A shift from distal to proximal neoplasia in the colon: a decade of polyps and CRC in Italy.
BACKGROUND
In the last years a trend towards proximalization of colorectal carcinomas (CRC) has been reported. This study aims to evaluate the distribution of CRC and adenomatous polyps (ADP) to establish the presence of proximalization and to assess the potential predictors.


METHODS
We retrieved histology reports of colonic specimens excised during colonoscopy, considering the exams performed between 1997 and 2006 at Cuneo Hospital, Italy. We compared the proportion of proximal lesions in the period 1997-2001 and in the period 2002-2006.


RESULTS
Neoplastic lesions were detected in 3087 people. Proximal CRC moved from 25.9% (1997-2001) to 30.0% (2002-2006). Adjusting for sex and age, the difference was not significant (OR 1.23; 95% CI: 0,95-1,58). The proximal ADP proportion increased from 19.2% (1997-2001) to 26.0% (2002-2006) (OR: 1.43; 95% CI: 1.17-1.89). The corresponding figures for advanced proximal ADP were 6.6% and 9.5% (OR: 1.48; 95% CI: 1.02-2.17). Adjusting for gender, age, diagnostic period, symptoms and number of polyps the prevalence of proximal advanced ADP was increased among people ≥ 70 years compared to those aged 55-69 years (OR 1.49; 95% CI: 1.032.16). The main predictor of proximal advanced neoplasia was the number of polyps detected per exam (> 1 polyp versus 1 polyp: considering all ADP: OR 2.16; 95% CI: 1.59-2.93; considering advanced ADP OR 1.63; 95% CI: 1.08-2.46). Adjusting for these factors, the difference between the two periods was no longer significant.


CONCLUSIONS
CRC do not proximalize while a trend towards a proximal shift in adenomas was observed among people ≥ 70 years.
Medicina Interna, Azienda Ospedaliera S, Croce e Carle, Cuneo, Italy. fenoglio.l@ospedale.cuneo.it
Luigi
L
Fenoglio
Elisabetta
E
Castagna
Alberto
A
Comino
Cora
C
Luchino
Carlo
C
Senore
Elena
E
Migliore
Franco
F
Capucci
Sergio
S
Panzone
Alberto
A
Silvestri
Luigi
L
Ghezzo
Domenico
D
Ferrigno
D018256:Adenomatous Polyps / Q000453:epidemiology / Q000473:pathology*; D000368:Aged; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies