BRCA1/2数据解读中国专家共识（2021版）

乳腺癌易感基因（breast cancer susceptibility gene,BRCA）包括BRCA1和BRCA2,是重要的抑癌基因,其编码产物参与DNA损伤同源性重组修复。BRCA1/2基因检测在卵巢癌、乳腺癌、胰腺癌、前列腺癌等相关肿瘤的遗传风险评估、治疗选择、预后判断等方面具有重要意义。变异解读是BRCA1...     

BRCA1,BRCA2基因与乳腺癌,卵巢癌多发家族

目前研究普遍认为,ＢＲＣＡ１,ＢＲＣＡ２基因属抑癌基因,这些基因的某些突变型的携带,患乳腺癌,卵巢癌等恶性肿瘤的危险性显增高,本介绍了ＢＲＣＡ１,ＢＲＣＡ２基因定位和克隆后,近年来对上述基因相关家族的特点,基因外显率,抑癌机制,基因突变热点,突变类型的种族特异性等方面的研究进展,介绍了肿瘤高度和中度危险家族的划分方法和意义,并分析了今后我国在相关领域深入研究的思路。     

BRCA1、BRCA2基因与乳腺癌、卵巢癌多发家族

目前研究普遍认为，BRCA1、BRCA2基因属抑癌基因，这些基因的某些突变型的携带者，患乳腺癌、卵巢癌等恶性肿瘤的危险性显著增高。本文介绍了BRCA1、BRCA2基因定位和克隆后，近年来对上述基因相关家族的特声、、基因外显年、抑癌机制、基因突变热点、突变类型的种族特异性等方面的研究进展，介绍了肿病高度和中反危险家族的划分方法和意义，并分析了今后我国在相关领域深入研究的思路。     

遗传性乳腺癌-卵巢癌综合征中BRCA1/2的表达

目的检测BRCA1/2在遗传性乳腺癌-卵巢癌综合征(HBOC)患者所患卵巢癌和散发性卵巢癌组织中蛋白表达的差异,探讨其在HBOC患者卵巢癌发病中的意义。方法收集我院妇科2001年1月至2010年10月HBOC患者卵巢癌40例和散发性卵巢癌20例(对照组)的石蜡组织标本,行免疫组化检测BRCA蛋白的表达;收集2011年1月-2013年12月HBOC卵巢癌11例和同期散发性卵巢癌10例(对照组)的新鲜标本,行Western Blot检测BRCA蛋白的表达。结果免疫组化结果显示HBOC组BRCA2蛋白阳性产物OD值(0.64±0.013)明显高于对照组(0.24±0.002,0.05)。Western blot结果显示HBOC组BRCA2蛋白OD值(0.68±0.02)明显高于对照组(0.26±0.01,0.05)。但是,对于BRCA1没有明显区别。结论 BRCA2蛋白在HBOC患者卵巢癌组织过表达提示BRCA2可能与HBOC的发病相关。     

海南西部地区乳腺癌患者 BRCA1 / 2 基因突变状态分析

目的 不同的区域及种族的 BRCA1 / 2 基因突变频率差异较大, 着重分析海南西部地区乳腺癌患 者 BRCA1 / 2 基因的突变状态及对患者预后的影响。 方法 选取 2015 年 10 月 ~ 2020 年 12 月在海南西部中 心医院住院并确诊为原发性乳腺癌的 256 例患者为研究对象, 采用变性高效液相色谱法 ( denaturing high performance liquid chromatography, DHPLC) 筛查乳腺癌患者是否存在 BRCA1 / 2 基因突变, 分析 BRCA1 / 2 基 因突变状态及 BRCA1 / 2 基因突变患者的临床特征, 并随访分析患者 5 年生存情况, COX 回归分析影响患者 预后的因素。 结果 256 例乳腺癌患者中共检出 53 例患者发生 BRCA1 / 2 基因突变, 其中 BRCA1 突变率 12. 11 % (31 / 256), BRCA2 突变率 8. 59 % (22 / 256), 其中有害变异率为 7. 03 % (18 / 256)。 BRCA1 / 2 基 因突变患者家族病史、 妇科疾病史、 乳腺疾病史、 雌激素受体 (estrogen receptor, ER)、 原癌基因 (CerbB2) 蛋白阳性比例以及临床病理分级、 临床分期与未突变患者比较差异有统计学意义 (P< 0. 05)。 患者总 体生存率为 83. 59 % , BRCA1 / 2 基因突变者生存率低于未突变者 (P< 0. 05), COX 回归分析显示, BRCA1 / 2 基因突变、 乳腺疾病史、 临床分期、 CerbB-2 阳性、 CEA、 CA199 均是影响乳腺癌患者生存的危险因素 (P< 0. 05)。 结论 通过 DHPLC 可有效筛查海南西部地区乳腺癌患者 BRCA1 / 2 基因的有害变异, BRCA1 / 2 基因突变与临床病理特征及预后密切相关。     

HER-2/neu基因蛋白、BRCA1和BRCA2基因突变检测在乳腺癌诊断和治疗中的临床意义

乳腺癌(breast cancer)是指发生于乳腺导管上皮细胞的恶性肿瘤,是女性常见的肿瘤之一,约占全身恶性肿瘤的7%-10%,全世界每年新发乳腺癌约150万例,死亡约57万例.北美、欧洲等西方发达国家为高发区,其发病率为亚、非、拉地区的4倍左右.我国虽属乳腺癌低发区的国家,但近20年来发病率有增高趋势,特别是在北京、上海等经济发达地区,乳腺癌已成为威胁女性健康的重要危害,有可能超过宫颈癌而居女性恶性肿瘤的首位.近年来,随着分子生物学研究的迅速进展,肿瘤发生基因学说研究的突飞猛进,使得乳腺癌的早期诊断和治疗有了希望.     

中国上海家族性乳腺癌BRCA1和BRCA2基因的突变

目的研究上海地区家族性乳腺癌中BRCA1／BRCA2基因的突变位点及携带情况。方法研究对象来自35个汉族家族性乳腺癌家系，家系中至少有一个一级亲属乳腺癌患病史。共35例患者，其中13例发病年龄≤加岁。由静脉血提取基因组DNA，对BRCA1／BRCA2基因的全部编码序列进行扩增。扩增产物突变分析先由变性高效液相色谱分析进行筛查，之后进行DNA直接测序证实。结果在BRCA1基因中发现有4个突变位点，其中2个为新发现位点——拼接点突变（IVS17-1G〉T；IVS21＋1G〉C）；另两个为已报道的致病突变位点——移码突变（1100delAT；5640delA）。BRCA2基因的1个致病突变位点位于11号外显子上，为移码突变（5802delAATT）。另外，共发现有12个新的单核苷重复多态位点，都未引起氨基酸编码改变；其中，8个在BRCA1基因上，4个在BRCA2基因上。在家族性乳腺癌中，BRCA1突变频率（11．4％）高于BRCA2基因（2．9％）。结论新发现的2个BRCA1基因的拼接点突变可能是中国上海人群家族性乳腺癌的特有突变位点；在我国上海地区人群中，BRCA1基因突变起着比BRCA2基因更大的作用；该研究丰富了中国人群中BRCA基因的突变谱，并为未来的临床基因检测提供了筛查模式。     

少发的乳癌和/或卵巢癌家族中BRCA1和BRCA2基因原发突变的特点

BRCA1与 BRCA2 是新近发现的两个乳癌发生密切相关的基因 ,是导致乳癌和 /或卵巢癌家族性高发的重要原因 ,既往关于 BRCA1和 BRCA2基因的研究多是在多发性乳癌和 /或卵巢癌家族中进行的 ,并发现 BRCA1和 BRCA2 基因的突变约占乳癌和 /或卵巢癌家族中一半患者的发生有关。本实验对 BRCA1和 BRCA2 基因在少发性乳癌和/或卵巢癌家族中突变特点进行研究。选择 1 0 4个乳癌和 /或卵巢癌家族 ,每个家族含有 3～ 9个乳癌和 /或卵巢癌患者不等 ,平均 3.8个。应用蛋白剪切试验及突变特异测定方法 ,对 93个家族中的癌患者和 1 1个家族中…     

维吾尔族和汉族散发性乳腺癌患者BRCA1/2基因突变的检测

目的探讨新疆维吾尔族和汉族散发性乳腺癌患者乳腺癌易感基因1/2(BRCA1/2)突变情况及与临床病理参数的关系。方法采用PCR和DNA直接测序法,对新疆地区230例散发性乳腺癌患者(维吾尔族、汉族各115例)石蜡组织进行BRCA1基因第2、11(11A和11B)、20号外显子和BRCA2基因第11号部分外显子,共5对引物进行突变检测。结果 230例乳腺癌患者中,BRCA基因突变率为6.96%(16/230),其中1例BRCA1基因-5 382位点的突变及7例新发突变位点;维吾尔族和汉族患者中BRCA基因突变检出率分别为7.83%(9/115)和6.09%(7/115);BRCA基因突变组发病年龄均≤50岁;突变组16例患者中绝经前患者(13例)的突变率明显高于绝经后患者(3例)(P0.05)。结论 BRCA1基因突变可能与新疆地区散发性乳腺癌发生相关。     

Systematic misclassification of missense variants in BRCA1 and BRCA2 “coldspots”

