The subset of ovarian cancer (OC) diagnosed ≤ 30yo represents a distinct subgroup exhibiting disparities from late-onset OC in many aspects, including indefinite germline cancer predisposition. We performed DNA/RNA-WES with HLA-typing, PRS assessment and survival analysis in 123 early-onset OC-patients compared to histology/stage-matched late-onset and unselected OC-patients, and population-matched controls. Only 6/123(4.9%) early-onset OC-patients carried a germline pathogenic variant (GPV) in high-penetrance OC-predisposition genes. Nevertheless, our comprehensive germline analysis of early-onset OC-patients revealed two divergent trajectories of potential germline susceptibility. Firstly, overrepresentation analysis highlighted a connection to breast cancer (BC) that was supported by the CHEK2 GPV enrichment in early-onset OC(p = 1.2 × 10-4), and the presumably BC-specific PRS313, which successfully stratified early-onset OC-patients from controls(p = 0.03). The second avenue pointed towards the impaired immune response, indicated by LY75-CD302 GPV(p = 8.3 × 10-4) and diminished HLA diversity compared with controls(p = 3 × 10-7). Furthermore, we found a significantly higher overall GPV burden in early-onset OC-patients compared to controls(p = 3.8 × 10-4). The genetic predisposition to early-onset OC appears to be a heterogeneous and complex process that goes beyond the traditional Mendelian monogenic understanding of hereditary cancer predisposition, with a significant role of the immune system. We speculate that rather a cumulative overall GPV burden than specific GPV may potentially increase OC risk, concomitantly with reduced HLA diversity.

• MeSH
• checkpoint kinasa 2 genetika   MeSH
• dospělí MeSH
• genetická predispozice k nemoci * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nádory vaječníků * genetika   MeSH
• studie případů a kontrol MeSH
• věk při počátku nemoci * MeSH
• zárodečné mutace * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The polygenic risk score (PRS) allows the quantification of the polygenic effect of many low-penetrance alleles on the risk of breast cancer (BC). This study aimed to evaluate the performance of two sets comprising 77 or 313 low-penetrance loci (PRS77 and PRS313) in patients with BC in the Czech population. METHODS: In a retrospective case-control study, variants were genotyped from both the PRS77 and PRS313 sets in 1329 patients with BC and 1324 noncancer controls, all women without germline pathogenic variants in BC predisposition genes. Odds ratios (ORs) were calculated according to the categorical PRS in individual deciles. Weighted Cox regression analysis was used to estimate the hazard ratio (HR) per standard deviation (SD) increase in PRS. RESULTS: The distributions of standardized PRSs in patients and controls were significantly different (p < 2.2 × 10-16) with both sets. PRS313 outperformed PRS77 in categorical and continuous PRS analyses. For patients in the highest 2.5% of PRS313, the risk reached an OR of 3.05 (95% CI, 1.66-5.89; p = 1.76 × 10-4). The continuous risk was estimated as an HRper SD of 1.64 (95% CI, 1.49-1.81; p < 2.0 × 10-16), which resulted in an absolute risk of 21.03% at age 80 years for individuals in the 95th percentile of PRS313. Discordant categorization into PRS deciles was observed in 248 individuals (9.3%). CONCLUSIONS: Both PRS77 and PRS313 are able to stratify individuals according to their BC risk in the Czech population. PRS313 shows better discriminatory ability. The results support the potential clinical utility of using PRS313 in individualized BC risk prediction.

• MeSH
• dospělí MeSH
• genetická predispozice k nemoci * MeSH
• genetické rizikové skóre MeSH
• hodnocení rizik metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multifaktoriální dědičnost genetika   MeSH
• nádory prsu * genetika   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

Ovarian cancer (OC) is one of the leading causes of cancer-related deaths in women. Most patients are diagnosed with advanced epithelial OC in their late 60s, and early-onset adult OC diagnosed ≤30 years is rare, accounting for less than 5% of all OC cases. The most significant risk factor for OC development are germline pathogenic/likely pathogenic variants (GPVs) in OC predisposition genes (including BRCA1, BRCA2, BRIP1, RAD51C, RAD51D, Lynch syndrome genes, or BRIP1), which contribute to the development of over 20% of all OC cases. GPVs in BRCA1/BRCA2 are the most prevalent. The presence of a GPV directs tailored cancer risk-reducing strategies for OC patients and their relatives. Identification of OC patients with GPVs can also have therapeutic consequences. Despite the general assumption that early cancer onset indicates higher involvement of hereditary cancer predisposition, the presence of GPVs in early-onset OC is rare (<10% of patients), and their heritability is uncertain. This review summarizes the current knowledge on the genetic predisposition to early-onset OC, with a special focus on epithelial OC, and suggests other alternative genetic factors (digenic, oligogenic, polygenic heritability, genetic mosaicism, imprinting, etc.) that may influence the development of early-onset OC in adult women lacking GPVs in known OC predisposition genes.

• MeSH
• dospělí MeSH
• epiteliální ovariální karcinom genetika   MeSH
• genetická predispozice k nemoci * MeSH
• geny BRCA2 MeSH
• lidé MeSH
• nádory vaječníků * patologie   MeSH
• protein BRCA1 genetika   MeSH
• protein BRCA2 genetika   MeSH
• rizikové faktory MeSH
• zárodečné mutace MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Zárodečné mutace v predispozičních genech se podílejí na vzniku přibližně 10% všech karcinomů prsu, ale podíl genetických faktorů na vzniku onemocnění je vyšší. V posledních letech byla díky celogenomovým asociačním (GWAS) studiím identifikována skupina častých jednonukleotidových polymorfismů (SNPs), které individuálně velmi málo, avšak signifikantně, modifikují riziko vzniku karcinomu prsu. Výskyt konkrétních SNP u jedince vede k jejich aditivnímu účinku na riziko vzniku karcinomu prsu. Genotypizace polymorfních lokusů umožňuje riziko onemocnění kvantifikovat a na základě tzv. skóre polygenního rizika (PRS) stratifikovat. Výsledkem studie bude zhodnocení klinického využití stanovení PRS pro stratifikaci rizika vzniku karcinomu prsu u nosiček mutací v predispozičních genech bez nádorového onemocnění, které by umožnilo určení vhodného postupu a načasování preventivních opatření snižujících riziko vzniku onemocnění. Sekundárním cílem je zhodnocení výpovědní hodnoty stanovení PRS jako nezávislého faktoru ovlivňujícího riziko vzniku karcinomu prsu v obecné populaci žen v ČR.; Germline mutations in susceptibility genes predispose to approx. 10% of all breast cancer (BC) cases, but genetic factors cause much higher fraction of all BC cases. Recently, many rare single nucleotide polymorphisms (SNPs) were identified in genome-wide association studies (GWAS). These SNPs each account for a very low of risk, but when many risk variants are considered collectively, their predictive power is much greater. A combination of particular SNPs in an individual lead to their cumulative effect increasing the BC risk. Genotyping of these loci enables a calculation of polygenic risk score (PRS) for modification and individualization BC risk estimates. We will evaluate of a clinical utility of PRS for a stratification of BC risk in healthy carriers of mutation in predisposition genes, which could facilitate to assess a proper management and timing of preventive steps decreasing the BC risk. Another result is an estimation of a clinical value of PRS determination as an independent factor influencing risk of BC development in general population of women in the Czech Republic.

• Klíčová slova
• breast cancer, karcinom prsu, stratifikace rizika, risk stratification, PRS-polygenic risk score, PRS-polygenic risk score,

• NLK Publikační typ
• závěrečné zprávy o řešení grantu AZV MZ ČR