1
|
Goudarzi Y, Monirvaghefi K, Aghaei S, Amiri SS, Rezaei M, Dehghanitafti A, Azarpey A, Azani A, Pakmehr S, Eftekhari HR, Tahmasebi S, Zohourian Shahzadi S, Rajabivahid M. Effect of genetic profiling on surgical decisions at hereditary colorectal cancer syndromes. Heliyon 2024; 10:e34375. [PMID: 39145015 PMCID: PMC11320152 DOI: 10.1016/j.heliyon.2024.e34375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/06/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024] Open
Abstract
Hereditary colorectal cancer syndromes, such as Lynch syndrome and familial adenomatous polyposis (FAP), present significant clinical challenges due to the heightened cancer risks associated with these genetic conditions. This review explores genetic profiling impact on surgical decisions for hereditary colorectal cancer (HCRC), assessing options, timing, and outcomes. Genotypes of different HCRCs are discussed, revealing a connection between genetic profiles, disease severity, and outcomes. For Lynch syndrome, mutations in the MLH1, MSH2, MSH6, and PMS2 genes guide the choice of surgery. Subtotal colectomy is recommended for patients with mutations in MLH1 and MSH2, while segmental colectomy is preferred for those with MSH6 and PMS2 mutations. In cases of metachronous colon cancer after segmental colectomy, subtotal colectomy with ileorectal anastomosis is advised for all mutations. Surgical strategies for primary rectal cancer include anterior resection or abdominoperineal resection (APR), irrespective of the specific mutation. For rectal cancer occurring after a previous segmental colectomy, proctocolectomy with ileal pouch-anal anastomosis (IPAA) or APR with a permanent ileostomy is recommended. In FAP, surgical decisions are based on genotype-phenotype correlations. The risk of desmoid tumors post-surgery supports a single-stage approach, particularly for certain APC gene variants. Juvenile Polyposis Syndrome (JPS) surgical decisions involve genetic testing, polyp characteristics with attention to vascular lesions in SMAD4 mutation carriers. However, genetic profiling does not directly dictate the specific surgical approach for JPS. In conclusion this review highlights the critical role of personalized surgical plans based on genetic profiles to optimize patient outcomes and reduce cancer risk. Further research is needed to refine these strategies and enhance clinical guidelines.
Collapse
Affiliation(s)
- Yasaman Goudarzi
- Department of Medical Science, Shahroud Branch, Islamic Azad University, Iran
| | - Khaterehsadat Monirvaghefi
- Department of Adult Hematology & Oncology, School of Medicine, Ayatollah Khansari Hospital, Arak University of Medical Sciences, Arak, Iran
| | - Salar Aghaei
- Faculty of Medicine, Medical University of Kurdistan, Sanandaj, Iran
| | - Seyed Siamak Amiri
- Department of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahdi Rezaei
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
| | - Atefeh Dehghanitafti
- Department of General Surgery, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Azarpey
- Emory University School of Medicine, Atlanta, GA, USA
| | - Alireza Azani
- Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | | | - Hamid Reza Eftekhari
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Safa Tahmasebi
- Student Research Committee, Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mansour Rajabivahid
- Department of Internal Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
2
|
Melendez-Rosado J, Castaneda D, Strassmann V, Altinel Y, Ioannidis A, Rhode S, Da Silva G, Wexner SD, Lopez R, Jimenez B. The Characterization and Outcomes of Colorectal Malignancy in Patients ≤40 Years of Age: A Single-Center Experience. Am Surg 2022:31348221096589. [PMID: 35533112 DOI: 10.1177/00031348221096589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implementation of screening modalities has led to a decreased incidence of colorectal malignancies. Unfortunately, overall incidence has remained unchanged as cases have increased in patients below the suggested screening age. Therefore, we evaluated characteristics and oncological outcomes of malignancies in patients ≤40 years of age. METHODS Single-center retrospective analysis of prospectively collected data of malignancies in patients ≤40 years evaluated in our institution between 2010 and 2016. Basic descriptors for demographic, clinical, histologic, and genetic data were collected. Disease-free survival (DFS) and 5-year overall survival (OS) were compared for patients between 30-40 years and <30 years. RESULTS Fifty-six patients ≤40 years were identified, 44 of whom (96.5%) had adenocarcinomas. Most common malignancy location was the rectum (64.3%). Despite aggressive tumor characteristics such as moderate/poor differentiation (88.6%), lymphovascular invasion (26.8%), perineural invasion (21.4%), and advanced tumor stage T3/T4 (60.7%), OS rate was 94.6%. Both age groups had similar oncologic characteristics. There was a trend toward worse OS (2/11 and 1/45, P = .06) but not for DFS (7/11 and 15/43, P = .18) in patients <30 years of age compared to 30-40 years. There were no differences in OS (3/44 vs 0/88, P = .44) or DFS (17/42 vs 3/8, P = .80) between sporadic vs non-sporadic malignancies, respectively. CONCLUSIONS Patients ≤40 years of age with malignancy have advanced tumor stages and aggressive tumor characteristics at diagnosis. Although there is higher OS risk for patients <30 compared to those aged 30-40 years, no differences were found for DFS between these two groups.
Collapse
Affiliation(s)
- Jose Melendez-Rosado
- Department of Gastroenterology, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Daniel Castaneda
- Department of Gastroenterology, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Victor Strassmann
- Department of Colorectal Surgery, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Yuksel Altinel
- Department of Colorectal Surgery, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Argyrios Ioannidis
- Department of Colorectal Surgery, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Sara Rhode
- Department of Hematology/Oncology, 2569Cleveland Clinic Florida, Weston, FL, USA
| | - Giovanna Da Silva
- Department of Colorectal Surgery, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| | - Rocio Lopez
- Quantitative Health and Science, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Brenda Jimenez
- Department of Gastroenterology, Digestive Disease Institute, 219819Cleveland Clinic Florida, Weston, FL, USA
| |
Collapse
|
3
|
Laish I, Goldberg Y, Friedman E, Kedar I, Katz L, Levi Z, Gingold-Belfer R, Kopylov U, Feldman D, Levi-Reznick G, Half E. Genetic testing for assessment of lynch syndrome in young patients with polyps. Dig Liver Dis 2021; 53:1640-1646. [PMID: 34148862 DOI: 10.1016/j.dld.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Routine screening for establishing Lynch syndrome (LS) in young individuals diagnosed with adenomas is not recommended due to its low yield, and limited sensitivity of the employment of immunohistochemistry for DNA mismatch-repair proteins on polyps. Hence we aimed to evaluate the yield of germline mutational analysis in diagnosis of LS in a young Israeli cohort with colorectal adenomatous polyps. METHODS Data were retrospectively collected on consecutive patients, age ≤ 45 years, who underwent colonoscopy with removal of at least one adenoma during 2015-2020, and subsequently genetic testing by multigene panel or LS-Jewish founder mutation panel. RESULTS Overall, 92 patients were included (median age 35 years, range 23-45 years), of whom 79 (85.8%) underwent multigene panel genotyping, and 13 (14.2%) analysis for Jewish founder LS gene mutations. Altogether, 18 patients were identified with pathogenic mutations in actionable genes, including LS-associated genes in 6 (6.5%), BRCA2 in 2 (2.5%), GREM1 in 1(1.2%), and low-penetrance genes- APC I1307K and CHEK2- in 9 (11.4%) patients. Compared with non-LS patients, LS-carriers had a significantly higher median PREMM5 score (2.6 vs. 1.3; P = 0.04). CONCLUSIONS Young individuals diagnosed with adenomatous polyps should be offered genetic testing when fulfilling clinical guidelines for LS, but weight should also be given to adenoma characteristics in the PREMM5 score.
Collapse
Affiliation(s)
- Ido Laish
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yael Goldberg
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Eitan Friedman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Inbal Kedar
- Recanati Genetics Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Lior Katz
- Department of Gastroenterology and Hepatology, Hadassah Medical Center, Jerusalem, Israel
| | - Zohar Levi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Gastroenterology Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Rachel Gingold-Belfer
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Gastroenterology Institute, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel
| | - Uri Kopylov
- Gastroenterology Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Feldman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Gastroenterology Institute, Meir Medical Center, Kfar-Saba, Israel
| | | | - Elizabeth Half
- Gastroenterology Institute, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Khorram MR, Goshayeshi L, Maghool F, Bergquist R, Ghaffarzadegan K, Eslami S, Khooei A, Hoseini B. Prevalence of Mismatch Repair-Deficient Colorectal Adenoma/Polyp in Early-Onset, Advanced Cases: a Cross-Sectional Study Based on Iranian Hereditary Colorectal Cancer Registry. J Gastrointest Cancer 2021; 52:263-268. [PMID: 32193764 DOI: 10.1007/s12029-020-00395-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lynch syndrome (LS) increases the risk of many types of cancer, mainly colorectal cancer (CRC). The purpose of this study was to assess the prevalence of mismatch repair (MMR) deficiency in patients under the age of 50 with advanced adenomatous polyps, aiming at an early diagnosis of LS. METHODS This retrospective, cross-sectional study included eligible patients with advanced adenomas diagnosed ≤ 50 years of age registered between April 2014 and February 2017 at three pathology centers in Mashhad. Pathological records were reviewed, and colon tissue specimens were analyzed by immunohistochemistry (IHC) staining to identify proteins which serve as markers for LS as they are related to loss of MMR gene (MLH1, MSH2, MSH6, and PMS2) expression. RESULTS Of 862 consecutive patients, a total of 50 adenomas (54% males, 46% females of mean age 41.24 ± 6.5) met the eligibility criteria. Of the adenomas examined, 20 (40%) had a tubulovillous component, 34 (68%) had high-grade dysplasia, and 30 (60%) had were larger than 10 mm protrusions. None of the patients had loss of MMR protein expression. CONCLUSION No individual with MMR genetic disorder was identified by IHC screening of early-onset advanced colorectal adenomas. This strategy is therefore not an effective strategy for detecting MMR mutation carriers.
Collapse
Affiliation(s)
- Mahla Rahmani Khorram
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ladan Goshayeshi
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Maghool
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Kamran Ghaffarzadegan
- Pathology Department, Education and Research Department, Razavi Hospital, Mashhad, Iran
| | - Saeid Eslami
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alireza Khooei
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran.
| |
Collapse
|
5
|
Urso EDL, Ponz de Leon M, Vitellaro M, Piozzi GN, Bao QR, Martayan A, Remo A, Stigliano V, Oliani C, Lucci Cordisco E, Pucciarelli S, Ranzani GN, Viel A. Definition and management of colorectal polyposis not associated with APC/MUTYH germline pathogenic variants: AIFEG consensus statement. Dig Liver Dis 2021; 53:409-417. [PMID: 33504457 DOI: 10.1016/j.dld.2020.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
An expert consensus panel convened by the Italian Association for Inherited and Familial Gastrointestinal Tumors (Associazione Italiana per lo Studio della Familiarità ed Ereditarietà dei Tumori Gastrointestinali, AIFEG) reviewed the literature and agreed on a number of position statements regarding the definition and management of polyposis coli without an identified pathogenic mutation on the APC or MUTYH genes, defined in the document as NAMP (non-APC/MUTYH polyposis).
Collapse
Affiliation(s)
- Emanuele Damiano Luca Urso
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University Hospital of Padua, Italy
| | - Maurizio Ponz de Leon
- Department of Internal Medicine, University of Modena and Reggio Emilia. Retired, Italy
| | - Marco Vitellaro
- Unit of Hereditary Digestive Tract Tumors, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Colorectal Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | - Guglielmo Niccolò Piozzi
- Colorectal Surgery Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Quoc Riccardo Bao
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University Hospital of Padua, Italy
| | - Aline Martayan
- Clinical Pathology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Remo
- Pathology Unit, Services Department, ULSS9 Scaligera, Verona, Italy
| | - Vittoria Stigliano
- Division of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | | | - Salvatore Pucciarelli
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University Hospital of Padua, Italy
| | | | - Alessandra Viel
- Functional Oncogenomics and Genetics Unit, IRCCS Centro di Riferimento Oncologico di Aviano (CRO), Aviano, Italy
| |
Collapse
|
6
|
Laish I, Katz L, Ben-Horin S, Yablecovitch D, Naftali T. Risk of metachronous neoplasia on surveillance colonoscopy among young and older patients after polypectomy. Dig Liver Dis 2020; 52:427-433. [PMID: 32037272 DOI: 10.1016/j.dld.2019.12.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/12/2019] [Accepted: 12/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Few reports address the appropriate colonoscopy surveillance interval for individuals <50-years-old. We compared the risk of metachronous neoplasia among young (<50 years), adult (50-74 years) and older (≥75 y) age groups. METHODS This was a single center retrospective cohort study. Eligible subjects underwent their first colonoscopy with polypectomy between 2005 and 2014 and had at least one surveillance colonoscopy 3-5 years later. Patients (N = 495) were stratified at baseline into low-risk adenoma (LRA) and advanced adenoma groups. Study outcomes were overall and high-risk neoplasia at surveillance colonoscopy. RESULTS In the baseline LRA-group (N = 201), the 5-year risk of metachronous high-risk neoplasia was 12.5%, 15.2% and 22.5% (P = 0.426) in the young, adult and older age groups, respectively. In the baseline advanced adenoma group (N = 294), the 3-year risk of metachronous high-risk neoplasia was 13.3%, 14.8% and 25.3% (P = 0.041), respectively. In multivariate analysis, the only risk factor for metachronous high-risk neoplasia was older age (OR 1.876, CI 1.087-3.238; P = 0.024). CONCLUSIONS Considering the comparable risk of metachronous high-risk neoplasia in young and adult patients, surveillance recommendations after polypectomy should not differ. Since this risk is higher among older people, more frequent surveillance schedule can be considered for this age group but should be individualized.
Collapse
Affiliation(s)
- Ido Laish
- Gastroenterology Department, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Lior Katz
- Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Yablecovitch
- Gastroenterology Department, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Timna Naftali
- Gastroenterology Department, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Dabir PD, Bruggeling CE, van der Post RS, Dutilh BE, Hoogerbrugge N, Ligtenberg MJL, Boleij A, Nagtegaal ID. Microsatellite instability screening in colorectal adenomas to detect Lynch syndrome patients? A systematic review and meta-analysis. Eur J Hum Genet 2019; 28:277-286. [PMID: 31695176 DOI: 10.1038/s41431-019-0538-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 11/09/2022] Open
Abstract
The colorectal cancer spectrum has changed due to population screening programs, with a shift toward adenomas and early cancers. Whether it would be a feasible option to test these adenomas for detection of Lynch syndrome (LS) patients is unclear. Through meta-analysis and systematic review, risk factors for DNA mismatch repair deficiency (dMMR) and microsatellite instability (MSI) in adenomas were identified in LS and unselected patient cohorts. Data were extracted for patient age and MMR variant together with adenoma type, grade, size, and location. A total of 41 studies were included, and contained more than 519 LS patients and 1698 unselected patients with 1142 and 2213 adenomas respectively. dMMR/MSI was present in 69.5% of conventional adenomas in LS patients, compared with 2.8% in unselected patients. In the LS cohort, dMMR/MSI was more frequently present in patients older than 60 years (82% versus 54%). dMMR/MSI was also more common in villous adenomas (84%), adenomas over 1 cm (81%), and adenomas with high grade dysplasia (88%). No significant differences were observed for dMMR/MSI in relation to MMR variants and location of adenomas. In the context of screening, we conclude that detection of dMMR/MSI in conventional adenomas of unselected patients is uncommon and might be considered as indication for LS testing. Within the LS cohort, 69.5% of LS patients could have been detected through dMMR/MSI screening of their conventional adenomas.
