Article Text

Download PDFPDF

Original article
Tumour risks and genotype–phenotype correlations associated with germline variants in succinate dehydrogenase subunit genes SDHB, SDHC and SDHD
  1. Katrina A Andrews1,
  2. David B Ascher2,3,
  3. Douglas Eduardo Valente Pires2,4,
  4. Daniel R Barnes5,
  5. Lindsey Vialard6,
  6. Ruth T Casey1,
  7. Nicola Bradshaw7,
  8. Julian Adlard8,
  9. Simon Aylwin9,
  10. Paul Brennan10,
  11. Carole Brewer11,
  12. Trevor Cole6,
  13. Jackie A Cook12,
  14. Rosemarie Davidson7,
  15. Alan Donaldson13,
  16. Alan Fryer14,
  17. Lynn Greenhalgh14,
  18. Shirley V hodgson15,
  19. Richard Irving16,
  20. Fiona Lalloo17,
  21. Michelle McConachie18,
  22. Vivienne P M McConnell19,
  23. Patrick J Morrison19,
  24. Victoria Murday7,
  25. Soo-Mi Park20,
  26. Helen L Simpson21,
  27. Katie Snape15,
  28. Susan Stewart6,
  29. Susan E Tomkins13,
  30. Yvonne Wallis6,
  31. Louise Izatt22,
  32. David Goudie18,
  33. Robert S Lindsay23,
  34. Colin G Perry23,
  35. Emma R Woodward17,
  36. Antonis C Antoniou5,
  37. Eamonn R Maher1,21
  1. 1 Department of Medical Genetics, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cancer Research UK Cambridge Cancer Centre and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2 Department of Biochemistry, University of Cambridge, Cambridge, UK
  3. 3 Department of Biochemistry and Molecular Biology, Bio21 Institute, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
  5. 5 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  6. 6 West Midlands Regional Genetics service, Birmingham Women’s Hospital, Birmingham, UK
  7. 7 Department of Clinical Genetics, Queen Elizabeth University Hospital, Glasgow, UK
  8. 8 Yorkshire Regional Genetics Service, St. James’s University Hospital, Leeds, UK
  9. 9 Department of Endocrinology, King’s College Hospital, London, UK
  10. 10 Northern Genetics Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  11. 11 Peninsula Clinical Genetics Service, Royal Devon & Exeter Hospital, Exeter, UK
  12. 12 Department of Clinical Genetics, Sheffield Children’s Hospital, Sheffield, UK
  13. 13 Department of Clinical Genetics, St Michael’s Hospital, Bristol, UK
  14. 14 Department of Clinical Genetics, Liverpool Women’s NHS Foundation Trust, Liverpool, UK
  15. 15 Department of Medical Genetics, St. George’s University of London, London, UK
  16. 16 Queen Elizabeth Medical Centre, Queen Elizabeth Hospital, Birmingham, UK
  17. 17 Manchester Centre for Genomic Medicine, St Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
  18. 18 East of Scotland Regional Genetics Service, Ninewells Hospital and Medical School, Dundee, UK
  19. 19 Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
  20. 20 Department of Clinical Genetics, Addenbrooke’s Treatment Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  21. 21 The Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  22. 22 Department of Clinical Genetics, Guy’s Hospital, London, UK
  23. 23 Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland
  1. Correspondence to Professor Eamonn R Maher, Department of Medical Genetics, University of Cambridge, Cambridge CB2 0QQ, UK; erm1000{at}


Background Germline pathogenic variants in SDHB/SDHC/SDHD are the most frequent causes of inherited phaeochromocytomas/paragangliomas. Insufficient information regarding penetrance and phenotypic variability hinders optimum management of mutation carriers. We estimate penetrance for symptomatic tumours and elucidate genotype–phenotype correlations in a large cohort of SDHB/SDHC/SDHD mutation carriers.

Methods A retrospective survey of 1832 individuals referred for genetic testing due to a personal or family history of phaeochromocytoma/paraganglioma. 876 patients (401 previously reported) had a germline mutation in SDHB/SDHC/SDHD (n=673/43/160). Tumour risks were correlated with in silico structural prediction analyses.

Results Tumour risks analysis provided novel penetrance estimates and genotype–phenotype correlations. In addition to tumour type susceptibility differences for individual genes, we confirmed that the SDHD:p.Pro81Leu mutation has a distinct phenotype and identified increased age-related tumour risks with highly destabilising SDHB missense mutations. By Kaplan-Meier analysis, the penetrance (cumulative risk of clinically apparent tumours) in SDHB and (paternally inherited) SDHD mutation-positive non-probands (n=371/67 with detailed clinical information) by age 60 years was 21.8% (95% CI 15.2% to 27.9%) and 43.2% (95% CI 25.4% to 56.7%), respectively. Risk of malignant disease at age 60 years in non-proband SDHB mutation carriers was 4.2%(95% CI 1.1% to 7.2%). With retrospective cohort analysis to adjust for ascertainment, cumulative tumour risks for SDHB mutation carriers at ages 60 years and 80 years were 23.9% (95% CI 20.9% to 27.4%) and 30.6% (95% CI 26.8% to 34.7%).

Conclusions Overall risks of clinically apparent tumours for SDHB mutation carriers are substantially lower than initially estimated and will improve counselling of affected families. Specific genotype–tumour risk associations provides a basis for novel investigative strategies into succinate dehydrogenase-related mechanisms of tumourigenesis and the development of personalised management for SDHB/SDHC/SDHD mutation carriers.

  • cancer: endocrine
  • genetics
  • molecular genetics
  • oncology
  • genetic epidemiology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors ERM conceived, designed and supervised the study. KAA collected the data and performed the Kaplan-Meier analysist. DBA and DEVP produced the in silico structural prediction analysis. DRB and ACA performed the retrospective cohort analysis calculations. The remaining authors clinically characterised the patients at their respective centres. All authors were involved in drafting the article or revising it critically for important intellectual content and in the final approval of the version to be submitted. KAA and ERM wrote the first draft of the paper and are responsible for the overall content as guarantors.

  • Funding This work was supported by the East Anglian Foundation Programme (to KAA), the University of Cambridge (KAA), NIHR Cambridge Biomedical Research Centre (KAA and ERM), Cancer Research UK Cambridge Cancer Centre (ERM), European Research Council Advanced Researcher Award (ERM), British Heart Foundation (EM), NIHR Senior Investigator Award (ERM), Newton Fund RCUK-CONFAP Grant awarded by The Medical Research Council (MRC), Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) (to DEVP and DBA), NHMRC CJ Martin Fellowship (APP1072476) and Jack Brockhoff Foundation (JBF 4186, 2016) (to DBA), Instituto René Rachou (CPqRR/FIOCRUZ Minas) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (to DEVP), Health Research Board Ireland (RTC) and Cancer Research – UK grant C12292/A20861 (to ACA). The University of Cambridge has received salary support in respect of EM from the NHS in the East of England through the Clinical Academic Reserve. The views expressed are those of the authors and not necessarily those of the NHS or Department of Health.

  • Disclaimer The funding agencies had no role in study design, data collection or analysis or writing of the article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval South Birmingham Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles