International Journal of Colorectal Disease

, Volume 23, Issue 8, pp 801–806

Proximal colon cancer in patients aged 51–60 years of age should be tested for microsatellites instability. A comment on the Revised Bethesda Guidelines

  • E. Urso
  • S. Pucciarelli
  • M. Agostini
  • I. Maretto
  • C. Mescoli
  • R. Bertorelle
  • A. Viel
  • M. Rugge
  • D. Nitti
Original Article

DOI: 10.1007/s00384-008-0484-2

Cite this article as:
Urso, E., Pucciarelli, S., Agostini, M. et al. Int J Colorectal Dis (2008) 23: 801. doi:10.1007/s00384-008-0484-2

Abstract

Purpose

The Bethesda guidelines suggest to perform microsatellite instability (MSI) test in early onset rectal cancer and not in patients >50 years with proximal colon cancer. The aim of the study was to evaluate whether the risk of high MSI (MSI-H) is greater in proximal colon cancer of patients 51–60 years old than in early-onset rectal cancer.

Methods

Consecutive colorectal cancer (CRC) patients were evaluated. Tumor location, cancer family history, MSI status and histology were recorded. Mutations in MLH1/MSH2 were investigated in MSI-H tumors. Patients were subdivided into groups: group A, proximal colon cancer patients 51–60 years old and groups B, C and D, patients ≤50 years old, with rectal cancer, proximal and distal colon cancer, respectively.

Results

Out of 409 CRC patients evaluated, 48 (12%) showed tumors with MSI-H. No MSI-H tumors were found in distal and rectal tumors of patients at sixth decade of life. Group A included 27 patients, eight (29.7%) MSI-H cancers, four missense mutations in MLH1/MSH2; groups B, C and D included 26, 11 and 11 patients with two (7.7%), two (18%) and two (18%) MSI-H cancers, respectively. One missense mutation on MSH2 in group B, one pathogenetic mutation on MSH1 in group C and one pathogenetic mutation on MSH2 in group D were found. Tumors of group A showed an increased probability to have MSI-H if compared to those of group B (OD = 4.907, p = 0.043).

Conclusions

The Bethesda criteria should be broadened to include patients 51–60 years old with proximal colon cancer.

Keywords

Colorectal cancerMicrosatellite instabilityHereditary non-polyposisColorectal cancer (HNPCC)Inherited gastrointestinal syndromes

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • E. Urso
    • 1
  • S. Pucciarelli
    • 1
    • 5
  • M. Agostini
    • 1
  • I. Maretto
    • 1
  • C. Mescoli
    • 2
  • R. Bertorelle
    • 3
  • A. Viel
    • 4
  • M. Rugge
    • 2
  • D. Nitti
    • 1
  1. 1.Clinica Chirurgica IIUniversity of PadovaPaduaItaly
  2. 2.II Servizio di Anatomia PatologicaUniversity of PadovaPaduaItaly
  3. 3.Servizio Immunologia e Diagnostica Molecolare OncologicaIstituto Oncologico VenetoPaduaItaly
  4. 4.I Servizio di Oncologia SperimentaleCentro di Riferimento Oncologico (CRO)AvianoItaly
  5. 5.Dipartimento di Scienze Oncologiche e ChirurgicheClinica Chirurgica IIPaduaItaly