Abstract
BackgroundAccumulating evidence indicates inherited risk in the aetiology of lung cancer, although smoking exposure is the major attributing factor. Family history is a simple substitute for inherited susceptibility. Previous studies have shown some possible yet conflicting links between family history of cancer and EGFR mutation in lung cancer. As EGFR-mutated lung cancer favours female, never-smoker, adenocarcinoma and Asians, it may be argued that there may be some underlying genetic modifiers responsible for the pathogenesis of EGFR mutation.MethodsWe searched four databases for all original articles on family history of malignancy and EGFR mutation status in lung cancer published up to July 2018. We performed a meta-analysis by using a random-effects model and odds ratio estimates. Heterogeneity and sensitivity were also investigated. Then we conducted a second literature research to curate case reports of familial lung cancers who studied both germline cancer predisposing genes and their somatic EGFR mutation status; and explored the possible links between cancer predisposing genes and EGFR mutation.ResultsEleven studies have been included in the meta-analysis. There is a significantly higher likelihood of EGFR mutation in lung cancer patients with family history of cancer than their counterparts without family history, preferentially in Asians (OR = 1.35[1.06–1.71], P = 0.01), those diagnosed with adenocarcinomas ((OR = 1.47[1.14–1.89], P = 0.003) and those with lung cancer-affected relatives (first and second-degree: OR = 1.53[1.18–1.99], P = 0.001; first-degree: OR = 1.76[1.36–2.28, P < 0.0001]). Familial lung cancers more likely have concurrent EGFR mutations along with mutations in their germline cancer predisposition genes including EGFR T790 M, BRCA2 and TP53. Certain mechanisms may contribute to the combination preferences between inherited mutations and somatic ones.ConclusionsPotential genetic modifiers may contribute to somatic EGFR mutation in lung cancer, although current data is limited. Further studies on this topic are needed, which may help to unveil lung carcinogenesis pathways. However, caution is warranted in data interpretation due to limited cases available for the current study.
Highlights
Accumulating evidence indicates inherited risk in the aetiology of lung cancer, smoking exposure is the major attributing factor
Given the contradictory epidemiological findings and the potential implication in lung carcinogenesis, we conducted a meta-analysis to pool the risk estimates from previous studies focusing on family history of cancer and somatic Epidermal growth factor receptor (EGFR) mutation; by a second literature research, we summarized familial lung cancer cases with both potential Cancer predisposition gene (CPG) and somatic EGFR mutation status reported to help to throw a light on this topic
Most of the studies focused on non-small cell lung cancers (NSCLCs) or lung adenocarcinomas (ADCs)
Summary
Accumulating evidence indicates inherited risk in the aetiology of lung cancer, smoking exposure is the major attributing factor. Though the predominant risk factor, smoke exposure has widely differing attribution to lung cancer risk across different ethnicities, e.g. over 80% in both males and females in the US [2] and UK [3], but only 57.5% in males and 11.5% in females in China [4] These significant differences indicate lung cancer aetiology is significantly impacted by other risk factors including inherited susceptibility. Family history of lung cancer still had a significantly increased risk in never-smoker probands [7], especially in Asians after adjusting confounders including smoking [9, 12]. Some significant risk loci have been found to be genome-wide significantly associated with never-smoker lung cancers [14, 15]
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