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Efficacy of annual colonoscopic surveillance in individuals with hereditary nonpolyposis colorectal cancer.
Clin Gastroenterol Hepatol. 2010 Feb; 8(2):174-82.CG

Abstract

BACKGROUND & AIMS

Individuals with hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome) have a high risk for developing colorectal cancer (CRC). We evaluated the efficacy of annual surveillance colonoscopies to detect adenomas and CRCs.

METHODS

In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fulfilled the Amsterdam criteria without microsatellite instability (MSS group).

RESULTS

Compliance to annual intervals was good, with 81% of colonoscopies completed within 15 months. Ninety-nine CRC events were observed in 90 patients. Seventeen CRCs (17%) were detected through symptoms (8 before baseline colonoscopy, 8 at intervals >15 months to the preceding colonoscopy, and 1 interval cancer). Only 2 of 43 CRCs detected by follow-up colonoscopy were regionally advanced. Tumor stages were significantly lower among CRCs detected by follow-up colonoscopies compared with CRCs detected by symptoms (P = .01). Cumulative CRC risk at the age of 60 years was similar in the MUT and MSI groups (23.0% combined; 95% confidence interval [CI], 14.8%-31.2%) but considerably lower in the MSS group (1.8%; 95% CI, 0.0%-5.1%). Adenomas at baseline colonoscopy predicted an earlier occurrence of subsequent adenoma (hazard ratio, 2.6; 95% CI, 1.7-4.0) and CRC (hazard ratio, 3.9; 95% CI, 1.7-8.5), providing information about interindividual heterogeneity of adenomas and kinetics of CRC formation.

CONCLUSIONS

Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families.

Authors+Show Affiliations

Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany. christoph.engel@imise.uni-leipzig.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19835992

Citation

Engel, Christoph, et al. "Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 8, no. 2, 2010, pp. 174-82.
Engel C, Rahner N, Schulmann K, et al. Efficacy of annual colonoscopic surveillance in individuals with hereditary nonpolyposis colorectal cancer. Clin Gastroenterol Hepatol. 2010;8(2):174-82.
Engel, C., Rahner, N., Schulmann, K., Holinski-Feder, E., Goecke, T. O., Schackert, H. K., Kloor, M., Steinke, V., Vogelsang, H., Möslein, G., Görgens, H., Dechant, S., von Knebel Doeberitz, M., Rüschoff, J., Friedrichs, N., Büttner, R., Loeffler, M., Propping, P., & Schmiegel, W. (2010). Efficacy of annual colonoscopic surveillance in individuals with hereditary nonpolyposis colorectal cancer. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 8(2), 174-82. https://doi.org/10.1016/j.cgh.2009.10.003
Engel C, et al. Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer. Clin Gastroenterol Hepatol. 2010;8(2):174-82. PubMed PMID: 19835992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of annual colonoscopic surveillance in individuals with hereditary nonpolyposis colorectal cancer. AU - Engel,Christoph, AU - Rahner,Nils, AU - Schulmann,Karsten, AU - Holinski-Feder,Elke, AU - Goecke,Timm O, AU - Schackert,Hans K, AU - Kloor,Matthias, AU - Steinke,Verena, AU - Vogelsang,Holger, AU - Möslein,Gabriela, AU - Görgens,Heike, AU - Dechant,Stefan, AU - von Knebel Doeberitz,Magnus, AU - Rüschoff,Josef, AU - Friedrichs,Nicolaus, AU - Büttner,Reinhard, AU - Loeffler,Markus, AU - Propping,Peter, AU - Schmiegel,Wolff, AU - ,, Y1 - 2009/10/14/ PY - 2009/07/21/received PY - 2009/10/02/revised PY - 2009/10/02/accepted PY - 2009/10/20/entrez PY - 2009/10/20/pubmed PY - 2010/4/22/medline SP - 174 EP - 82 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 8 IS - 2 N2 - BACKGROUND & AIMS: Individuals with hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome) have a high risk for developing colorectal cancer (CRC). We evaluated the efficacy of annual surveillance colonoscopies to detect adenomas and CRCs. METHODS: In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fulfilled the Amsterdam criteria without microsatellite instability (MSS group). RESULTS: Compliance to annual intervals was good, with 81% of colonoscopies completed within 15 months. Ninety-nine CRC events were observed in 90 patients. Seventeen CRCs (17%) were detected through symptoms (8 before baseline colonoscopy, 8 at intervals >15 months to the preceding colonoscopy, and 1 interval cancer). Only 2 of 43 CRCs detected by follow-up colonoscopy were regionally advanced. Tumor stages were significantly lower among CRCs detected by follow-up colonoscopies compared with CRCs detected by symptoms (P = .01). Cumulative CRC risk at the age of 60 years was similar in the MUT and MSI groups (23.0% combined; 95% confidence interval [CI], 14.8%-31.2%) but considerably lower in the MSS group (1.8%; 95% CI, 0.0%-5.1%). Adenomas at baseline colonoscopy predicted an earlier occurrence of subsequent adenoma (hazard ratio, 2.6; 95% CI, 1.7-4.0) and CRC (hazard ratio, 3.9; 95% CI, 1.7-8.5), providing information about interindividual heterogeneity of adenomas and kinetics of CRC formation. CONCLUSIONS: Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/19835992/Efficacy_of_annual_colonoscopic_surveillance_in_individuals_with_hereditary_nonpolyposis_colorectal_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(09)01013-1 DB - PRIME DP - Unbound Medicine ER -