分析胰腺导管腺癌(PDAC)患者同源重组缺陷(HRD)的发生情况。
我们对PubMed,Scopus,和Cochrane图书馆数据库,和在线癌症基因组数据集。主要结果是在更好表征的HRD基因(BRCA1,BRCA2,PALB2,ATM,ATR,CHEK2,RAD51和FANC基因)。次要结果是种系突变的总体患病率,以及散发性和家族性病例;阿什肯纳齐犹太人(AJ)种系BRCA1/2突变的患病率;以及基于其他定义的HRD的患病率(即,其他基因的改变,基因组疤痕,和突变签名)。使用具有Freeman-Tukey变换的随机效应建模进行分析。PROSPERO注册号:(CRD42020190813)。
有21,842名参与者的60项研究被纳入系统评价,57项被纳入荟萃分析。种系和体细胞突变的患病率为BRCA1:0.9%,BRCA2:3.5%,PALB2:0.2%,ATM:2.2%,CHEK2:0.3%,FANC:0.5%,RAD51:0.0%,ATR:0.1%。种系突变的患病率为BRCA1:0.9%(AJ中为2.4%),BRCA2:3.8%(AJ为8.2%),PALB2:0.2%,ATM:2%,CHEK2:0.3%,和FANC:0.4%。散发性和家族性病例之间没有显着差异。通过靶向下一代测序,HRD患病率介于14.5%-16.5%之间,通过全基因组或全外显子组测序,允许互补基因组分析,HRD患病率介于24%-44%之间。包括基因组疤痕和其他特征(HRD的替代标记)。
与限于基因水平方法的分析相比,HRD的替代读数确定了更大比例的HRD患者。显然需要协调HRD定义并验证用于治疗选择的最佳生物标志物。应向所有PDAC患者提供通用HRD筛查,包括整合的体细胞和种系分析。
To analyze the prevalence of homologous recombination deficiency (HRD) in patients with pancreatic ductal adenocarcinoma (PDAC).
We conducted a systematic
review and meta-analysis of the prevalence of HRD in PDAC from PubMed, Scopus, and Cochrane Library databases, and online cancer genomic data sets. The main outcome was pooled prevalence of somatic and germline mutations in the better characterized HRD genes (BRCA1, BRCA2, PALB2, ATM, ATR, CHEK2, RAD51, and the FANC genes). The secondary outcomes were prevalence of germline mutations overall, and in sporadic and familial cases; prevalence of germline BRCA1/2 mutations in Ashkenazi Jewish (AJ); and prevalence of HRD based on other definitions (ie, alterations in other genes, genomic scars, and mutational signatures). Random-effects modeling with the Freeman-Tukey transformation was used for the analyses. PROSPERO registration number: (CRD42020190813).
Sixty studies with 21,842 participants were included in the systematic
review and 57 in the meta-analysis. Prevalence of germline and somatic mutations was BRCA1: 0.9%, BRCA2: 3.5%, PALB2: 0.2%, ATM: 2.2%, CHEK2: 0.3%, FANC: 0.5%, RAD51: 0.0%, and ATR: 0.1%. Prevalence of germline mutations was BRCA1: 0.9% (2.4% in AJ), BRCA2: 3.8% (8.2% in AJ), PALB2: 0.2%, ATM: 2%, CHEK2: 0.3%, and FANC: 0.4%. No significant differences between sporadic and familial cases were identified. HRD prevalence ranged between 14.5%-16.5% through targeted next-generation sequencing and 24%-44% through whole-genome or whole-exome sequencing allowing complementary genomic analysis, including genomic scars and other signatures (surrogate markers of HRD).
Surrogate readouts of HRD identify a greater proportion of patients with HRD than analyses limited to gene-level approaches. There is a clear need to harmonize HRD definitions and to validate the optimal biomarker for treatment selection. Universal HRD screening including integrated somatic and germline analysis should be offered to all patients with PDAC.