiology, clinical presentation, and management of colon cancer. Gastroenterol ClinNorth Am, 37, 1-24. https://doi.org/10.1016/j.gtc.2007.12.002
  10. Census (from the Statistical Center of Iran, in Persian.) online available from: http://www.sci.org.ir
  11. Claes E, Denayer L, Evers-Kiebooms G, et al (2005). Predictive testing for hereditary nonpolyposis colorectal cancer. Genetic Testing, 9, 54-65. https://doi.org/10.1089/gte.2005.9.54
  12. da Silva FC, de Oliveira LP, Santos EM, et al (2010). Frequency of extracolonic tumors in Brazilian families with Lynch syndrome: analysis of a hereditary colorectal cancer institutional registry. Fam Cancer, 9, 563-70 https://doi.org/10.1007/s10689-010-9373-2
  13. Dolatkhah R, Somi MH, Jabbarpour Bonyadi M, et al (2015). Colorectal cancer in Iran: molecular epidemiology and screening strategies. J Cancer Epidemiol, 2015, 1-10.
  14. Dominguez-Valentin M, Therkildsen C, Da Silva S, Nilbert M (2015). Familial colorectal cancer type X: genetic profiles and phenotypic features. Modern Pathol, 28, 30-36.
  15. Fatemi SR, Malek FN, Shivarani S, et al (2010). Prevalence of colorectal cancer in relatives of Iranian patients diagnosed with colorectal cancer. Asian Pac J Cancer Prev, 1, 91-3.
  16. Francisco I, Albuquerque C, Lage P, et al (2011). Familial colorectal cancer type X syndrome: two distinct molecular entities? Fam Cancer, 10, 623-31. https://doi.org/10.1007/s10689-011-9473-7
  17. Griffin PM, Liff JM, Greenberg RS, Clark WS (1991). Adenocarcinomas of the colon and rectum in persons under 40 years old. A population-based study. Gastroenterol, 100, 1033-1040. https://doi.org/10.1016/0016-5085(91)90279-T
  18. Haghighi MM, Vahedi M, Mohebbi SR, et al (2009). Comparison of survival between patients with hereditary non polyposis colorectal cancer (HNPCC) and sporadic colorectal cancer. Asian Pac J Cancer Prev, 10, 209-12.
  19. Kolahdoozan S, Sadjadi A, Radmard AR (2010). Five common cancers in Iran. Arch Iran Med, 13, 143-146.
  20. Kratzke R, Franklin MJ (2012). Lung cancer epidemiology. Encyclop Cancer, pp, 2100-4.
  21. Jasperson KW, Tuohy TM, Neklason DW, Burt RW (2010). Hereditary and familial colon cancer. Gastroenterol, 138, 2044-58. https://doi.org/10.1053/j.gastro.2010.01.054
  22. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. Ca Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  23. Lindor NM (2009). Familial colorectal cancer type X: the other half of hereditary nonpolyposis colon cancer syndrome. Surg Oncol Clin N Am, 18, 637-45. https://doi.org/10.1016/j.soc.2009.07.003
  24. Lynch HT, Chapelle A (1999). Genetic susceptibility to non-polyposis colorectal cancer. J Med Genet, 36, 801-18.
  25. Lynch HT, Lynch PM, Lanspa SJ, et al (2009). Review of the lynch syndrome: history, molecular genetics, screening, differential diagnosis, and medicolegal ramifications. Clin Genet, 76, 1-18.
  26. Maserat E, Fatemi R, Zali MR (2009). New perspective for integrated information management in national colorectal cancer screening in Iran. Asian Pac J Cancer Prev, 10, 701-6.
  27. Maul JS, Warner NR, Kuwada SK, et al (2006). Extracolonic cancers associated with hereditary nonpolyposis colorectal cancer in the Utah Population Database. Am J Gastroenterol, 101, 1591-6. https://doi.org/10.1111/j.1572-0241.2006.00636.x
  28. Mitchell E, Macdonald S, Campbell NC, Weller D, Macleod U (2008). Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review. British J Cancer, 98, 60-70. https://doi.org/10.1038/sj.bjc.6604096
  29. Mitry E, Benhamiche AM, Jouve JL, et al (2001). Colorectal adenocarcinoma in patients under 45 years of age: comparison with older patients in a well-defined French population. Dis Colon Rectum, 44, 380-387. https://doi.org/10.1007/BF02234737
  30. Mousavi S, Alamolhoda A, Gouya M, Lickiss N (2008). Implementation of Comprehensive National Cancer Control Program in Iran: an experience in a developing country. Ann Oncol, 19, 398-400.