PurposeGuidelines for variant interpretation incorporate variant hotspots in critical functional domains as evidence for pathogenicity (e.g., PM1 and PP2), but do not use “coldspots,” that is, regions without essential functions that tolerate variation, as evidence a variant is benign. To improve variant classification we evaluated BRCA1 and BRCA2 missense variants reported in ClinVar to identify regions where pathogenic missenses are extremely infrequent, defined as coldspots.MethodsWe used Bayesian approaches to model variant classification in these regions.ResultsBRCA1 exon 11 (~60% of the coding sequence), and BRCA2 exons 10 and 11 (~65% of the coding sequence), are coldspots. Of 89 pathogenic (P) or likely pathogenic (LP) missense variants in BRCA1, none are in exon 11 (odds <0.01, 95% confidence interval [CI] 0.0–0.01). Of 34 P or LP missense variants in BRCA2, none are in exons 10–11 (odds <0.01, 95% CI 0.0–0.01). More than half of reported missense variants of uncertain significance (VUS) in BRCA1 and BRCA2 are in coldspots (3115/5301 = 58.8%). Reclassifying these 3115 VUS as likely benign would substantially improve variant classification.ConclusionIn BRCA1 and BRCA2 coldspots, missense variants are very unlikely to be pathogenic. Classification schemes that incorporate coldspots can reduce the number of VUS and mitigate risks from reporting benign variation as VUS.     

早发性乳腺癌/卵巢癌BRCA1基因突变分析

目的探讨中国北方地区汉族人群早发性乳腺癌和卵巢癌与BRCA1基因的关系.方法应用聚合酶链反应-单链构象多态性分析和DNA直接测序法检测BRCA1基因外显子2和外显子11部分序列.结果对12例早发性乳腺癌/卵巢癌患者PCR-SSCP的检测中,在外显子2发现1例突变,经DNA测序证实突变为第166碱基插入碱基"C".结论 BRCA1基因突变可能与北方地区汉族人群早发性乳腺癌有关.     

CNTNAP2基因变异导致Pitt-Hopkins样综合征1型1例

目的 分析CNTNAP2基因变异引起婴幼儿期癫痫发作、精神运动发育迟缓。方法 患儿,女,5岁4月龄,因“运动、语言、认知落后”来我院康复科就诊。患儿主要表现为精神运动发育迟缓、癫痫,共济失调,现有孤独症倾向。患儿行染色体微阵列检测(CMA)和家系全外显子组测序分析(trio-WES)。结果 CMA结果未见异常。WES发现2个复合杂合致病变异CNTNAP2(NM＿014141.6):c.451C>T(p.Q151^*),来源于母亲;c.3588＿3591delGACA(N1198Pfs^*21),来源于父亲;变异与Pitt-Hopkins样综合征1型(PTHSL1)相关。Sanger测序验证结果与WES结果一致。这2个变异可能影响CNTNAP2蛋白的盘状结构域(discoidin domain,又称F5/8 C型结构域)和层粘连蛋白G样结构域(laminin G-like 4)功能异常,从而引起患儿癫痫发作和精神运动发育迟缓。结论 CNTNAP2基因纯合变异或复合杂合变异导致的主要临床表现为认知障碍、癫痫和行为异常。国内尚未见PTHSL1报道...     

Presymptomatic testing for BRCA1 and BRCA2: how distressing are the pre-test weeks?

Presymptomatic DNA testing for autosomal dominant hereditary breast/ovarian cancer (HBOC) became an option after the identification of the BRCA1 and BRCA2 genes in 1994-1995. Healthy female mutation carriers have a high lifetime risk for breast cancer (56-87%) or ovarian cancer (10-60%) and may opt for intensive breast and ovary surveillance or prophylactic surgery (mastectomy/oophorectomy).We studied general and cancer related distress in 85 healthy women with a 25% or 50% risk of being carrier of a BRCA1/BRCA2 gene mutation and 66 partners in the six to eight week period between genetic counselling/blood sampling and disclosure of the test result. Questionnaire and interview data are analysed. Associations are explored between levels of distress and (1) expected consequences of being identified as a mutation carrier, (2) personality traits, (3) sociodemographic variables, and (4) experiences related to HBOC.Mean pre-test anxiety and depression levels in women at risk of being a carrier and partners were similar to those of a normal Dutch population. In about 25% of those at risk of being a carrier and 10% of the partners, increased to high levels of general and cancer related distress were found. Increased levels of distress were reported by women who (1) anticipated an increase in problems after an unfavourable test outcome, (2) considered prophylactic mastectomy if found to be mutation carrier, (3) had an unoptimistic personality, (4) tended to suppress their emotions, (5) were younger than 40 years, and (6) were more familiar with the serious consequences of HBOC. Recently obtained awareness of the genetic nature of cancer in the family was not predictive of distress.The majority of the women and their partners experienced a relatively calm period before the disclosure of the test result and seemed to postpone distressing thoughts until the week of disclosure of the result. The low distress levels may partly be explained by the use of strategies to minimise the emotional impact of a possibly unfavourable test outcome. However, a minority reported feeling very distressed. Several factors were found to be predictive for increased distress levels.     

