Showing papers by "Michael Goggins published in 2015"

A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas.

Abstract: International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to invasive carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: (1) To improve concordance and to align with practical consequences, a 2-tiered system (low vs. high grade) is proposed for all precursor lesions, with the provision that the current PanIN-2 and neoplasms with intermediate-grade dysplasia now be categorized as low grade. Thus, "high-grade dysplasia" is to be reserved for only the uppermost end of the spectrum ("carcinoma in situ"-type lesions). (2) Current data indicate that PanIN of any grade at a margin of a resected pancreas with invasive carcinoma does not have prognostic implications; the clinical significance of dysplasia at a margin in a resected pancreas with IPMN lacking invasive carcinoma remains to be determined. (3) Intraductal lesions 0.5 to 1 cm can be either large PanINs or small IPMNs. The term "incipient IPMN" should be reserved for lesions in this size with intestinal or oncocytic papillae or GNAS mutations. (4) Measurement of the distance between an IPMN and invasive carcinoma and sampling of intervening tissue are recommended to assess concomitant versus associated status. Conceptually, concomitant invasive carcinoma (in contrast with the "associated" group) ought to be genetically distinct from an IPMN elsewhere in the gland. (5) "Intraductal spread of invasive carcinoma" (aka, "colonization") is recommended to describe lesions of invasive carcinoma invading back into and extending along the ductal system, which may morphologically mimic high-grade PanIN or even IPMN. (6) "Simple mucinous cyst" is recommended to describe cysts >1 cm having gastric-type flat mucinous lining at most minimal atypia without ovarian-type stroma to distinguish them from IPMN. (7) Human lesions resembling the acinar to ductal metaplasia and atypical flat lesions of genetically engineered mouse models exist and may reflect an alternate pathway of carcinogenesis; however, their biological significance requires further study. These revised recommendations are expected to improve our management and understanding of precursor lesions in the pancreas.

Common variation at 2p13.3, 3q29, 7p13 and 17q25.1 associated with susceptibility to pancreatic cancer

Abstract: Pancreatic cancer is the fourth leading cause of cancer death in the developed world. Both inherited high-penetrance mutations in BRCA2 (ref. 2), ATM, PALB2 (ref. 4), BRCA1 (ref. 5), STK11 (ref. 6), CDKN2A and mismatch-repair genes and low-penetrance loci are associated with increased risk. To identify new risk loci, we performed a genome-wide association study on 9,925 pancreatic cancer cases and 11,569 controls, including 4,164 newly genotyped cases and 3,792 controls in 9 studies from North America, Central Europe and Australia. We identified three newly associated regions: 17q25.1 (LINC00673, rs11655237, odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.19-1.34, P = 1.42 × 10(-14)), 7p13 (SUGCT, rs17688601, OR = 0.88, 95% CI = 0.84-0.92, P = 1.41 × 10(-8)) and 3q29 (TP63, rs9854771, OR = 0.89, 95% CI = 0.85-0.93, P = 2.35 × 10(-8)). We detected significant association at 2p13.3 (ETAA1, rs1486134, OR = 1.14, 95% CI = 1.09-1.19, P = 3.36 × 10(-9)), a region with previous suggestive evidence in Han Chinese. We replicated previously reported associations at 9q34.2 (ABO), 13q22.1 (KLF5), 5p15.33 (TERT and CLPTM1), 13q12.2 (PDX1), 1q32.1 (NR5A2), 7q32.3 (LINC-PINT), 16q23.1 (BCAR1) and 22q12.1 (ZNRF3). Our study identifies new loci associated with pancreatic cancer risk.

Analysis of heritability and shared heritability based on genome-wide association studies for thirteen cancer types

Abstract: Background: Studies of related individuals have consistently demonstrated notable familial aggregation of cancer. We aim to estimate the heritability and genetic correlation attributable to the add ...

