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



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.



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).



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.
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.
Sabela
S
Carballal
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.
Daniel
D
Rodríguez-Alcalde
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.
Leticia
L
Moreira
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.
Luis
L
Hernández
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Lorena
L
Rodríguez
Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
Francisco
F
Rodríguez-Moranta
Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain.
Victoria
V
Gonzalo
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.
Luis
L
Bujanda
Gastroenterology Department, Hospital del Mar, Barcelona, Spain.
Xavier
X
Bessa
Gastroenterology Department, Hospital Clínico de San Carlos, Madrid, Spain.
Carmen
C
Poves
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain.
Joaquin
J
Cubiella
Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra y Vigo, Ourense, Spain.
Inés
I
Castro
Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain.
Mariano
M
González
Gastroenterology Department, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain.
Eloísa
E
Moya
Gastroenterology Department, Complejo Hospitalario de Navarra, Navarra, Spain.
Susana
S
Oquiñena
Gastroenterology Department, Hospital de Sagunto, Sagunto, Valencia, Spain.
Joan
J
Clofent
Gastroenterology Department, Hospital Universitario de Canarias, Tenerife, Spain.
Enrique
E
Quintero
Gastroenterology Department, Hospital Morales Meseguer, Murcia, Spain.
Pilar
P
Esteban
Gastroenterology Department, Hospital Josep Trueta, Girona, Spain.
Virginia
V
Piñol
Gastroenterology Department, Hospital General Universitario de Alicante, Alicante, Spain.
Francisco Javier
FJ
Fernández
Gastroenterology Department, Hospital General de Alicante, Alicante, Spain.
Rodrigo
R
Jover
Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomedica Ourense, Pontevedra, y Vigo, Vigo, Spain.
Lucía
L
Cid
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.
María
M
López-Cerón
Pathology Department, Centre for Biomedical Diagnosis, Hospital Clínic de Barcelona, Barcelona, Spain.
Miriam
M
Cuatrecasas
Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain.
Jorge
J
López-Vicente
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.
Maria Liz
ML
Leoz
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.
Liseth
L
Rivero-Sánchez
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.
Antoni
A
Castells
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.
María
M
Pellisé
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.
Francesc
F
Balaguer
D011125:Adenomatous Polyposis Coli / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D000328:Adult; D000368:Aged; D001706:Biopsy; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D063189:Symptom Assessment / Q000379:methods
COLONOSCOPY; COLORECTAL CANCER; COLORECTAL CANCER SCREENING; PRE-MALIGNANCY - GI TRACT