Detection of metachronous neoplasms in colorectal cancer patients: identification of risk factors.
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.
Ballesté
Belen
B
Gastroenterology Department, Hospital del Mar, and University of Barcelona, Spain.
Bessa
Xavier
X
Piñol
Virginia
V
Castellví-Bel
Sergi
S
Castells
Antoni
A
Alenda
Cristina
C
Paya
Artemio
A
Jover
Rodrigo
R
Xicola
Rosa Ma
RM
Pons
Elisenda
E
Llor
Xavier
X
Cordero
Carmen
C
Fernandez-Bañares
Ferran
F
de Castro
Luisa
L
Reñé
Josep Maria
JM
Andreu
Montserrat
M
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
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