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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}


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.


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  • Contributors All authors have contributed to this article in the following way: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conception and design: JEGI, ED; data acquisition: all authors; data analysis and interpretation: all authors; drafting the manuscript: JEGI; critical revision of the manuscript: all authors; statistical analysis: JEGI; supervision: all authors.

  • Funding KWF Kankerbestrijding (grant no. UVA 2014-7500).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.