J E G IJspeert1, S A Q Rana2, N S S Atkinson3, Y J van Herwaarden4, B A J Bastiaansen1, M E van Leerdam5, S Sanduleanu6, T M Bisseling4, M C W Spaander7, S K Clark2, G A Meijer8, N van Lelyveld9, J J Koornstra10, I D Nagtegaal11, J E East3, A Latchford2, E Dekker1. 1. Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 2. The Polyposis Registry, St Mark's Hospital, London, UK. 3. Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK. 4. Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands. 5. Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. Division of Gastroenterology and Hepatology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. 7. Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. 8. Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 9. Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands. 10. Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 11. Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Abstract
OBJECTIVE: Serrated polyposis syndrome (SPS) is accompanied by an increased risk of colorectal cancer (CRC). Patients fulfilling the clinical criteria, as defined by the WHO, have a wide variation in CRC risk. We aimed to assess risk factors for CRC in a large cohort of patients with SPS and to evaluate the risk of CRC during surveillance. DESIGN: In this retrospective cohort analysis, all patients with SPS from seven centres in the Netherlands and two in the UK were enrolled. WHO criteria were used to diagnose SPS. Patients who only fulfilled WHO criterion-2, with IBD and/or a known hereditary CRC syndrome were excluded. RESULTS: In total, 434 patients with SPS were included for analysis; 127 (29.3%) were diagnosed with CRC. In a per-patient analysis ≥1 serrated polyp (SP) with dysplasia (OR 2.07; 95% CI 1.28 to 3.33), ≥1 advanced adenoma (OR 2.30; 95% CI 1.47 to 3.67) and the fulfilment of both WHO criteria 1 and 3 (OR 1.60; 95% CI 1.04 to 2.51) were associated with CRC, while a history of smoking was inversely associated with CRC (OR 0.36; 95% CI 0.23 to 0.56). Overall, 260 patients underwent surveillance after clearing of all relevant lesions, during which two patients were diagnosed with CRC, corresponding to 1.9 events/1000 person-years surveillance (95% CI 0.3 to 6.4). CONCLUSION: The presence of SPs containing dysplasia, advanced adenomas and/or combined WHO criteria 1 and 3 phenotype is associated with CRC in patients with SPS. Patients with a history of smoking show a lower risk of CRC, possibly due to a different pathogenesis of disease. The risk of developing CRC during surveillance is lower than previously reported in literature, which may reflect a more mature multicentre cohort with less selection bias. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: Serrated polyposis syndrome (SPS) is accompanied by an increased risk of colorectal cancer (CRC). Patients fulfilling the clinical criteria, as defined by the WHO, have a wide variation in CRC risk. We aimed to assess risk factors for CRC in a large cohort of patients with SPS and to evaluate the risk of CRC during surveillance. DESIGN: In this retrospective cohort analysis, all patients with SPS from seven centres in the Netherlands and two in the UK were enrolled. WHO criteria were used to diagnose SPS. Patients who only fulfilled WHO criterion-2, with IBD and/or a known hereditary CRC syndrome were excluded. RESULTS: In total, 434 patients with SPS were included for analysis; 127 (29.3%) were diagnosed with CRC. In a per-patient analysis ≥1 serrated polyp (SP) with dysplasia (OR 2.07; 95% CI 1.28 to 3.33), ≥1 advanced adenoma (OR 2.30; 95% CI 1.47 to 3.67) and the fulfilment of both WHO criteria 1 and 3 (OR 1.60; 95% CI 1.04 to 2.51) were associated with CRC, while a history of smoking was inversely associated with CRC (OR 0.36; 95% CI 0.23 to 0.56). Overall, 260 patients underwent surveillance after clearing of all relevant lesions, during which two patients were diagnosed with CRC, corresponding to 1.9 events/1000 person-years surveillance (95% CI 0.3 to 6.4). CONCLUSION: The presence of SPs containing dysplasia, advanced adenomas and/or combined WHO criteria 1 and 3 phenotype is associated with CRC in patients with SPS. Patients with a history of smoking show a lower risk of CRC, possibly due to a different pathogenesis of disease. The risk of developing CRC during surveillance is lower than previously reported in literature, which may reflect a more mature multicentre cohort with less selection bias. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Arne G C Bleijenberg; Joep E G IJspeert; Daniel Rodríguez-Alcalde; Sabela Carballal; Maurits R Visser; Maria Pellise; Jan Jacob Koornstra; Salman A Rana; Andrew Latchford; Francesc Balaguer; Evelien Dekker Journal: Fam Cancer Date: 2020-04 Impact factor: 2.375
Authors: Kevin J Monahan; Nicola Bradshaw; Sunil Dolwani; Bianca Desouza; Malcolm G Dunlop; James E East; Mohammad Ilyas; Asha Kaur; Fiona Lalloo; Andrew Latchford; Matthew D Rutter; Ian Tomlinson; Huw J W Thomas; James Hill Journal: Gut Date: 2019-11-28 Impact factor: 23.059