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Gut. 2016 Nov;65(11):1829-1837. doi: 10.1136/gutjnl-2015-309647. Epub 2015 Aug 11.

Colorectal cancer risk factors in patients with serrated polyposis syndrome: a large multicentre study.

Author information

1
Gastroenterology 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
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.
3
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
4
Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
5
Gastroenterology 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
Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
7
Gastroenterology Department, Hospital Clínico de San Carlos, Madrid, Spain.
8
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain.
9
Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain.
10
Gastroenterology Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain.
11
Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain.
12
Gastroenterology Department, Hospital de Sagunto, Sagunto, Valencia, Spain.
13
Gastroenterology Department, Hospital Universitario de Canarias, Tenerife, Spain.
14
Gastroenterology Department, Hospital Morales Meseguer, Murcia, Spain.
15
Gastroenterology Department, Hospital Josep Trueta, Girona, Spain.
16
Gastroenterology Department, Hospital General Universitario de Alicante, Alicante, Spain.
17
Gastroenterology Department, Hospital General de Alicante, Alicante, Spain.
18
Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomedica Ourense, Pontevedra, y Vigo, Vigo, Spain.
19
Pathology Department, Centre for Biomedical Diagnosis, Hospital Clínic de Barcelona, Barcelona, Spain.

Abstract

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.

KEYWORDS:

COLONOSCOPY; COLORECTAL CANCER; COLORECTAL CANCER SCREENING; PRE-MALIGNANCY - GI TRACT

PMID:
26264224
DOI:
10.1136/gutjnl-2015-309647
[Indexed for MEDLINE]

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