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Original article
Colorectal cancer risk factors in patients with serrated polyposis syndrome: a large multicentre study
  1. Sabela Carballal1,
  2. Daniel Rodríguez-Alcalde2,
  3. Leticia Moreira1,
  4. Luis Hernández2,
  5. Lorena Rodríguez3,
  6. Francisco Rodríguez-Moranta3,
  7. Victoria Gonzalo4,
  8. Luis Bujanda5,
  9. Xavier Bessa6,
  10. Carmen Poves7,
  11. Joaquin Cubiella8,
  12. Inés Castro8,
  13. Mariano González9,
  14. Eloísa Moya10,
  15. Susana Oquiñena11,
  16. Joan Clofent12,
  17. Enrique Quintero13,
  18. Pilar Esteban14,
  19. Virginia Piñol15,
  20. Francisco Javier Fernández16,
  21. Rodrigo Jover17,
  22. Lucía Cid18,
  23. María López-Cerón1,
  24. Miriam Cuatrecasas19,
  25. Jorge López-Vicente2,
  26. Maria Liz Leoz1,
  27. Liseth Rivero-Sánchez1,
  28. Antoni Castells1,
  29. María Pellisé1,
  30. Francesc Balaguer1
  31. for the Gastrointestinal Oncology Group of the Spanish Gastroenterological Association
  1. 1Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
  2. 2Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain
  3. 3Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
  4. 4Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
  5. 5Gastroenterology Department, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
  6. 6Gastroenterology Department, Hospital del Mar, Barcelona, Spain
  7. 7Gastroenterology Department, Hospital Clínico de San Carlos, Madrid, Spain
  8. 8Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain
  9. 9Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain
  10. 10Gastroenterology Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
  11. 11Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain
  12. 12Gastroenterology Department, Hospital de Sagunto, Sagunto, Valencia, Spain
  13. 13Gastroenterology Department, Hospital Universitario de Canarias, Tenerife, Spain
  14. 14Gastroenterology Department, Hospital Morales Meseguer, Murcia, Spain
  15. 15Gastroenterology Department, Hospital Josep Trueta, Girona, Spain
  16. 16Gastroenterology Department, Hospital General Universitario de Alicante, Alicante, Spain
  17. 17Gastroenterology Department, Hospital General de Alicante, Alicante, Spain
  18. 18Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomedica Ourense, Pontevedra, y Vigo, Vigo, Spain
  19. 19Pathology Department, Centre for Biomedical Diagnosis, Hospital Clínic de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Francesc Balaguer, Department of Gastroenterology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain; fprunes{at}


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.


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  • SC and DR-A contributed equally.

  • MP and FB contributed equally.

  • Twitter Follow Luis Hernandez at @fingusmingus and Francisco Rodríguez-Moranta at @frmoranta

  • 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.