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431.
Lindor NM Guidugli L Wang X Vallée MP Monteiro AN Tavtigian S Goldgar DE Couch FJ 《Human mutation》2012,33(1):8-21
Clinical mutation screening of the BRCA1 and BRCA2 genes for the presence of germline inactivating mutations is used to identify individuals at elevated risk of breast and ovarian cancer. Variants identified during screening are usually classified as pathogenic (increased risk of cancer) or not pathogenic (no increased risk of cancer). However, a significant proportion of genetic tests yields variants of uncertain significance (VUS) that have undefined risk of cancer. Individuals carrying these VUS cannot benefit from individualized cancer risk assessment. Recently, a quantitative "posterior probability model" for assessing the clinical relevance of VUS in BRCA1 or BRCA2, which integrates multiple forms of genetic evidence has been developed. Here, we provide a detailed review of this model. We describe the components of the model and explain how these can be combined to calculate a posterior probability of pathogenicity for each VUS. We explain how the model can be applied to public data and provide tables that list the VUS that have been classified as not pathogenic or pathogenic using this method. While we use BRCA1 and BRCA2 VUS as examples, the method can be used as a framework for classification of the pathogenicity of VUS in other cancer genes. 相似文献
432.
Dhirapong A Lleo A Yang GX Tsuneyama K Dunn R Kehry M Packard TA Cambier JC Liu FT Lindor K Coppel RL Ansari AA Gershwin ME 《Hepatology (Baltimore, Md.)》2011,53(2):527-535
Primary biliary cirrhosis (PBC) is considered a model autoimmune disease due to the clinical homogeneity of patients and the classic hallmark of antimitochondrial antibodies (AMAs). Indeed, the presence of AMAs represents the most highly directed and specific autoantibody in autoimmune diseases. However, the contribution of B cells to the pathogenesis of PBC is unclear. Therefore, although AMAs appear to interact with the biliary cell apotope and contribute to biliary pathology, there is no correlation of disease severity and titer of AMAs. The recent development of well-characterized monoclonal antibodies specific for the B cell populations, anti-CD20 and anti-CD79, and the development of a well-defined xenobiotic-induced model of autoimmune cholangitis prompted us to use these reagents and the model to address the contribution of B cells in the pathogenesis of murine PBC. Prior to the induction of autoimmune cholangitis, mice were treated with either anti-CD20, anti-CD79, or isotype-matched control monoclonal antibody and followed for B cell development, the appearance of AMAs, liver pathology, and cytokine production. Results of the studies reported herein show that the in vivo depletion of B cells using either anti-CD20 or anti-CD79 led to the development of a more severe form of cholangitis than observed in control mice, which is in contrast with results from several other autoimmune models that have documented an important therapeutic role of B cell-specific depletion. Anti-CD20/CD79-treated mice had increased liver T cell infiltrates and higher levels of proinflammatory cytokines. CONCLUSION: Our results reflect a novel disease-protective role of B cells in PBC and suggest that B cell depletion therapy in humans with PBC should be approached with caution. 相似文献
433.
Primary sclerosing cholangitis (PSC) is a chronic fibroinflammatory syndrome involving the biliary tract, often accompanied by inflammatory bowel disease (IBD). This syndrome is a prototype disease linking chronic inflammation to carcinogenesis. Indeed, PSC is associated with an increased risk of cholangiocarcinoma (CCA), gallbladder cancer, hepatocellular carcinoma (HCC), and colorectal cancer. Herein, we review the risk for these malignancies in PSC and discuss rational cancer surveillance strategies for these patients. Where evidence is limited, we suggest a pragmatic approach. In this regard, we recommend interval screening for CCA with noninvasive imaging modalities and serum carbohydrate antigen 19-9 determinations annually. These imaging studies also serve to screen for gallbladder cancer and HCC. Screening for colorectal cancer is more firmly established in PSC patients with IBD and includes colonoscopy at the time of PSC diagnosis and, thereafter, at 1-2-year intervals. We also highlight areas where more information is required, such as management of biliary tract dysplasia and cancer chemoprevention in PSC. 相似文献
434.
435.
Primary sclerosing cholangitis (PSC) is a chronic cholestatic condition affecting the extrahepatic and intrahepatic biliary tree. The incidence is seemingly increasing in children as a result of increased use of cholangiographic screening techniques in children with inflammatory bowel disease. The clinical presentation of PSC in childhood is variable and frequently without obvious cholestatic features, and cholangiography is essential for the diagnosis of this disorder. Histologic findings may help to exclude autoimmune sclerosing cholangitis. The underlying pathogenesis remains poorly understood and, as a result, therapeutic agents that halt disease progression and improve prognosis are lacking. PSC treatment is mainly supportive and directed at controlling cholestatic symptoms and preventing complications. Ursodeoxycholic acid is helpful in inducing biochemical improvement; long-term pediatric studies to determine a benefit of this agent in young patients are lacking, although results from adult studies have not been promising. Some agents such as antibiotics are under investigation with some promising results. Liver transplantation is required for children who progress to end-stage liver disease. Prospective multicenter trials in children with PSC are needed. 相似文献
436.
437.
Jenkins MA Hayashi S O'Shea AM Burgart LJ Smyrk TC Shimizu D Waring PM Ruszkiewicz AR Pollett AF Redston M Barker MA Baron JA Casey GR Dowty JG Giles GG Limburg P Newcomb P Young JP Walsh MD Thibodeau SN Lindor NM Lemarchand L Gallinger S Haile RW Potter JD Hopper JL Jass JR;Colon Cancer Family Registry 《Gastroenterology》2007,133(1):48-56
BACKGROUND & AIMS: The revised Bethesda guidelines for Lynch syndrome recommend microsatellite instability (MSI) testing all colorectal cancers in patients diagnosed before age 50 years and colorectal cancers diagnosed in patients between ages 50 and 59 years with particular pathology features. Our aim was to identify pathology and other features that independently predict high MSI (MSI-H). METHODS: Archival tissue from 1098 population-based colorectal cancers diagnosed before age 60 years was tested for MSI. Pathology features, site, and age at diagnosis were obtained. Multiple logistic regression was performed to determine the predictive value of each feature, as measured by an odds ratio (OR), from which a scoring system (MsPath) was developed to estimate the probability a colorectal cancer is MSI-H. RESULTS: Fifteen percent of tumors (162) were MSI-H. Independent predictors were tumor-infiltrating lymphocytes (OR, 9.1; 95% confidence interval [CI], 5.9-14.1), proximal subsite (OR, 4.7; 95% CI, 3.1-7.3), mucinous histology (OR, 2.8; 95% CI, 1.7-4.8), poor differentiation (OR, 1.9; 95% CI, 1.2-3.1), Crohn's-like reaction (OR, 1.9; 95% CI, 1.2-2.9), and diagnosis before age 50 years (OR, 1.9; 95% CI, 1.3-2.9). MsPath score >or=1.0 had a sensitivity of 93% and a specificity of 55% for MSI-H. CONCLUSIONS: The probability an individual colorectal cancer is MSI-H is predicted well by the MsPath score. There is little value in testing for DNA mismatch repair loss in tumors, or for germline mismatch repair mutations, for colorectal cancers diagnosed in patients before age 60 years with an MSPath score <1 (approximately 50%). Pathology can identify almost all MSI-H colorectal cancers diagnosed before age 60 years. 相似文献
438.
Lindor NM Lindor RA Apicella C Dowty JG Ashley A Hunt K Mincey BA Wilson M Smith MC Hopper JL 《Familial cancer》2007,6(4):473-482
Context Models have been developed to predict the probability that a person carries a detectable germline mutation in the BRCA1 or BRCA2 genes. Their relative performance in a clinical setting is unclear.
Objective To compare the performance characteristics of four BRCA1/BRCA2 gene mutation prediction models: LAMBDA, based on a checklist and scores developed from data on Ashkenazi Jewish (AJ) women;
BRCAPRO, a Bayesian computer program; modified Couch tables based on regression analyses; and Myriad II tables collated by
Myriad Genetics Laboratories.
Design and setting Family cancer history data were analyzed from 200 probands from the Mayo Clinic Familial Cancer Program, in a multispecialty
tertiary care group practice. All probands had clinical testing for BRCA1 and BRCA2 mutations conducted in a single laboratory.
Main outcomes measures For each model, performance was assessed by the area under the receiver operator characteristic curve (ROC) and by tests of
accuracy and dispersion. Cases “missed” by one or more models (model predicted less than 10% probability of mutation when
a mutation was actually found) were compared across models.
Results All models gave similar areas under the ROC curve of 0.71 to 0.76. All models except LAMBDA substantially under-predicted
the numbers of carriers. All models were too dispersed.
Conclusions In terms of ranking, all prediction models performed reasonably well with similar performance characteristics. Model predictions
were widely discrepant for some families. Review of cancer family histories by an experienced clinician continues to be vital
to ensure that critical elements are not missed and that the most appropriate risk prediction figures are provided. 相似文献
439.
C. Fiorella Murillo Perez Stephanie Ioannou Iman Hassanally Palak J. Trivedi Christophe Corpechot Adriaan J. van der Meer Willem J. Lammers Pier Maria Battezzati Keith D. Lindor Frederik Nevens Kris V. Kowdley Tony Bruns Nora Cazzagon Annarosa Floreani Andrew L. Mason Aliya Gulamhusein Cyriel Y. Ponsioen Marco Carbone Ana Lleo Marlyn J. Mayo George N. Dalekos Nikolaos K. Gatselis Douglas Thorburn Xavier Verhelst Albert Parés Maria-Carlota Londoño Harry L. A. Janssen Pietro Invernizzi Raj Vuppalanchi Gideon M. Hirschfield Bettina E. Hansen Cynthia Levy the Global PBC Study Group 《Liver international》2023,43(7):1497-1506