Rita Vale Rodrigues1, Isabel Claro2, Pedro Lage2, Isadora Rosa2, Sara Ferreira2, João Pereira da Silva3, António Dias Pereira3. 1. Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal. rita.vale.rodrigues@gmail.com. 2. Gastroenterology Department and Familial Cancer Risk Clinic, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Lisbon, Portugal. 3. Gastroenterology Department, Instituto Português de Oncologia de Lisboa de Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisbon, Portugal.
Abstract
PURPOSE: Lynch syndrome (LS) is associated with a high risk of colorectal cancer (CRC). The aim of this study was to assess the cumulative risk for the development of colorectal adenomas or carcinomas in a LS CRC surveillance program and to audit the quality of the endoscopic procedures. METHODS: We evaluated 147 asymptomatic LS mutation carriers, without previous CRC, in a surveillance program with colonoscopy every 12-18 months, between 2005 and 2016. Data was obtained by retrospective review of colonoscopy reports and hospital clinical files. The main outcome was assessed using Kaplan-Meier curves. Logistic regression was used to study the risk of developing adenomas. RESULTS: Patients were under surveillance for 1092 observation years (mean, 7.7 years/patient). Most exams presented adequate bowel preparation (83.5%) and 99.2% achieved cecal intubation. The estimated risk for adenomas at age 60 was 75.6% in men (95%CI, 60.5-88.3) and 65.5% in women (95%CI, 50.8-79.7). Male gender (OR 2.4; 95%CI, 1.2-4.9; p = 0.018) and age at start of surveillance > 40 years (OR 3.7; 95%CI, 1.8-7.7; p < 0.001) were independent risk factors for adenoma detection. CRC was diagnosed in 11 patients with an estimated cumulative risk at age 60 of 18.4% (95%CI, 9.2-34.8%); 72.7% of CRC were classified as stage I; no patient died from CRC. CONCLUSION: A colonoscopic surveillance program in LS patients allowed the detection of adenomas in a large group of mutation carriers and diagnosis of early-stage carcinomas. Our findings may help other teams to adopt similar strategies or to refer patients early to specialized centers.
PURPOSE:Lynch syndrome (LS) is associated with a high risk of colorectal cancer (CRC). The aim of this study was to assess the cumulative risk for the development of colorectal adenomas or carcinomas in a LS CRC surveillance program and to audit the quality of the endoscopic procedures. METHODS: We evaluated 147 asymptomatic LS mutation carriers, without previous CRC, in a surveillance program with colonoscopy every 12-18 months, between 2005 and 2016. Data was obtained by retrospective review of colonoscopy reports and hospital clinical files. The main outcome was assessed using Kaplan-Meier curves. Logistic regression was used to study the risk of developing adenomas. RESULTS:Patients were under surveillance for 1092 observation years (mean, 7.7 years/patient). Most exams presented adequate bowel preparation (83.5%) and 99.2% achieved cecal intubation. The estimated risk for adenomas at age 60 was 75.6% in men (95%CI, 60.5-88.3) and 65.5% in women (95%CI, 50.8-79.7). Male gender (OR 2.4; 95%CI, 1.2-4.9; p = 0.018) and age at start of surveillance > 40 years (OR 3.7; 95%CI, 1.8-7.7; p < 0.001) were independent risk factors for adenoma detection. CRC was diagnosed in 11 patients with an estimated cumulative risk at age 60 of 18.4% (95%CI, 9.2-34.8%); 72.7% of CRC were classified as stage I; no patient died from CRC. CONCLUSION: A colonoscopic surveillance program in LS patients allowed the detection of adenomas in a large group of mutation carriers and diagnosis of early-stage carcinomas. Our findings may help other teams to adopt similar strategies or to refer patients early to specialized centers.
Authors: Hans F A Vasen; Mohamed Abdirahman; Richard Brohet; Alexandra M J Langers; Jan H Kleibeuker; Mariette van Kouwen; Jan Jacob Koornstra; Henk Boot; Annemieke Cats; Evelien Dekker; Silvia Sanduleanu; Jan-Werner Poley; James C H Hardwick; Wouter H de Vos Tot Nederveen Cappel; Andrea E van der Meulen-de Jong; T Gie Tan; Maarten A J M Jacobs; Faig Lall A Mohamed; Sijbrand Y de Boer; Paul C van de Meeberg; Marie-Louise Verhulst; Jan M Salemans; Nico van Bentem; B Dik Westerveld; Juda Vecht; Fokko M Nagengast Journal: Gastroenterology Date: 2010-03-02 Impact factor: 22.682
Authors: Elena Stoffel; Bhramar Mukherjee; Victoria M Raymond; Nabihah Tayob; Fay Kastrinos; Jennifer Sparr; Fei Wang; Prathap Bandipalliam; Sapna Syngal; Stephen B Gruber Journal: Gastroenterology Date: 2009-07-18 Impact factor: 22.682
Authors: Yvonne M C Hendriks; Anja Wagner; Hans Morreau; Fred Menko; Astrid Stormorken; Franz Quehenberger; Lodewijk Sandkuijl; Pal Møller; Maurizio Genuardi; Hans Van Houwelingen; Carli Tops; Marjo Van Puijenbroek; Paul Verkuijlen; Gemma Kenter; Anneke Van Mil; Hanne Meijers-Heijboer; Gita B Tan; Martijn H Breuning; Riccardo Fodde; Juul Th Wijnen; Annette H J T Bröcker-Vriends; Hans Vasen Journal: Gastroenterology Date: 2004-07 Impact factor: 22.682
Authors: Leigha Senter; Mark Clendenning; Kaisa Sotamaa; Heather Hampel; Jane Green; John D Potter; Annika Lindblom; Kristina Lagerstedt; Stephen N Thibodeau; Noralane M Lindor; Joanne Young; Ingrid Winship; James G Dowty; Darren M White; John L Hopper; Laura Baglietto; Mark A Jenkins; Albert de la Chapelle Journal: Gastroenterology Date: 2008-05-02 Impact factor: 22.682
Authors: Francis M Giardiello; John I Allen; Jennifer E Axilbund; C Richard Boland; Carol A Burke; Randall W Burt; James M Church; Jason A Dominitz; David A Johnson; Tonya Kaltenbach; Theodore R Levin; David A Lieberman; Douglas J Robertson; Sapna Syngal; Douglas K Rex Journal: Am J Gastroenterol Date: 2014-07-22 Impact factor: 10.864
Authors: H F Vasen; J T Wijnen; F H Menko; J H Kleibeuker; B G Taal; G Griffioen; F M Nagengast; E H Meijers-Heijboer; L Bertario; L Varesco; M L Bisgaard; J Mohr; R Fodde; P M Khan Journal: Gastroenterology Date: 1996-04 Impact factor: 22.682