Collapse
Affiliation(s)
- Parag D Dabir
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Carlijn E Bruggeling
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas E Dutilh
- Theoretical Biology and Bioinformatics, Utrecht University, Utrecht, The Netherlands.,Centre for Molecular and Biomolecular Informatics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolijn J L Ligtenberg
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemarie Boleij
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
| |
Collapse
|
8
|
Factors related to colorectal cancer in advanced adenomas and serrated polyps: a further step toward individualized surveillance. Eur J Gastroenterol Hepatol 2018; 30:1337-1343. [PMID: 30085964 DOI: 10.1097/meg.0000000000001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM The risk of presenting synchronous or metachronous neoplasm, either adenoma or carcinoma, increases after an initial colonic lesion develops. It is known as tumor multicentricity and constitutes the rationale for surveillance programs. This study was designed to identify the clinical, pathologic, and molecular features related to previous or synchronous colorectal cancer (CRC) in patients with advanced adenomas (AA) or serrated polyps (SP). PATIENTS AND METHODS We carried out a prospective analysis of 4143 colonoscopies performed at our medical department between 1 September 2014 and 30 September 2015. Patients with AA/SP associated with previous or synchronous CRC are compared with patients with solitary AA/SP. We also performed immunohistochemical for the mismatch repair proteins in 120 AA or SP, 60 of them related to CRC. RESULTS Three-hundred and seventy-nine AA or SP were removed. Among these, 66 (17.3%) were associated with a previous (n=31) or synchronous CRC (n=35). Age older than or equal to 65 years (odds ratio: 1.15, 95% confidence interval: 1.05-1.26, P=0.002) and male sex (odds ratio: 2.13, 95% confidence interval: 1.3-3.49, P=0.003) were found to be independent predictive factors for CRC in patients with AA/SP by multivariate analysis. Only one of the 120 AA/SP available for immunohistochemical testing showed loss of staining and it was not related to CRC. CONCLUSION In patients with AA or SP, it is possible to identify a subgroup that is more likely to be associated with CRC and then prone to tumor multicentricity. These results have potential implications for establishing criteria for a more targeted surveillance.
Collapse
|
9
|
Wong HL, Christie M, Gately L, Tie J, Lee B, Semira C, Lok SW, Wong R, Gibbs P. Mismatch repair deficiency assessment by immunohistochemistry: for Lynch syndrome screening and beyond. Future Oncol 2018; 14:2725-2739. [DOI: 10.2217/fon-2018-0319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
While mismatch repair (MMR) deficiency has been studied extensively, the assessment of MMR status in colorectal and other cancers remains highly relevant, particularly in light of recent data demonstrating that MMR deficiency is a strong predictor for treatment benefit with immune checkpoint inhibitors across multiple tumor types. In colorectal cancer, there is a growing consensus in support of routine MMR testing for Lynch syndrome screening, to inform prognosis and adjuvant chemotherapy use in early stage disease, and to predict response to immunotherapy in advanced disease. Here, we provide a review of the Ventana MMR Immunohistochemistry Panel, which was recently approved by the US FDA for use in Lynch syndrome screening.
Collapse
Affiliation(s)
- Hui-li Wong
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Christie
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Pathology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Lucy Gately
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, St. Vincent's Health, Fitzroy, Victoria, Australia
| | - Jeanne Tie
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Oncology, Western Health Medical School, University of Melbourne, Footscray, Victoria, Australia
| | - Belinda Lee
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Oncology, Northern Health, Epping, Victoria, Australia
| | - Christine Semira
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
| | - Sheau Wen Lok
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Rachel Wong
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia
| | - Peter Gibbs
- Systems Biology & Personalised Medicine Division, The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia
- Department of Medical Oncology, Western Health Medical School, University of Melbourne, Footscray, Victoria, Australia
| |
Collapse
|
10
|
Nagpal SJS, Mukhija D, Sanaka M, Lopez R, Burke CA. Metachronous colon polyps in younger versus older adults: a case-control study. Gastrointest Endosc 2018; 87:657-665. [PMID: 28549732 DOI: 10.1016/j.gie.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 05/11/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The incidence of colorectal cancer in the United States has decreased substantially in individuals aged 50 and older. In contrast, it is increasing in young adults. The polyp characteristics on baseline and follow-up colonoscopy in young adults are not well characterized. We describe the polyp characteristics on baseline and follow-up colonoscopy in adults <40 years and determined factors associated with the occurrence of metachronous, advanced neoplasia or high-risk (HR) polyp features. We compared the occurrence of metachronous advanced neoplasia in young adults with those 50 years and older to assess whether postpolypectomy surveillance guidelines seem appropriate for polyp-bearing adults less than age 40 years. METHODS Patients <40 years of age with >1 polyp removed on colonoscopy followed by a postpolypectomy colonoscopy were eligible. The primary outcome was the occurrence of advanced neoplasia or HR polyp features on follow-up colonoscopy. Secondary endpoints included factors associated with metachronous advanced neoplasia in young adults. The occurrence of metachronous advanced neoplasia in young adults was compared with a cohort of patients aged 50 years and older. RESULTS Included were 128 patients with a mean age of 34.9 years; 124 patients (97%) had adenomas and 7% had sessile serrated polyps (SSPs). Advanced neoplasia was seen in 35% of patients at baseline. The median follow-up time was 33.6 months. Metachronous advanced neoplasia was identified in 7% of patients on follow-up colonoscopy. Baseline factors associated with metachronous advanced neoplasia included the presence of an SSP (hazard ratio, 7.8; 95% CI, 1.09-56.3; P = .041) with a trend in those with advanced neoplasia (hazard ratio, 3.4; 95% confidence interval, .89-12.8; P = .072). The occurrence of metachronous advanced neoplasia did not differ between the young and older cohorts (7% vs 12.2%, P = .58); however, young adults were less likely to have HR polyp features on follow-up (8.6% vs 20.3%, P = .008). CONCLUSIONS More than 1 in 3 adults <40 years old undergoing colonoscopy had advanced neoplasia on baseline colonoscopy. The occurrence of metachronous advanced neoplasia in young adults is similar to older adults and appears to be associated with the size, pathology, and number of baseline polyps. Our data suggest young polyp-bearing adults may undergo postpolypectomy colonoscopy at intervals currently recommended by national guidelines. Confirmation in larger studies is warranted.