Should genetic testing for BRCA1/2 be permitted for minors? Opinions of BRCA mutation carriers and their adult offspring

Although professional guidelines recommend against testing minors for adult-onset genetic conditions, the genetic testing of minors for BRCA1/2 alterations has been debated in the literature. To better understand the opinions of BRCA mutation carriers regarding the genetic testing of minors and the cognitive and affective processes underlying these opinions, we interviewed BRCA mutation carriers and their adult offspring who had learned of their parent's BRCA mutation. Semi-structured interviews were conducted with 53 parents and 22 offspring. In response to a closed-ended question, 52% (n = 39) of participants were opposed to the testing of minors. Responses to an open-ended question indicate that many participants (24%, n = 18) feel that testing could be permitted for some minor offspring. Psychological risks and the insufficient maturity of minors were frequent concerns of participants opposed to testing minors. The potential to impact health behaviors was frequently cited as a reason to support the genetic testing of minors. These preliminary results suggest that many BRCA mutation carriers and their adult offspring have concerns about, or are opposed to the genetic testing of minors. However, a significant minority in our study would support testing minors. Greater support for testing among offspring could indicate increasing requests for early genetic diagnosis. Further research is necessary to explore the risks and benefits of providing genetic testing to minors for adult-onset hereditary cancer syndromes in order to inform clinical practice and public policy and to ensure optimal psychosocial and medical outcomes for all members in families at risk for genetically determined disease.     

三阴性乳腺癌患者BRCA1和BRCA2基因突变的临床特征及预后因素

目的:探究三阴性乳腺癌患者BRCA1和BRCA2基因突变检测的临床意义及预后因素分析.方法:研究对象选取为2003年1月至2015年12月之间的三阴性乳腺癌156例,所有患者均通过PCR法和DNA序列测定检验BRCA1和BRCA2基因突变情况,分析乳腺癌患者BRCA1和BRCA2基因突变特点.应用Log-Rank检验对BRCA1和/或BRCA2基因突变的三阴性乳腺癌患者的各项指标如年龄、ECOG状态、临床分期、淋巴结阳性数、月经状态和给药方式进行单因素分析.应用Cox风险比例回归模型分析患者年龄、ECOG状态、临床分期、淋巴结阳性数、肿瘤大小、月经状态和给药方式等多因素分析.结果:三阴乳腺癌患者发生基因突变21例,总体发生率13.46％,BRCA1突变15例,BRCA2突变6例.Log-Rank检验结果显示,发病年龄越大,ECOG评分越高,临床分期越晚,淋巴结阳性数越多,预后越差(P＜0.05),而发病时月经状态和给药方式与预后无关.COX风险比例回归模型显示,肿瘤大小(相对危险度,3.163;95％CI:1.455～9.287;P＜0.05)和淋巴结转移数(相对危险度,1.859;95％CI:1.254～6.875;P＜0.05)是BRCA基因突变三阴性乳腺癌独立的预后因素.结论:BRCA1和BRCA2基因突变可能与乳腺癌尤其是三阴乳腺癌可能有着密切的相关性,发病年龄、ECOG评分,临床分期和淋巴结阳性数及肿瘤大小与BRCA基因突变的三阴乳腺癌预后有关.     

乳腺癌相关基因BRCA1和BRCA2专利案引发的基因可专利性思考

<正>基因发明的可专利性多年来一直备受争议,其在一些主要国家均能获专利保护,然而,美国最高法院于2013年对Myriad案的判决改变了美国对于基因可专利这个议题的态度,并进一步影响了美国专利商标局(USPTO)的相关专利的审查标准,本文通过回顾和分析Myriad案始末,探讨该案对美国基因专利领域的深远影响,以期对我国拟进军美国相关市场的专利申请人提出建议。     

Informed consent documents for BRCA1 and BRCA2 screening: how large is the readability gap?

The decision to undergo testing for the BRCA1 and BRCA2 mutations, which are associated with an increased risk of breast and ovarian cancer, can have long-term consequences on women's lives. Women who decide to undergo such testing are required to sign informed consent documents, which indicate that they understand the test and its risks and benefits. These documents are generally written for advanced-level readers. However, the reading abilities of many women are substantially lower than the level of the consent forms, resulting in a 'readability gap'. This disparity suggests that women may not fully understand the documents they are asked to sign. The 'readability gap' poses the serious issues about informed consent, raising questions about institutional review boards and the effectiveness of the documents that are currently in use.