Time to progression of pancreatic ductal adenocarcinoma from low-to-high tumour stages

Abstract: Objective Although pancreatic ductal adenocarcinoma is considered a rapidly progressive disease, mathematical models estimate that it takes many years for an initiating pancreatic cancer cell to grow into an advanced stage cancer. In order to estimate the time it takes for a pancreatic cancer to progress through different tumor, node, metastasis (TNM) stages, we compared the mean age of patients with pancreatic cancers of different sizes and stages. Design Patient age, tumour size, stage and demographic information were analysed for 13 131 patients with pancreatic ductal adenocarcinoma entered into the National Cancer Institute9s Surveillance, Epidemiology and End Results (SEER) database. Multiple linear regression models for age were generated, adjusting for patient ethnicity, gender, tumour location and neoplastic grades. Results African-American ethnicity and male gender were associated with an earlier age at diagnosis. Patients with stage I cancers (mean age 64.8 years) were on average 1.3 adjusted years younger at diagnosis than those with stage IV cancers (p=0.001). Among patients without distant metastases, those with T1 stage cancers were on average 1.06 and 1.19 adjusted years younger, respectively, than patients with T3 or T4 cancers (p=0.03 for both). Among patients with stage IIB cancers, those with T1/T2 cancers were 0.79 adjusted years younger than those with T3 cancers (p=0.06). There was no significant difference in the mean adjusted age of patients with stage IA versus stage IB cancers. Conclusions These results are consistent with the hypothesis that once pancreatic ductal adenocarcinomas become detectable clinically progression from low-stage to advanced-stage disease is rapid.

Vitamin D Metabolic Pathway Genes and Pancreatic Cancer Risk

Abstract: Evidence on the association between vitamin D status and pancreatic cancer risk is inconsistent. This inconsistency may be partially attributable to variation in vitamin D regulating genes. We selected 11 vitamin D-related genes (GC, DHCR7, CYP2R1, VDR, CYP27B1, CYP24A1, CYP27A1, RXRA, CRP2, CASR and CUBN) totaling 213 single nucleotide polymorphisms (SNPs), and examined associations with pancreatic adenocarcinoma. Our study included 3,583 pancreatic cancer cases and 7,053 controls from the genome-wide association studies of pancreatic cancer PanScans-I-III. We used the Adaptive Joint Test and the Adaptive Rank Truncated Product statistic for pathway and gene analyses, and unconditional logistic regression for SNP analyses, adjusting for age, sex, study and population stratification. We examined effect modification by circulating vitamin D concentration (≤50, >50 nmol/L) for the most significant SNPs using a subset of cohort cases (n = 713) and controls (n = 878). The vitamin D metabolic pathway was not associated with pancreatic cancer risk (p = 0.830). Of the individual genes, none were associated with pancreatic cancer risk at a significance level of p<0.05. SNPs near the VDR (rs2239186), LRP2 (rs4668123), CYP24A1 (rs2762932), GC (rs2282679), and CUBN (rs1810205) genes were the top SNPs associated with pancreatic cancer (p-values 0.008-0.037), but none were statistically significant after adjusting for multiple comparisons. Associations between these SNPs and pancreatic cancer were not modified by circulating concentrations of vitamin D. These findings do not support an association between vitamin D-related genes and pancreatic cancer risk. Future research should explore other pathways through which vitamin D status might be associated with pancreatic cancer risk.

Analysis of Heritability and Shared Heritability Based on Genome-Wide Association Studies for 13 Cancer Types

Abstract: Background: Studies of related individuals have consistently demonstrated notable familial aggregation of cancer. We aim to estimate the heritability and genetic correlation attributable to the additive effects of common single-nucleotide polymorphisms (SNPs) for cancer at 13 anatomical sites. Methods: Between 2007 and 2014, the US National Cancer Institute has generated data from genome-wide association studies (GWAS) for 49 492 cancer case patients and 34 131 control patients. We apply novel mixed model methodology (GCTA) to this GWAS data to estimate the heritability of individual cancers, as well as the proportion of heritability attributable to cigarette smoking in smoking-related cancers, and the genetic correlation between pairs of cancers. Results: GWAS heritability was statistically significant at nearly all sites, with the estimates of array-based heritability, hl 2, on the liability threshold (LT) scale ranging from 0.05 to 0.38. Estimating the combined heritability of multiple smoking characteristics, we calculate that at least 24% (95% confidence interval [CI] = 14% to 37%) and 7% (95% CI = 4% to 11%) of the heritability for lung and bladder cancer, respectively, can be attributed to genetic determinants of smoking. Most pairs of cancers studied did not show evidence of strong genetic correlation. We found only four pairs of cancers with marginally statistically significant correlations, specifically kidney and testes (ρ = 0.73, SE = 0.28), diffuse large B-cell lymphoma (DLBCL) and pediatric osteosarcoma (ρ = 0.53, SE = 0.21), DLBCL and chronic lymphocytic leukemia (CLL) (ρ = 0.51, SE =0.18), and bladder and lung (ρ = 0.35, SE = 0.14). Correlation analysis also indicates that the genetic architecture of lung cancer differs between a smoking population of European ancestry and a nonsmoking Asian population, allowing for the possibility that the genetic etiology for the same disease can vary by population and environmental exposures. Conclusion: Our results provide important insights into the genetic architecture of cancers and suggest new avenues for investigation. Studies of related individuals have consistently demonstrated that there is notable familial aggregation of cancer. The three largest studies, based on the Swedish Family-Cancer Database (1–3), the Utah Population and Cancer Registry Database (4,5), and the Icelandic Cancer Registry (6), have shown familial aggregation for cancer at nearly every anatomical site. For common cancers such as prostate, breast, and lung, the familial relative risk (FRR), defined as the increase in risk associated with each affected first-degree relative of an individual, is generally estimated to be below or around 2.0. In contrast, for some rare cancers occurring early in life, such as those of testes and bone, estimates of FRR can exceed 5. Although shared environmental factors contribute to this aggregation, studies of twins (7,8) and extended family members (6,9,10) have clearly identified a substantial genetic contribution, commonly known as heritability. Genome-wide association studies (GWAS) have provided an opportunity to study the contribution of common single-nucleotide polymorphisms (SNPs) to the heritability of complex traits, including cancers. In addition to identifying specific susceptibility SNPs, novel mixed-effect modeling methods (11–13) can utilize GWAS data to quantify the additive heritability attributable to all common susceptibility SNPs captured by genotyping arrays, regardless of whether those SNPs individually have reached the stringent level of genome-wide statistical significance. Understanding the total contribution of common SNPs will be instrumental for evaluating the potential clinical applications of genetics in risk stratification and for guiding future genetic studies of cancer(14,15). Evidence also suggests that there is overlap between cancers with respect to their genetic architectures. Previous family studies have observed familial co-aggregation of cancers among certain sites (5,6), including pairs of cancers at neighboring sites, such as the colon and rectum, as well as for more distant and seemingly unrelated sites such as the cervix and esophagus (6). GWAS have also directly identified shared regions such as 8q24.1 and 5p15.33 (TERT-CLPTM1L) containing SNPs affecting cancer at multiple sites, while earlier studies have identified major genes such as TP53 (16) and BRCA (17) containing highly penetrant rare variants affecting multiple cancers. Sites with overlapping genetic architectures may be studied together to understand shared biology and to increase power to detect susceptibility loci. In this study, we performed an analysis of heritability and shared heritability for cancer at 13 different sites using data from case/control GWAS of more than 80 000 individuals carried out or reported to the US National Cancer Institute. We expand upon recent GWAS estimates of heritability (13) by nearly doubling the number of cases evaluated, exploring six new cancer (sub)types, and considering populations of nonEuropean ancestry. We use detailed information on multiple D ow naded rom http/academ ic.p.com /jnci/article-ab07/12/djv279/2457731 by U niersity of Vrona user on 19 Feruary 2020 7 of 11 | JNCI J Natl Cancer Inst, 2015, Vol. 107, No. 12 a r t ic le a r t ic le smoking characteristics to assess the proportion of heritability in smoking-related cancers that can be attributed to the genetic determinants of cigarette smoking. Furthermore, we use genetic correlation analysis to assess shared heritability across cancer sites and for lung cancer across two distinct ethnic populations to assess the evidence of gene-environment interactions for this complex malignancy. These analyses provide insights into the contribution of common SNPs to cancer heritability, coheritability and their relationships to a major environmental risk-factor, smoking.

Pancreatic cancer: Classifying pancreatic cancer using gene expression profiling.

Abstract: Despite some advances in our understanding of the molecular characteristics of pancreatic cancer, much more progress is needed. In a new study, RNA profiling of pancreatic cancers was used to identify gene signatures of tumour cells and stromal cells to help predict patient outcomes.

Correction: Vitamin D Metabolic Pathway Genes and Pancreatic Cancer Risk

Abstract: Three authors are not included in the author byline. Laufey T. Amundadottir should be listed as the 8th author and affiliated with the Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. The contributions of this author are as follows: Performed the experiments, contributed reagents/materials/analysis/tools. Stephen J Chanock should be listed as the 15th author and affiliated with the National Cancer Institute, Division of Cancer Epidemiology & Genetics, Rockville. MD. The contributions of this author are as follows: performed the experiments, funded GWAS. Stephen Van Den Eeden should be listed as the 44th author and affiliated with the Kaiser Permanente Division of Research. 2000 Broadway, Oakland, CA 94612. The contributions of this author are as follows: conceived and designed the experiments, wrote the manuscript.