Gastroenterology

Gastroenterology

Volume 153, Issue 1, July 2017, Pages 106-112.e2
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Increased Risk of Colorectal Cancer in Patients With Multiple Serrated Polyps and Their First-Degree Relatives

https://doi.org/10.1053/j.gastro.2017.04.003Get rights and content

Background & Aims

We investigated whether patients with multiple serrated polyps, but not meeting the World Health Organization criteria for serrated polyposis syndrome, and their relatives have similar risks for colorectal cancer (CRC) as those diagnosed with serrated polyposis.

Methods

We collected data from patients with more than 10 colonic polyps, recruited in 2008–2009 from 24 hospitals in Spain for a study of causes of multiple colonic polyps.

We analyzed data from 53 patients who met the criteria for serrated polyposis and 145 patients who did not meet these criteria, but who had more than 10 polyps throughout the colon, of which more than 50% were serrated. We calculated age- and sex-adjusted standardized incidence ratios (SIRs) for CRC in both groups, as well as in their first-degree relatives.

Results

The prevalence of CRC was similar between patients with confirmed serrated polyposis and multiple serrated polyps (odds ratio, 1.35; 95% confidence interval [CI], 0.64–2.82; P = .40). The SIR for CRC in patients with serrated polyposis (0.51; 95% CI, 0.01–2.82) did not differ significantly from the SIR for CRC in patients with multiple serrated polyps (0.74; 95% CI, 0.20–1.90; P = .70). The SIR for CRC also did not differ significantly between first-degree relatives of these groups (serrated polyposis: 3.28, 95% CI, 2.16–4.77; multiple serrated polyps: 2.79, 95% CI, 2.10–3.63; P = .50). Kaplan–Meier analysis showed no differences in the incidence of CRC between groups during the follow-up period (log-rank, 0.6).

Conclusions

The risk of CRC in patients with multiple serrated polyps who do not meet the criteria for serrated polyposis, and in their first-degree relatives, is similar to that of patients diagnosed with serrated polyposis.

Section snippets

Patients

Patients were selected from the EPIPOLIP project, a multicenter nationwide study that recruited patients from 24 Spanish hospitals to investigate the causes of multiple colonic polyps.16 This project included patients with more than 10 adenomatous or serrated colonic polyps found in single or successive colonoscopies, with the exception of those who had been diagnosed previously with familial adenomatous polyposis, Lynch syndrome, hamartomatous polyposis, inflammatory bowel disease, and those

Clinical Characteristics of SPS and MSP Patients

Of 567 patients included in the EPIPOLIP registry, 53 (9.3%) met the WHO criteria for SPS (SPS group). In 145 additional patients (25.6%), serrated polyps represented more than 50% of the total polyps found (MSP group).

As shown in Table 1, the mean age of patients at diagnosis was higher in the MSP group compared with the SPS group (54.9 vs 48.9 y; P < .001) and they were more frequently male (P = .02). The MSP group had fewer polyps (P < .001), with a median number of polyps larger than 10 mm

Discussion

The primary finding of this study was the identification of a group of patients with MSP who do not meet the WHO criteria for SPS, but who share with them a similar personal and familial risk of CRC. These results identify the need for a specific surveillance strategy for this newly classified CRC risk group and their relatives. Moreover, these results underscore the limitations of the WHO criteria for SPS diagnosis and the need to improve identifying patients with serrated polyps who are at

Acknowledgments

The authors thank San Francisco Edit for editorial assistance.

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    This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e29. Learning Objective: Upon completion of this CME activity, successful learners will be able to assess the risk of colorectal cancer (CRC) in patients with multiple serrated colon polyps and the risk of CRC in their first-degree relatives.

    Conflicts of interest The authors disclose no conflicts.

    Funding This work was supported by the Instituto de Salud Carlos III (PI08/0726, INT-09/208, PI11/2630, INT-12-078, INT13-196, PI14/01386), Fundación de Investigación Biomédica de la Comunidad Valenciana–Instituto de Investigación Sanitaria y Biomédica de Alicante foundation (UGP-13-221, UGP-14-265), and the Asociación Española Contra el Cáncer (Fundación Científica GCB13131592CAST). Carla Guarinos received a predoctoral grant from Conselleria d’Educació de la Generalitat Valenciana (VALi+d. EXP ACIF/2010/018) and Eva Hernández-Illán received a grant from the Instituto de Salud Carlos III (FI12/00233). Asociación para la Investigación en Gastroenterología de la Provincia de Alicante, a private association that promotes research in gastrointestinal diseases in Alicante, also supported the logistic aspects of the study, but declares no conflict of interest.

    Authors names in bold designate shared co-first authorship.

    Authors share co-first authorship.

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