在林奇综合征中预测生殖基因突变和癌症风险
Sining Chen1, Wenyi Wang, Shing Lee
1Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md 21205, USA. sichen@jhsph.edu
JAMA
|September 28, 2006
概括
一个新的工具,MMRpro,准确预测林奇综合征 (遗传性非多重性结直肠癌) 的风险. 它通过识别可能从不匹配修复基因测试中受益的个人来改善高风险家庭的遗传咨询和癌症预防.
科学领域:
- 遗传学 是一个遗传学.
- 在瘤学瘤学.
- 医疗信息学 医疗信息学
背景情况:
- 鉴定林奇综合征 (遗传性非多重性结直肠癌) 的高风险家庭对于遗传咨询和癌症预防至关重要.
- 林奇综合征风险评估的现有临床指南是有效的,但在适用性和成本方面存在局限性.
- 准确预测不匹配修复基因突变对于及时干预至关重要.
研究的目的:
- 开发和验证MMRpro模型,一个遗传咨询和风险预测工具.
- 估计携带MLH1,MSH2或MSH6基因有害突变的概率.
- 预测高风险人群患结直肠或子宫内膜癌的可能性.
主要方法:
- 对MMRpro模型的外部验证对来自美国,加拿大和澳大利亚的226个临床家庭的279名个人进行.
- 该模型将结合了结直肠和子宫内膜癌的详细家族病史,以及微卫星不稳定性等瘤特征.
- MMRpro模拟了不匹配修复突变的自体主导遗传,使用透率,突变流行率和瘤预测值的元分析的参数.
主要成果:
- 在独立验证过程中,MMRpro在预测突变载体状态方面表现出很高的准确性.
- 该模型实现了0.83的一致性指数 (95% CI,0.78-0.88) 和0.94的观察到预测病例比率 (95% CI,0.84-1.05).
- 这些结果表明,与现有的替代品和当前的临床指南相比,其准确度更高.
结论:
- MMRpro是一个适用于高风险人群的广泛适用和准确的预测模型.
- 该工具增强了目前针对林奇综合征的查和遗传咨询实践.
- MMRpro比现有指导方针更敏感和更具体,有助于对不匹配修复生殖系检测的决策,即使瘤样本无法获得或生殖系检测是负面的.
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