Hereditary non-Polyposis Colo-Rectal Cancer Between Dogma and Reality

Mircea Cazacu1, C. Lungoci1, T. Oniu1, O. Fabian1, Anca Mihailov2
1) IVth Surgical Clinic, University of Medicine and Pharmacy. 2) Oncological Institute, Cluj-Napoca

Abstract

Introduction. The allocation of patients in thehereditary non-polyposis colo-rectal cancer (HNPCC) group is made according to the fulfilment of "the Amsterdam criteria" which offers a homogenous but apparently rigid frame, considering current molecular genetics research. Thus, more and more patients that do not fulfil entirely those criteria and an important number of patients with sporadic cancers are found to have these genetic defects.

Purpose
. A comparative analysis of the morphoclinical features in non-polyposis colo-rectal cancer patients with positive family histories which fulfil entirely or partially "the Amsterdam criteria" versus the patients with sporadic non-polyposis colorectal cancers.
Patients and methods. We performed a retrospective analysis on colo-rectal cancer patients operated consecutively by the same surgical team. The patients were allocated into two groups: group A - patients with colo-rectal cancers and positive family history and group B with colo-rectal cancer and negative family history. The cases with familial polyposis and those with uncertain family history were excluded. We analyzed comparatively the differences in sex, age, stage, tumour site, pathological characteristics. The differences were calculated using the chi-square test, p<0.05 being considered statistically significant.

Results
. A number of 219 colo-rectal cancer patients underwent surgery between 1993-1999 and their medical records were assessed retrospectively. The group A contained 30 patients with colo-rectal cancer and positive family history and group B consisted of 172 patients with colo-rectal cancer and negative family history. We noted important differences between the two groups regarding age (in group A we found significantly more patients aged under 50, p=0.003), stage (the group A consisted mostly of patients in Dukes C and D stages, while in group B we noted an approximately equal distribution of A+B and C+D cases, p=0.01), pathological type (the group A contained significantly more cases with diffuse, poorly differentiated carcinoma (p=0.02).

Conclusions
. Although not fulfilling all "the Amsterdam criteria" for eligibility in the HNPCC group, the patients with colo-rectal cancer and positive family history showed morphoclinical features which suggested poor prognosis compared to those with negative family history.

Key words


Hereditary colo-rectal cancer - Amsterdam Criteria - prognosis