Shashank Sarvepalli1, Carol A Burke2, Marc Monachese3, Brandie H Leach4, Lisa Laguardia5, Margaret O'Malley5, Matthew F Kalady6, James M Church6. 1. Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA. 2. Department of Gastroenterology and Hepatology, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Colorectal Surgery; Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA; Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA. 4. Department of Colorectal Surgery; Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA; Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA; Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA. 5. Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA. 6. Department of Colorectal Surgery; Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA; Sanford R. Weiss, MD, Center for Hereditary Colorectal Neoplasia, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
BACKGROUND AND AIMS: Proctocolectomy prevents colorectal cancer in familial adenomatous polyposis (FAP). Colorectal polyp progression is one of the indications for surgery. No data exist regarding the natural history of colorectal polyposis in young patients with FAP. This study examined the rate of polyposis progression and factors associated with it. METHODS: Patients with FAP <30 years old who had undergone ≥2 colonoscopies since 2000 were identified. Rate of polyposis progression was calculated by review of polyp counts obtained from baseline and last colonoscopy, accounting for any polyps removed during the observation period. Endoscopic and non-endoscopic factors affecting the rate of polyposis progression were evaluated. Multivariate analysis was performed to identify factors associated with rate of polyposis progression. RESULTS: One hundred sixty-eight patients (52% female; median age, 13.5 years) were included. Median rate of polyposis progression was 25.4 polyps/year (interquartile range, 9.5-69.8). Highest median rate of polyposis progression (89 polyps/year) was associated with mutation in codon 1309. The rate of polyposis progression was independently associated with the location of mutation in the adenomatous polyposis coli gene, the number of polyps at the initial colonoscopy, and exposure to chemoprevention. Of the 39.9% of patients who underwent surgery, an increase in polyp number was the most common indication (53.7%). CONCLUSIONS: The rate of polyposis progression in young patients with FAP varies with a median of about 25 new polyps per year. Progression is associated with distinct factors, which can be used in discussion with patients regarding the need for and timing of prophylactic colorectal surgery.
BACKGROUND AND AIMS: Proctocolectomy prevents colorectal cancer in familial adenomatous polyposis (FAP). Colorectal polyp progression is one of the indications for surgery. No data exist regarding the natural history of colorectal polyposis in young patients with FAP. This study examined the rate of polyposis progression and factors associated with it. METHODS:Patients with FAP <30 years old who had undergone ≥2 colonoscopies since 2000 were identified. Rate of polyposis progression was calculated by review of polyp counts obtained from baseline and last colonoscopy, accounting for any polyps removed during the observation period. Endoscopic and non-endoscopic factors affecting the rate of polyposis progression were evaluated. Multivariate analysis was performed to identify factors associated with rate of polyposis progression. RESULTS: One hundred sixty-eight patients (52% female; median age, 13.5 years) were included. Median rate of polyposis progression was 25.4 polyps/year (interquartile range, 9.5-69.8). Highest median rate of polyposis progression (89 polyps/year) was associated with mutation in codon 1309. The rate of polyposis progression was independently associated with the location of mutation in the adenomatous polyposis coli gene, the number of polyps at the initial colonoscopy, and exposure to chemoprevention. Of the 39.9% of patients who underwent surgery, an increase in polyp number was the most common indication (53.7%). CONCLUSIONS: The rate of polyposis progression in young patients with FAP varies with a median of about 25 new polyps per year. Progression is associated with distinct factors, which can be used in discussion with patients regarding the need for and timing of prophylactic colorectal surgery.
Authors: Sai Ge; Duo Cheng; Xuhui Zhang; Ting Xu; Zhenghang Wang; Fengxiao Dong; Lan Su; Jinlei Song; Jia Wang; Jian Li; Lin Shen; Xicheng Wang Journal: Am J Cancer Res Date: 2022-09-15 Impact factor: 5.942
Authors: Shashank Sarvepalli; Carol A Burke; Marc Monachese; Rocio Lopez; Brandie H Leach; Lisa Laguardia; Margaret OʼMalley; Matthew F Kalady; James M Church Journal: Am J Gastroenterol Date: 2018-10-17 Impact factor: 10.864
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
Authors: Danial Mehranfard; Gabriela Perez; Andres Rodriguez; Julia M Ladna; Christopher T Neagra; Benjamin Goldstein; Timothy Carroll; Alice Tran; Malav Trivedi; Robert C Speth Journal: J Renin Angiotensin Aldosterone Syst Date: 2021-07-05 Impact factor: 1.636