Paul Limburg, MD1, Douglas W. Mahoney, MS2, David Ahlquist, MD2, Hatim T. Allawi, MBA, PhD3, Scott Johnson, PhD4, Michael W. Kaiser, PhD5, Sandra Statz, MS1, Rondell Graham, MBBS2, Patrick Foote, BS2, Karen Doering, MBA2, Kelli N. Burger, BS2, Graham Lidgard, PhD1, John Kisiel, MD2
1Exact Sciences, Madison, WI; 2Mayo Clinic, Rochester, MN; 3Exact Sciences Development Company, Madison, WI; 4Exact Sciences Corporation, Madison, WI; 5Exact Sciences Laboratories, LLC, Madison, WI
Introduction: Colorectal cancer (CRC) screening is broadly endorsed for individuals 50-75 years of age. Given recent increases in CRC incidence and mortality for patients < 50 years old, the American Cancer Society now recommends initiation of average-risk CRC screening at age 45 (Wolf AMD CA Cancer J Clin 2018). The performance of recommended tests, including the multi-target stool DNA (mt-sDNA; marketed as Cologuard™) test, has been minimally described in populations under 50 years old. To address this knowledge gap, we conducted a retrospective study of DNA markers (KRAS, BMP3, NDRG4) included in the mt-sDNA assay to quantify and compare tissue marker levels in sporadic CRC cases and normal colon controls from patients in 45-49 and 50-64 year-old age groups. Our primary hypothesis was that mt-sDNA marker levels would be statistically similar between cases in both age groups.
Methods: Patient samples were identified from a pathology tissue archive at Mayo Clinic, excluding those with inflammatory bowel disease or familial cancer syndromes. Formalin-fixed, paraffin-embedded tissues were reviewed by a GI pathologist for 45-49 year-old (n=90) and 50-64 year-old (n=96) CRC cases; normal colon samples (45-49, n=76; 50-64, n=92) were also included for comparison. DNA extracted from core punches was blinded and processed in a randomized order. Quantitative Allele specific Realtime Target and Signal amplification (QuARTS) assays were used to quantify KRAS mutations, and BMP3 and NDRG4 methylation. Marker level in each sample was reported as the QuARTS product of mutant KRAS, methylated BMP3 or NDRG4 relative to the ACTB product in each sample, reported as a percentage. At least 60 patients per group provided sufficient power to demonstrate differences in marker levels of +/- 25% between case groups and between control groups using the Wilcoxon Rank Sum test.
Results: CRC cases in the 45-49 vs 50-64 year-old groups did not differ significantly with respect to sex (p=0.77) or race/ethnicity (p=0.06); left-sided CRC was more common in the 45-49 vs 50-64 year-old group (87% vs. 72%; p=0.02). None of the marker levels were statistically different between cases of the younger vs older groups or between controls of these groups (Figure).
Discussion: These data support the expectation of no age-related differences in CRC detection by mt-sDNA, as the relevant molecular markers, when they occur, are present at similar levels across age groups 45-49 and 50-64 years.
Citation: Paul Limburg, MD; Douglas W. Mahoney, MS; David Ahlquist, MD; Hatim T. Allawi, MBA, PhD; Scott Johnson, PhD; Michael W. Kaiser, PhD; Sandra Statz, MS; Rondell Graham, MBBS; Patrick Foote, BS; Karen Doering, MBA; Kelli N. Burger, BS; Graham Lidgard, PhD; John Kisiel, MD. P1116 - MULTI-TARGET DNA ABERRATIONS IN SPORADIC COLORECTAL CANCER TISSUES DO NOT DIFFER BETWEEN YOUNGER AND OLDER PATIENTS. Program No. P1116. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.