Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis

J. E. G. IJspeert; S. A. Q. Rana; N. S. S. Atkinson; Y. J. van Herwaarden; B. A. J. Bastiaansen; M. E. van Leerdam; S. Sanduleanu; T. M. Bisseling; M. C. W. Spaander; S. K. Clark; G. A. Meijer; N. van Lelyveld; J. J. Koornstra; I. D. Nagtegaal; J. E. East; A. Latchford; E. Dekker; Dutch Workgroup Serrated Polyps

doi:10.1136/gutjnl-2015-310630

Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis

J. E. G. IJspeert, S. A. Q. Rana, N. S. S. Atkinson, Y. J. van Herwaarden, B. A. J. Bastiaansen, M. E. van Leerdam, S. Sanduleanu, T. M. Bisseling, M. C. W. Spaander, S. K. Clark, G. A. Meijer, N. van Lelyveld, J. J. Koornstra, I. D. Nagtegaal, J. E. East, A. Latchford, E. Dekker^*, Dutch Workgroup Serrated Polyps

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	278-284
Number of pages	7
Journal	Gut
Volume	66
Issue number	2
DOIs	https://doi.org/10.1136/gutjnl-2015-310630
Publication status	Published - Feb 2017

Keywords

ISLAND METHYLATOR PHENOTYPE
HYPERPLASTIC POLYPOSIS
SURVEILLANCE
GENETICS
PATHWAY
COLON
CLASSIFICATION
POLYPECTOMY
MANAGEMENT
NEOPLASIA

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10.1136/gutjnl-2015-310630

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IJspeert, J. E. G., Rana, S. A. Q., Atkinson, N. S. S., van Herwaarden, Y. J., Bastiaansen, B. A. J., van Leerdam, M. E., Sanduleanu, S., Bisseling, T. M., Spaander, M. C. W., Clark, S. K., Meijer, G. A., van Lelyveld, N., Koornstra, J. J., Nagtegaal, I. D., East, J. E., Latchford, A., Dekker, E., & Dutch Workgroup Serrated Polyps (2017). Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis. Gut, 66(2), 278-284. https://doi.org/10.1136/gutjnl-2015-310630

@article{86ae8ec00fc84eb39fc4a6c06c3161cd,

title = "Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis",

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.",

keywords = "ISLAND METHYLATOR PHENOTYPE, HYPERPLASTIC POLYPOSIS, SURVEILLANCE, GENETICS, PATHWAY, COLON, CLASSIFICATION, POLYPECTOMY, MANAGEMENT, NEOPLASIA",

author = "IJspeert, {J. E. G.} and Rana, {S. A. Q.} and Atkinson, {N. S. S.} and {van Herwaarden}, {Y. J.} and Bastiaansen, {B. A. J.} and {van Leerdam}, {M. E.} and S. Sanduleanu and Bisseling, {T. M.} and Spaander, {M. C. W.} and Clark, {S. K.} and Meijer, {G. A.} and {van Lelyveld}, N. and Koornstra, {J. J.} and Nagtegaal, {I. D.} and East, {J. E.} and A. Latchford and E. Dekker and {Dutch Workgroup Serrated Polyps}",

year = "2017",

month = feb,

doi = "10.1136/gutjnl-2015-310630",

language = "English",

volume = "66",

pages = "278--284",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

number = "2",

}

IJspeert, JEG, Rana, SAQ, Atkinson, NSS, van Herwaarden, YJ, Bastiaansen, BAJ, van Leerdam, ME, Sanduleanu, S, Bisseling, TM, Spaander, MCW, Clark, SK, Meijer, GA, van Lelyveld, N, Koornstra, JJ, Nagtegaal, ID, East, JE, Latchford, A, Dekker, E & Dutch Workgroup Serrated Polyps 2017, 'Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome: a multicentre cohort analysis', Gut, vol. 66, no. 2, pp. 278-284. https://doi.org/10.1136/gutjnl-2015-310630

TY - JOUR

T1 - Clinical risk factors of colorectal cancer in patients with serrated polyposis syndrome

T2 - a multicentre cohort analysis

AU - IJspeert, J. E. G.

AU - Rana, S. A. Q.

AU - Atkinson, N. S. S.

AU - van Herwaarden, Y. J.

AU - Bastiaansen, B. A. J.

AU - van Leerdam, M. E.

AU - Sanduleanu, S.

AU - Bisseling, T. M.

AU - Spaander, M. C. W.

AU - Clark, S. K.

AU - Meijer, G. A.

AU - van Lelyveld, N.

AU - Koornstra, J. J.

AU - Nagtegaal, I. D.

AU - East, J. E.

AU - Latchford, A.

AU - Dekker, E.

AU - Dutch Workgroup Serrated Polyps

PY - 2017/2

Y1 - 2017/2

N2 - 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.

AB - 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.

KW - ISLAND METHYLATOR PHENOTYPE

KW - HYPERPLASTIC POLYPOSIS

KW - SURVEILLANCE

KW - GENETICS

KW - PATHWAY

KW - COLON

KW - CLASSIFICATION

KW - POLYPECTOMY

KW - MANAGEMENT

KW - NEOPLASIA

U2 - 10.1136/gutjnl-2015-310630

DO - 10.1136/gutjnl-2015-310630

M3 - Article

SN - 0017-5749

VL - 66

SP - 278

EP - 284

JO - Gut

JF - Gut

IS - 2

ER -