Article Text

other Versions

PDF
Original article
Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis
  1. J E G IJspeert1,
  2. S A Q Rana2,
  3. N S S Atkinson3,
  4. Y J van Herwaarden4,
  5. B A J Bastiaansen1,
  6. M E van Leerdam5,
  7. S Sanduleanu6,
  8. T M Bisseling4,
  9. M C W Spaander7,
  10. S K Clark2,
  11. G A Meijer8,
  12. N van Lelyveld9,
  13. J J Koornstra10,
  14. I D Nagtegaal11,
  15. J E East3,
  16. A Latchford2,
  17. E Dekker1
  18. on behalf of the Dutch workgroup serrated polyps & polyposis (WASP)
  1. 1Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  2. 2The Polyposis Registry, St Mark's Hospital, London, UK
  3. 3Translational Gastroenterology Unit, Experimental Medicine Division, Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
  4. 4Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
  5. 5Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  6. 6Division of Gastroenterology and Hepatology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
  7. 7Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  8. 8Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  9. 9Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands
  10. 10Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  11. 11Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Dr Evelien Dekker, Department of Gastroenterology and Hepatology, Academic Medical Centre, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; e.dekker{at}amc.uva.nl

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.

  • COLONOSCOPY
  • COLORECTAL CANCER
  • COLONIC POLYPS
  • POLYPOSIS
  • SURVEILLANCE

Statistics from Altmetric.com

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.