Prevalence of Pathogenic Germline Variants in Patients With Gastric Cancer Ascertained Through Multigene Panel Testing.

Abstract

The prevalence of pathogenic/likely pathogenic germline variants (PGVs) in gastric cancer (GC) predisposition genes is not well understood. We aimed to determine this in patients with GC undergoing germline genetic testing at a large commercial laboratory. This was a cross-sectional study. Retrospective review of genetic testing in patients with GC at a commercial laboratory (Invitae Corp) from March 2015 to July 2023 was performed. Prevalence of PGVs was determined and compared with a control cohort of 20,139 individuals unaffected by cancer. Data were abstracted from test requisition forms. In total, 3,706 patients with GC underwent genetic testing, of which 494 (13.3%) patients carried PGVs, 1,200 (32.4%) had variants of uncertain significance, and 1,890 (51%) had negative testing. PGVs were identified in 38 genes, of which 385 of 494 (77.9%) were in a gene previously associated with GC, including 35% in homologous recombination repair genes (<i>BRCA1</i>, <i>BRCA2</i>, <i>PALB2</i>, and <i>ATM</i>), 19.5% in Hereditary Diffuse GC genes (<i>CDH1</i> and <i>CTNNA1</i>), and 17.4% in Lynch syndrome genes (<i>MLH1</i>, <i>MSH2</i>, <i>MSH6</i>, <i>PMS2</i>, and <i>EPCAM</i>). Comparing the GC cohort with the unaffected cohort, it was found that there was significant enrichment of PGVs in most GC-associated genes, except for <i>APC</i>, <i>EPCAM</i>, <i>MUTYH</i>, and <i>PMS2</i>. Odds of carrying a PGV was increased significantly in males and patients with a personal history of another cancer with odds ratio (OR) of 1.3 (95% CI, 1.1 to 1.6) and OR, 1.4 (95% CI, 1.1 to 1.7), respectively. In this large study of genetic testing in patients with GC, more than one in eight patients referred for germline testing was found to harbor a PGV in a cancer predisposition gene, which is higher than previous estimates. Most PGVs were identified in genes previously associated with GC.