title: Detection of metachronous neoplasms in colorectal cancer patients: identification of risk factors.
abstract: OBJECTIVE
  Patients with colorectal cancer have a high risk of developing metachronous neoplasms. Identification of predictive factors associated with such conditions would allow individualized follow-up strategies in these patients. This study was designed to identify individual and familial factors associated with the development of metachronous colorectal neoplasms in patients with colorectal cancer.
  
  
  METHODS
  In the context of a prospective, multicenter, general population-based study-the EPICOLON project-all patients with colorectal cancer attended in ten Spanish hospitals during a one-year period were included. Patients with familial adenomatous polyposis or inflammatory bowel disease were excluded. All patients were monitored by colonoscopy within two years of the diagnoses. Demographic, clinical, pathologic, molecular (microsatellite instability status and immunohistochemistry for MSH2 and MLH1), and familial characteristics (fulfillment of Amsterdam I or II criteria, and revised Bethesda guidelines) were analyzed.
  
  
  RESULTS
  A total of 353 patients were included in the study. At two years of follow-up, colonoscopy revealed the presence of adenomas in 89 (25 percent) patients and colorectal cancer in 14 (3.9 percent) patients, in 7 cases restricted to anastomosis. Univariate analysis demonstrated that development of metachronous neoplasm (adenoma or colorectal cancer) was associated with personal history of previous colorectal cancer (odds ratio, 5.58; 95 percent confidence interval, 1.01-31.01), and presence of previous or synchronous adenomas (odds ratio, 1.77; 95 percent confidence interval, 1.21-3.17). Although nonstatistical significance was achieved, metachronisms were associated with gender (P<0.09) and differentiation degree (P<0.08). Multivariate analysis identified previous or synchronous adenomas (odds ratio, 1.98; 95 percent confidence interval, 1.16-3.38) as independent predictive factor. Neither presence of tumor DNA microsatellite instability nor family history correlated with the presence of metachronous neoplasms.
  
  
  CONCLUSIONS
  Patients with previous or synchronous colorectal adenoma have an increased risk of developing metachronous colorectal neoplasms. Accordingly, this subgroup of patients may benefit from specific surveillance strategies.
authors.affiliation: Gastroenterology Department, Hospital del Mar, and University of Barcelona, Spain.
authors.forename: Belen
authors.initials: B
authors.lastname: Ballesté
authors.forename: Xavier
authors.initials: X
authors.lastname: Bessa
authors.forename: Virginia
authors.initials: V
authors.lastname: Piñol
authors.forename: Sergi
authors.initials: S
authors.lastname: Castellví-Bel
authors.forename: Antoni
authors.initials: A
authors.lastname: Castells
authors.forename: Cristina
authors.initials: C
authors.lastname: Alenda
authors.forename: Artemio
authors.initials: A
authors.lastname: Paya
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.forename: Rosa Ma
authors.initials: RM
authors.lastname: Xicola
authors.forename: Elisenda
authors.initials: E
authors.lastname: Pons
authors.forename: Xavier
authors.initials: X
authors.lastname: Llor
authors.forename: Carmen
authors.initials: C
authors.lastname: Cordero
authors.forename: Ferran
authors.initials: F
authors.lastname: Fernandez-Bañares
authors.forename: Luisa
authors.initials: L
authors.lastname: de Castro
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Reñé
authors.forename: Montserrat
authors.initials: M
authors.lastname: Andreu
mesh_terms: D048868:Adaptor Proteins, Signal Transducing / Q000235:genetics; D000368:Aged; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D016001:Confidence Intervals; D004260:DNA Repair; D004273:DNA, Neoplasm / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008297:Male; D053842:Microsatellite Instability; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein / Q000235:genetics; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics; D009687:Nuclear Proteins / Q000235:genetics; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D013997:Time Factors
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D004273:DNA, Neoplasm; C501486:MLH1 protein, human; D009687:Nuclear Proteins; C497172:MSH2 protein, human; D000070957:MutL Protein Homolog 1; D051718:MutS Homolog 2 Protein