  31. Mousavi SM, Gouya MM, Ramazani R, et al (2009). Cancer incidence and mortality in Iran. AnnOncol, 20, 556-63.
  32. Nemati A, Rahmatabadi ZK, Fatemi A, Emami MH (2011). Hereditary nonpolyposis colorectal cancer and familial colorectal cancer in central part of Iran, Isfahan. J Res Med Scien, 17, 67-73.
  33. Park YJ, Shin KH, Park JG (2000). Risk of gastric cancer in hereditary nonpolyposis colorectal cancer in Korea. Clin Cancer Res, 6, 2994-2998
  34. Peto J (2001). Cancer epidemiology in the last century and the next decade. Nature, 411, 390-395. https://doi.org/10.1038/35077256
  35. Pickhardt PJ, Kim DH, Meiners RJ, Wyatt KS, Hanson ME, Barlow DS et al (2010). Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiol, 255, 83-8. https://doi.org/10.1148/radiol.09090939
  36. Pinol V, Castells A, Andreu M, et al (2005). "Accuracy of revised bethesda guidelines, microsatellite instability, and immunohistochemistry for the identification of patients with hereditary nonpolyposis colorectal cancer". JAMA, 293, 1986-94. https://doi.org/10.1001/jama.293.16.1986
  37. Pourhoseingholi MA, Faghihzadeh S, Hajizadeh E, Abadi A, Zali MR (2009). Bayesian estimation of colorectal cancer mortality in the presence of misclassification in Iran. Asian Pac J Cancer Prev, 10, 691-4.
  38. Rybak C, Hall MJ (2011). Interpretation of genetic testing for lynch syndrome in patients with putative familial colorectal cancer. J Natl Compr Canc Netw, 9, 1311-20. https://doi.org/10.6004/jnccn.2011.0106
  39. Sadjadi A, Nooraie M, Ghorbani A, Alimohammadian M, et al (2007). The Incidence of prostate cancer in Iran. Arch Iranian Med, 10, 481 - 485.
  40. Safari A, Shariff ZM, Kandiah M, Rashidkhani B, Fereidooni F (2013). Dietary patterns and risk of colorectal cancer in tehran province: a case-control study. BMC Public Health, 13, 222. https://doi.org/10.1186/1471-2458-13-222
  41. Steinke V, Engel C, Buttner R,et al (2013). Hereditary nonpolyposis colorectal cancer (hnpcc)/lynch syndrome. Dtsch Arztebl Int, 110, 32-8.
  42. Stigliano V, Assisi D, Cosimelli M, et al (2008). Survival of hereditary non-polyposis colorectal cancer patients compared with sporadic colorectal cancer patients. J Experim Clin Cancer Res, 27, 39. https://doi.org/10.1186/1756-9966-27-39
  43. Sun S, Schiller JH, Gazdar AF (2007). Lung cancer in never smokers. Nature Reviews Cancer, 7, 778-790. https://doi.org/10.1038/nrc2190
  44. Syngal S, Fox EA, Eng C, Kolodner RD, Garber JE (2000). Sensitivity and specificity of clinical criteria for hereditary non-polyposis colorectal cancer associated mutations in MSH2 and MLH1. J Med Genet, 37, 641-5. https://doi.org/10.1136/jmg.37.9.641
  45. Vasen HFA, Blanco I, Aktan-Collan K, et al (2013). Revised guidelines for the clinical management of Lynch syndrome (HNPCC): recommendations by a group of European experts. Gut, 62, 812-23. https://doi.org/10.1136/gutjnl-2012-304356
  46. WHO (2012). Life expectancy data by country". Retrieved 1 June 2013. Available at: http://apps.who.int/gho/data/node.main.688?lang=en
  47. Yazdizadeh B, Jarrahi AM, Mortazavi H, et al (2005). Time trends in the occurrence of major GI cancers in Iran. Asian Pac J Cancer Prev, 6, 130 - 134.
  48. Yoder LH (2006). Lung cancer epidemiology. Medsurg nursing, 15, 171-4
  49. Yuen ST, Chan TL, Ho JW, et al (2002). Germline, somatic and epigenetic events underlying mismatch repair deficiency in colorectal and HNPCC-related cancers. Oncogene, 21, 7585-92. https://doi.org/10.1038/sj.onc.1205968

Cited by

  1. Screening for Lynch Syndrome in Young Colorectal Cancer Patients from Saudi Arabia Using Microsatellite Instability as the Initial Test vol.17, pp.4, 2016, https://doi.org/10.7314/APJCP.2016.17.4.1917