Relative frequency and morphology of cancers in STK11 mutation carriers¹

Abstract

$\text{Background \& Aims:}$ There is limited data on the spectrum and risk for cancer associated with germline serine/threonine protein kinase 11 (STK11) mutations that cause Peutz—Jeghers syndrome (PJS). $\text{Methods:}$ We analyzed the incidence of cancer in 240 individuals with PJS possessing germline mutations in STK11. $\text{Results:}$ Fifty-four cancers were found among carriers. Overall, the risk for developing cancer at ages 20, 30, 40, 50, 60, and 70 years was 1%, 3%, 19%, 32%, 63%, and 81%, respectively. Kaplan—Meier analysis showed similar cancer risks between missense and truncating mutation carriers (log-rank χ² = 2.48; P = 0.12). There was some evidence that mutations in exon 3 of STK11 were associated with a higher cancer risk than mutations within other regions of the gene. We found no difference in overall cancer risk between male and female carriers (log-rank χ² = 1.31; P = 0.25) or between familial and sporadic cases (log-rank χ² = 1.16, with 1 df; P = 0.28). The most common cancers represented were gastrointestinal in origin—gastroesophageal, small bowel, colorectal, and pancreatic—and the risk for these cancers at ages 30, 40, 50, and 60 years was 1%, 10%, 18%, and 42%, respectively. In women, the risk for breast cancer was substantially increased, being 32% by age 60 years. $\text{Conclusions:}$ These results quantitatively show the spectrum of cancer risk associated with STK11 germline mutations in the context of PJS and provide a valuable reference for defining surveillance regimens.