Collapse
Affiliation(s)
| | - Dhruvika Mukhija
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Madhusudhan Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rocio Lopez
- Department of Quantitative and Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Kim HG, Cho YS, Cha JM, Shin JE, Kim KO, Yang HJ, Koo HS, Joo YE, Boo SJ. Risk of metachronous neoplasia on surveillance colonoscopy in young patients with colorectal neoplasia. Gastrointest Endosc 2018; 87:666-673. [PMID: 28619245 DOI: 10.1016/j.gie.2017.05.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/24/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Few prior reports exist that address the appropriate colonoscopy surveillance interval for individuals <50 years old. We compared the risk of metachronous neoplasia between younger (20-49 years) and older (50-54 years) cohorts. METHODS This multicenter retrospective cohort study compared the incidence of metachronous neoplasia in younger and older cohorts according to baseline risk stratification. Subjects were eligible if they underwent their first colonoscopy between June 2006 and May 2010 and had at least 1 or more surveillance colonoscopy up to June 2015. RESULTS Among a total of 10,477 subjects who underwent baseline colonoscopy, 9722 were eligible after excluding 755 subjects. Of those 9722 subjects, 43% underwent surveillance colonoscopy. In the baseline high-risk adenoma group (n = 840), the 3-year risk of metachronous advanced neoplasia was 10.7% in the younger patients on screening colonoscopy and 8.9% in the older patients (P > .1). In the baseline low-risk adenoma group (n = 1869), the 5-year risk of metachronous advanced neoplasia was 4.9% in the younger patients on screening colonoscopy and 5.1% in the older patients (P > .1). Similarly, in the baseline no neoplasia group (n = 7013), the 5-year risk of metachronous advanced neoplasia was 4.1% in the younger patients on screening colonoscopy and 5.6% in the older patients (P > .1). CONCLUSIONS Considering the similar risk of metachronous advanced neoplasia in younger and older individuals, we suggest a 3-year surveillance interval for high-risk adenoma and a 5-year surveillance interval for low-risk adenoma in young individuals without a strong family history.
Collapse
Affiliation(s)
- Hyun Gun Kim
- Department of Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Medicine, Catholic University College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong Eun Shin
- Department of Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Kyeong Ok Kim
- Department of Internal, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyo-Joon Yang
- Department of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hoon Sup Koo
- Department of Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young-Eun Joo
- Department of Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Jin Boo
- Department of Medicine, Jeju National University School of Medicine, Jeju, Korea
| |
Collapse
|
12
|
Carter JH, Cottrell CE, McNulty SN, Vigh-Conrad KA, Lamp S, Heusel JW, Duncavage EJ. FGFR2 amplification in colorectal adenocarcinoma. Cold Spring Harb Mol Case Stud 2017; 3:mcs.a001495. [PMID: 28835367 PMCID: PMC5701301 DOI: 10.1101/mcs.a001495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 05/30/2017] [Indexed: 01/13/2023] Open
Abstract
FGFR2 is recurrently amplified in 5% of gastric cancers and 1%–4% of breast cancers; however, this molecular alteration has never been reported in a primary colorectal cancer specimen. Preclinical studies indicate that several FGFR tyrosine-kinase inhibitors (TKIs), such as AZD4547, have in vitro activity against the FGFR2-amplified colorectal cell line, NCI-H716. The efficacy of these inhibitors is currently under investigation in clinical trials for breast and gastric cancer. Thus, better characterizing colorectal tumors for FGFR2 amplification could identify a subset of patients who may benefit from FGFR TKI therapies. Here, we describe a novel FGFR2 amplification identified by clinical next-generation sequencing in a primary colorectal cancer. Further characterization of the tumor by immunohistochemistry showed neuroendocrine differentiation, similar to the reported properties of the NCI-H716 cell line. These findings demonstrate that the spectrum of potentially clinically actionable mutations detected by targeted clinical sequencing panels is not limited to only single-nucleotide polymorphisms and insertions/deletions but also to copy-number alterations.
