title: Comparison of nonampullary duodenal adenomas in patients with familial adenomatous polyposis versus patients with sporadic adenomas.
abstract: OBJECTIVE
  Nonampullary duodenal adenomas are either sporadic or associated with a hereditary syndrome such as familial adenomatous polyposis (FAP). The aim of this study is to compare characteristics and outcomes of sporadic and FAP-associated duodenal adenomas.
  
  
  METHODS
  We retrospectively collected clinical, endoscopic, and pathologic data in patients diagnosed with duodenal adenomas at our institution and included all available follow-up.
  
  
  RESULTS
  Two hundred thirteen subjects were identified; 118 had FAP and 95 had sporadic adenomas. FAP subjects were more likely to have multifocal disease. Initial size was not significantly associated with dysplasia. Fourteen (12%) with FAP and 33 (35%) with sporadic adenomas underwent EMR. Among those subjects who did not undergo EMR or surgery, there was no difference between the FAP and sporadic groups with progression to new dysplasia or cancer. However, the FAP group was significantly more likely to have dysplasia at follow-up (P = .05). There was a significant difference in overall survival between the FAP and sporadic groups (log-rank test, P < .001). In the subgroup of patients aged 40 years old and older who did not undergo intervention, the FAP group had a shorter time to pathology progression compared with the similar sporadic subgroup. Range of time to progression to cancer was 3 to 161 months.
  
  
  CONCLUSIONS
  FAP subjects were more likely to be younger and have multifocal disease. Progression of pathology was more likely in the older FAP group compared with the sporadic group. Time to progression to cancer was widely variable and, therefore, unpredictable.
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Division of Digestive Diseases, Emory University, Atlanta, Georgia, USA.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Cassani
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Gandhi
authors.initials: G
authors.lastname: Lanke
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Hsiang-Chun
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Xuemei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Lynch
authors.affiliation: Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000236:Adenoma / Q000473:pathology* / Q000601:surgery; D011125:Adenomatous Polyposis Coli / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000601:surgery; D016022:Case-Control Studies; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007417:Intestinal Polyps / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D047368:Tumor Burden