Study Type - Diagnostic (exploratory cohort) Level of Evidence 3a What's known on the subject? and What does the study add? Hereditary non-polyposis colorectal cancer (HNPCC), also known as Lynch syndrome, is an autosomal dominant multi-organ cancer syndrome. Upper urinary tract urothelial carcinomas belong to HNPCC-related tumours and rank third within this group after colorectal and endometrial cancer. However, many urologists are not aware of this association and it is presumed that some hereditary cancers are misclassified as sporadic and that their incidence is underestimated. Consequently, family members of patients with upper urinary tract urothelial carcinomas secondary to HNPCC may be denied appropriate surveillance and early detection. A significant proportion of patients (21.3%) with newly diagnosed upper urinary tract urothelial carcinomas may have underlying HNPCC. Demographic and epidemiological characteristics suggest different mechanisms of carcinogenesis among this population. Recognition of such potential is essential for appropriate clinical and genetic management of patients and family. In order to help to identify these patients, we propose a patient-specific checklist.
OBJECTIVE: • To identify, based on previously described clinical criteria, hereditary upper urinary tract urothelial carcinomas (UUT-UCs) that are likely to be misclassified as sporadic although they may belong to the spectrum of hereditary non-polyposis colorectal cancer (HNPCC) associated cancers.
PATIENTS AND METHODS: • We identified, using established clinical criteria, suspected hereditary UUT-UC among 1122 patients included in the French national database for UUT-UC. • Patients were considered at risk for hereditary status in the following situations: age at diagnosis <60 years with no previous history of bladder cancer; previous history of HNPCC-related cancer regardless of age; one first-degree relative with HNPCC-related cancer diagnosed before 50 years of age or two first-degree relatives diagnosed regardless of age.
RESULTS: • Overall, 239 patients (21.3%) were considered to be at risk of hereditary UUT-UC. • Compared with sporadic cases, hereditary cases are more likely to be female (P= 0.047) with less exposure to tobacco (P= 0.012) and occupational carcinogens (P= 0.037). A greater proportion of tumours were located in the renal pelvis (54.5% vs 48.4%; P= 0.026) and were lower grade (40% vs 30.1%; P= 0.015) in the hereditary cohort. • The overall, cancer-specific and recurrence-free survival rates were similar in both cohorts. • We propose a patient-specific risk identification tool.
CONCLUSIONS: • A significant proportion (21.3%) of patients with newly diagnosed UUT-UC may have underlying HNPCC as a cause. • Recognition of such potential and application of a patient-specific checklist upon diagnosis will allow identification and appropriate clinical and genetic management for patient and family.
Written by:
Audenet F, Colin P, Yates DR, Ouzzane A, Pignot G, Long JA, Soulie M, Phé V, Bensadoun H, Guy L, Ruffion A, Valeri A, Cormier L, Droupy S, de La Taille A, Saint F, Faïs PO, Houlgatte A, Cussenot O, Rouprêt M; for the French Collaborative National Database on UUT-UC Are you the author?
Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI Academic Department of Urology, CHU Lille, Lille Nord University Academic Department of Urology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, René Descartes University, Paris Academic Department of Urology, CHRU Grenoble, University of Grenoble Academic Department of Urology, CHRU Toulouse, University of Toulouse Department of Urology, Foch Hospital, University of Paris-Ile de France Ouest, Suresnes Academic Department of Urology, CHRU Caen, University of Caen Academic Department of Urology, CHRU Clermont-Ferrand, University of Clermont-Ferrand Academic Department of Urology, Lyon Sud Hospital, Claude Bernard Lyon 1 University Academic Department of Urology, CHRU Brest, University of Brest Academic Department of Urology, CHRU Dijon, University of Dijon Academic Department of Urology, CHRU Nîmes, University of Nîmes Academic Department of Urology, CHU Henri Mondor, Assistance Publique - Hôpitaux de Paris, Paris Est Créteil University Academic Department of Urology, CHRU Amiens, University of Amiens Academic Department of Urology, CHU Marseille, University of Marseille Department of Urology, Val de Grâce Military Hospital, Paris Academic Department of Urology of Tenon Hospital, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, France
Reference: BJU Int. 2012 Jun 15
doi: 10.1111/j.1464-410X.2012.11298.x
PubMed Abstract
PMID: 22703159