Association Between Inherited Germline Mutations in Cancer Predisposition Genes and Risk of Pancreatic Cancer

Abstract

<div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e332">IMPORTANCE</h5> <p id="P10">Individuals genetically predisposed to pancreatic cancer may benefit from early detection. Genes that predispose to pancreatic cancer and the risks of pancreatic cancer associated with mutations in these genes are not well defined. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e337">OBJECTIVE</h5> <p id="P11">To determine whether inherited germline mutations in cancer predisposition genes are associated with increased risks of pancreatic cancer. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e342">DESIGN, SETTING, AND PARTICIPANTS</h5> <p id="P12">Case-control analysis to identify pancreatic cancer predisposition genes; longitudinal analysis of patients with pancreatic cancer for prognosis. The study included 3030 adults diagnosed as having pancreatic cancer and enrolled in a Mayo Clinic registry between October 12, 2000, and March 31, 2016, with last follow-up on June 22, 2017. Reference controls were 123 136 individuals with exome sequence data in the public Genome Aggregation Database and 53 105 in the Exome Aggregation Consortium database. </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e347">EXPOSURES</h5> <p id="P13">Individuals were classified based on carrying a deleterious mutation in cancer predisposition genes and having a personal or family history of cancer. </p> </div><div class="section"> <a class="named-anchor" id="S5"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e352">MAIN OUTCOMES AND MEASURES</h5> <p id="P14">Germline mutations in coding regions of 21 cancer predisposition genes were identified by sequencing of products from a custom multiplex polymerase chain reaction–based panel; associations of genes with pancreatic cancer were assessed by comparing frequency of mutations in genes of pancreatic cancer patients with those of reference controls. </p> </div><div class="section"> <a class="named-anchor" id="S6"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e357">RESULTS</h5> <p id="P15">Comparing 3030 case patients with pancreatic cancer (43.2% female; 95.6% non-Hispanic white; mean age at diagnosis, 65.3 [SD, 10.7] years) with reference controls, significant associations were observed between pancreatic cancer and mutations in <i>CDKN2A</i> (0.3% of cases and 0.02% of controls; odds ratio [OR], 12.33; 95% CI, 5.43–25.61); <i>TP53</i> (0.2% of cases and 0.02% of controls; OR, 6.70; 95% CI, 2.52–14.95); <i>MLH1</i> (0.13% of cases and 0.02% of controls; OR, 6.66; 95% CI, 1.94–17.53) <i>; BRCA2</i> (1.9% of cases and 0.3% of controls; OR, 6.20; 95% CI, 4.62–8.17); <i>ATM</i> (2.3% of cases and 0.37% of controls; OR, 5.71; 95% CI, 4.38–7.33); and <i>BRCA1</i> (0.6% of cases and 0.2% of controls; OR, 2.58; 95% CI, 1.54–4.05). </p> </div><div class="section"> <a class="named-anchor" id="S7"> <!-- named anchor --> </a> <h5 class="section-title" id="d8117721e381">CONCLUSIONS AND RELEVANCE</h5> <p id="P16">In this case-control study, mutations in 6 genes associated with pancreatic cancer were found in 5.5% of all0 pancreatic cancer patients, including 7.9% of patients with a family history of pancreatic cancer and 5.2% of patients without a family history of pancreatic cancer. Further research is needed for replication in other populations. </p> </div>