title: Gastrointestinal stromal tumors: a case-only analysis of single nucleotide polymorphisms and somatic mutations.
abstract: BACKGROUND
  Gastrointestinal stromal tumors are rare soft tissue sarcomas that typically develop from mesenchymal cells with acquired gain-in-function mutations in KIT or PDGFRA oncogenes. These somatic mutations have been well-characterized, but little is known about inherited genetic risk factors. Given evidence that certain susceptibility loci and carcinogens are associated with characteristic mutations in other cancers, we hypothesized that these signature KIT or PDGFRA mutations may be similarly fundamental to understanding gastrointestinal stromal tumor etiology. Therefore, we examined associations between 522 single nucleotide polymorphisms and seven KIT or PDGFRA tumor mutations types. Candidate pathways included dioxin response, toxin metabolism, matrix metalloproteinase production, and immune and inflammatory response.
  
  
  METHODS
  We estimated odds ratios and 95% confidence intervals for associations between each candidate SNP and tumor mutation type in 279 individuals from a clinical trial of adjuvant imatinib mesylate. We used sequence kernel association tests to look for pathway-level associations.
  
  
  RESULTS
  One variant, rs1716 on ITGAE, was significantly associated with KIT exon 11 non-codon 557-8 deletions (odds ratio = 2.86, 95% confidence interval: 1.71-4.78) after adjustment for multiple comparisons. Other noteworthy associations included rs3024498 (IL10) and rs1050783 (F13A1) with PDGFRA mutations, rs2071888 (TAPBP) with wild type tumors and several matrix metalloproteinase SNPs with KIT exon 11 codon 557-558 deletions. Several pathways were strongly associated with somatic mutations in PDGFRA, including defense response (p = 0.005) and negative regulation of immune response (p = 0.01).
  
  
  CONCLUSIONS
  This exploratory analysis offers novel insights into gastrointestinal stromal tumor etiology and provides a starting point for future studies of genetic and environmental risk factors for the disease.
authors.forename: Katie M
authors.initials: KM
authors.lastname: O'Brien
authors.forename: Irene
authors.initials: I
authors.lastname: Orlow
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Antonescu
authors.forename: Karla
authors.initials: K
authors.lastname: Ballman
authors.forename: Linda
authors.initials: L
authors.lastname: McCall
authors.forename: Ronald
authors.initials: R
authors.lastname: Dematteo
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. Larry.Engel@unc.edu.
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Engel