Medicine Institute, Cleveland Clinic Foundation Cleveland, OH
Muhammad Salman Faisal, MD1, Carol A. Burke, MD, FACG2, Mohammad A. Abbass, MD3, Brandie Leach2, Margaret O'Malley2, Lisa LaGuardia, BSN2, Susan Milicia, BSN, RN2, David Liska, MD2, Matthew Kalady, MD2, James Church, MD2, Gautam Mankaney, MD4; 1Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic Foundation, Cleveland, OH; 3General Surgery, Cleveland, OH; 4Cleveland Clinic, Cleveland, OH
Introduction: Individuals with Lynch syndrome (LS) and Lynch-Like Syndrome (LLS) develop microsatellite unstable colorectal tumors that produce neo-antigens. Neo-antigens are highly immunogenic, resulting in enhanced immune surveillance of tumors. The impact of inflammatory, auto-immune conditions on cancer in these patients is not known. We compared the cancer incidence in patients with and without comorbid inflammatory diseases (CID). Methods: Patients with LS (pathogenic variant in a mismatch repair gene), or LLS (Amsterdam positive family history with MSI-H tumor) from a hereditary cancer registry undergoing surveillance were identified. Those with a CID disease (IBD/rheumatic disease) based on ICD-10 criteria were selected and considered “cases”. LS and LLS patients without a comorbid inflammatory disease were matched for age, gender, and genetic mutation in a 2:1 ratio and considered “controls”. We compared proportion of patients with cancer at the time of last follow up visit between the two groups. Results: 21 patients with LS/LLS and CID were compared to 43 controls. Mean age for cases was 53.9±15.7 yrs compared to controls 53.8±7.8 yrs. There was no major difference in race, sex, smoking and family history between the two groups (Table 1). Colonoscopies per yr following LS/LLS diagnosis was 0.89 in cases compared to 0.86 in controls (p=0.86). 76.2% cases vs 53.5% controls had a history of complete or partial colectomy. 83% of female cases compared to 76% of female controls had a TAH-BSO prophylactically or for endometrial cancer. Mean age at CID diagnosis was 38.9 ± 13.4 yrs. Diseases included: Crohn’s 5 (23.8%), ulcerative colitis 2 (9.5%), inflammatory/rheumatoid arthritis 7(33.3%), psoriatic arthritis 1(4.8), psoriasis 3(14.3%), and one case each of dermatomyositis, ankylosing spondylitis, and sarcoidosis. 84.2% cases developed any cancer compared to 76.7% in controls (p=0.74). Age at 1st cancer diagnosis was 45.5±14.6 yrs in cases and 43.8±7.1 yrs in controls (p=0.67). Cancer incidence after CID diagnosis was 57.1% in cases with median 10(6.0-16.5) yr follow-up versus 46.5% in controls (p=0.42) when followed for 10 yrs prior to their last follow up or death. Most of these were LS specific cancers: 52.4% of cases vs 44.2% of controls (p=0.54). Discussion: Our data does not demonstrate substantially different incidence rates of cancer between LS/LLS patients with and without comorbid inflammatory disease.
Disclosures: Muhammad Salman Faisal indicated no relevant financial relationships. Carol Burke indicated no relevant financial relationships. Mohammad Abbass indicated no relevant financial relationships. Brandie Leach indicated no relevant financial relationships. Margaret O''Malley indicated no relevant financial relationships. Lisa LaGuardia indicated no relevant financial relationships. Susan Milicia indicated no relevant financial relationships. David Liska indicated no relevant financial relationships. Matthew Kalady indicated no relevant financial relationships. James Church indicated no relevant financial relationships. Gautam Mankaney indicated no relevant financial relationships.