title: Colorectal cancer anatomic distribution patterns remain the same after sessile serrated adenoma/polyp considered cancer precursor: a 9-year comparison study from community-based endoscopy centers.
abstract: BACKGROUND
  The overall incidence of colorectal cancer (CRC) in the United States has steadily decreased. However, the incidence of right-sided CRC remains unchanged for the past two decades. The serrated neoplastic pathway (sessile serrated adenoma/polyp, SSA/P) has been considered an important pathway of colorectal carcinogenesis, especially in the right-sided CRC. The aim of this study was to compare CRC anatomic distribution patterns in a 9-year interval in the general population before and after SSA/P was recognized and treated as a CRC precursor.
  
  
  METHODS
  The Miraca Life Sciences (MLS) pathology database was queried for all primary CRCs diagnosed between 8/3/2000 to 12/31/2005 (control group) and 1/1/2014 to 12/31/2014 (current group). Patients' demographics, clinical information, and pathology reports were collected and analyzed.
  
  
  RESULTS
  A total of 5,602 patients with 5,685 CRCs were identified, of which 2,728 patients with 2,765 CRCs in current group and 2,874 patients with 2,920 CRCs in control group. Overall, there were no statistical differences in the current group in regards to the anatomical distribution patterns of CRCs in the proximal, right-sided, distal, and left-sided colon or genders compared with the control group (all P>0.05). Among the current group, there were 33 (1.2%) patients with 38 (1.4%) CRCs arising in SSA/Ps [serrated carcinomas (SCAs)], of which 33 (86.8%) were in the right-sided colon and 5 (13.2%) in the left-sided colon. Twenty-three (69.7%) SCA patients were female with significant advanced age than male (76.4vs. 69.6, P=0.023).
  
  
  CONCLUSIONS
  The overall current CRC anatomic distribution patterns after SSA/Ps managed as CRC precursor remain the same in the patients' population from the community-based endoscopy centers in the U.S. It is suggested that the current SSA/P management might need to be further modified.
authors.affiliation: Division of Digestive and Liver Diseases, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Yang
authors.affiliation: Miraca Life Sciences Research Institute, Irving, TX, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Noffsinger
authors.affiliation: Division of Digestive and Liver Diseases, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: Miraca Life Sciences Research Institute, Irving, TX, USA.
authors.forename: Qing-Hua
authors.initials: QH
authors.lastname: Yang
keywords: Colorectal cancer (CRC); anatomic distribution; cancer precursor; sessile serrated adenoma/polyp