Prevalence of defective DNA mismatch repair and MSH6 mutation in an unselected series of endometrial cancers.
Endometrial cancer is the most common gynecologic malignancy in the United States and the most frequent extracolonic tumor in hereditary nonpolyposis colorectal cancer (HNPCC). HNPCC patients have inherited defects in DNA mismatch repair and the microsatellite instability (MSI) tumor phenotype. Sporadic endometrial cancers also exhibit MSI, usually associated with methylation of the MLH1 promoter. Germ-line MSH6 mutations, which are rare in HNPCC, have been reported in several families with multiple members affected with endometrial carcinoma. We reasoned that MSH6 mutation might account for loss of mismatch repair in MSI-positive endometrial cancers in which the cause of MSI is unknown. We therefore investigated MSI and MLH1 promoter methylation in 441 endometrial cancer patients unselected for age or personal and family history of cancers. MSI and MLH1 promoter methylation status were associated with age of onset and tumor histology. One hundred cases (23% of the entire series) were evaluated for MSH6 defects. Inactivating germ-line MSH6 mutations were identified in seven women with MSI-positive, MLH1 promoter unmethylated cancers. Most of the MSI in these cases was seen with mononucleotide repeat markers. The MSH6 mutation carriers were significantly younger than the rest of the population (mean age 54.8 versus 64.6, P = 0.04). Somatic mutations were seen in 17 tumors, all of which had MSI. Our data suggest that inherited defects in MSH6 in women with endometrial cancer are relatively common. The minimum estimate of the prevalence of inherited MSH6 mutation in endometrial cancer is 1.6% (7 of 441), comparable with the predicted prevalence for patients with colorectal cancer.
Department of Surgery, Washington University School of Medicine, Campus Box 8109, 660 South Euclid Avenue, St. Louis, MO 63110, USA. goodfellowp@msnotes.wustl.edu
Paul J
PJ
Goodfellow
Barbara M
BM
Buttin
Thomas J
TJ
Herzog
Janet S
JS
Rader
Randall K
RK
Gibb
Elizabeth
E
Swisher
Katherine
K
Look
Ken C
KC
Walls
Ming-Yu
MY
Fan
David G
DG
Mutch
D000367:Age Factors; D000595:Amino Acid Sequence; D020137:Base Pair Mismatch / Q000235:genetics*; D003062:Codon / Q000235:genetics; D018388:Codon, Terminator / Q000235:genetics; D019175:DNA Methylation; D004251:DNA Transposable Elements / Q000235:genetics; D004268:DNA-Binding Proteins / Q000235:genetics*; D016889:Endometrial Neoplasms / Q000235:genetics*; D004717:Endometrium / Q000378:metabolism; D005091:Exons / Q000235:genetics; D005260:Female; D016368:Frameshift Mutation; D014644:Genetic Variation; D006801:Humans; D008875:Middle Aged; D008969:Molecular Sequence Data; D016254:Mutagenesis, Insertional; D009154:Mutation; D018807:Polymorphism, Single-Stranded Conformational; D012016:Reference Values; D017384:Sequence Deletion
D003062:Codon; D018388:Codon, Terminator; D004251:DNA Transposable Elements; D004268:DNA-Binding Proteins; C094443:G-T mismatch-binding protein