Objective Serrated polyposis syndrome (SPS) is associated with an increased colorectal cancer (CRC) risk, although the magnitude of the risk remains uncertain. Whereas intensive endoscopic surveillance for CRC prevention is advised, predictors that identify patients who have high CRC risk remain unknown. We performed a multicentre nationwide study aimed at describing the CRC risk in patients with SPS and identifying clinicopathological predictors independently associated with CRC.
Design From March 2013 through September 2014, patients with SPS were retrospectively recruited at 18 Spanish centres. Data were collected from medical, endoscopy and histopathology reports. Multivariate logistic regression was performed to identify CRC risk factors.
Results In 296 patients with SPS with a median follow-up time of 45 months (IQR 26–79.7), a median of 26 (IQR 18.2–40.7) serrated polyps and 3 (IQR 1–6) adenomas per patient were detected. Forty-seven patients (15.8%) developed CRC at a mean age of 53.9±12.8, and 4 out of 47 (8.5%) tumours were detected during surveillance (cumulative CRC incidence 1.9%). Patients with >2 sessile serrated adenomas/polyps (SSA/Ps) proximal to splenic flexure and ≥1 proximal SSA/P with high-grade dysplasia were independent CRC risk factors (incremental OR=2, 95% CI 1.22 to 3.24, p=0.006). Patients with no risk factors showed a 55% decrease in CRC risk (OR=0.45, 95% CI 0.24 to 0.86, p=0.01).
Conclusions Patients with SPS have an increased risk of CRC, although lower than previously published. Close colonoscopy surveillance in experienced centres show a low risk of developing CRC (1.9% in 5 years). Specific polyp features (SSA/P histology, proximal location and presence of high-grade dysplasia) should be used to guide clinical management.
- COLORECTAL CANCER
- COLORECTAL CANCER SCREENING
- PRE-MALIGNANCY - GI TRACT
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SC and DR-A contributed equally.
MP and FB contributed equally.
Contributors Study concept and design: FB, MP, AC, SC and DR-A; acquisition of data: SC, DR-A, LM, LH, LoRo, FR-M, VG, LB, XB, CP, JC, IC, MG, EM, SO, JClo, EQ, PE, VP, FJF, RJ, LC, ML-C, MC, JL-V, MLL and LiRi); analysis and interpretation of data: SC, DR-A and FB; drafting of the manuscript: SC, DR-A, MP and FB; critical revision of the manuscript for important intellectual content: AC and MP; statistical analysis: SC, DR-A, FB and MP.
Funding This work was supported by grants from the Instituto de Salud Carlos III (PI13/00719). This work was co-funded by the European Regional Development Fund (ERDF). Una manera de hacer Europa, Beca Gonzalo Miño of the Asociación Española de Gastroenterología, Ministerio de Economía y Competitividad (SAF 2007-64873 and SAF2010-19273), Fundación Científica de la Asociación Española contra el Cáncer (GCB13131592CAST), Agència de Gestió d'Ajuts Universitaris i de Recerca (2014 SGR 135) and Xarxa de Bancs de Tumors de Catalunya (XBTC). CIBEREHD is funded by the Instituto de Salud Carlos III.
Competing interests None.
Ethics approval Institutional review boards at each participating institution.
Research reporting checklists The present article follows the STROBE guidelines for research reporting of observational studies.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Authors are willing to share any data that are not published in the manuscript.