Collapse
Affiliation(s)
- Jamal H Carter
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Catherine E Cottrell
- Department of Pathology and Immunology, Washington University in St. Louis, Missouri 63130, USA.,Department of Genetics, Washington University in St. Louis, Missouri 63130, USA
| | - Samantha N McNulty
- Department of Pathology and Immunology, Washington University in St. Louis, Missouri 63130, USA
| | | | - Stephen Lamp
- Department of Pathology and Immunology, Washington University in St. Louis, Missouri 63130, USA
| | - Jonathan W Heusel
- Department of Pathology and Immunology, Washington University in St. Louis, Missouri 63130, USA.,Department of Genetics, Washington University in St. Louis, Missouri 63130, USA
| | - Eric J Duncavage
- Department of Pathology and Immunology, Washington University in St. Louis, Missouri 63130, USA
| |
Collapse
|
13
|
Xu QH, Chen ZT, Wu J. Clinical characteristics of colorectal polyps and adenocarcinoma: Analysis of 2273 cases. Shijie Huaren Xiaohua Zazhi 2017; 25:1416-1421. [DOI: 10.11569/wcjd.v25.i15.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the onset age, location and pathological type of colorectal polyps.
METHODS The χ2 test was used to analyze the relationship between age and the pathological type of polyps (including adenocarcinoma), as well as between the location and pathological type of adenomas.
RESULTS Of the 2273 patients included, 1245 (54.8%) were aged over 60 years, and 887 (39%) were aged between 45-59 years. Among 925 cases with non-neoplastic polyps, 420 (45.4%) were aged between 45-59 years, and 419 (45.5%) were aged over 60 years. Villous adenoma most commonly underwent malignant transformation (37.5%). Age was not related to the pathological type of adenoma. Adenocarcinomas mainly affected the rectum, sigmoid colon, and ascending colon, accounting for 34.1% (134/393), 21.1% (83/393), and 15.8% (62/393) of all adenocarcinomas, respectively. The rate of malignant transformation was highest in the hepatic flexure [58.5% (20/34)], followed by the ileocecal valve [52.8% (19/36)] and ascending colon [45.6% (62/136)].
CONCLUSION The occurrence of polyps and adenocarcinoma is related to age, which may be due to metabolic factors such as obesity and diabetes and long-term inflammatory response.
Collapse
|
14
|
Wong S, Lidums I, Rosty C, Ruszkiewicz A, Parry S, Win AK, Tomita Y, Vatandoust S, Townsend A, Patel D, Hardingham JE, Roder D, Smith E, Drew P, Marker J, Uylaki W, Hewett P, Worthley DL, Symonds E, Young GP, Price TJ, Young JP. Findings in young adults at colonoscopy from a hospital service database audit. BMC Gastroenterol 2017; 17:56. [PMID: 28424049 PMCID: PMC5395776 DOI: 10.1186/s12876-017-0612-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) diagnosed at <50 years is predominantly located in the distal colon and rectum. Little is known about which lesion subtypes may serve as CRC precursors in young adults. The aim of this work was to document the prevalence and histological subtype of lesions seen in patients aged <50 years, and any associated clinical features. METHODS An audit of the colonoscopy database at The Queen Elizabeth Hospital in Adelaide, South Australia over a 12-month period was undertaken. Findings were recorded from both colonoscopy reports and corresponding histological examination of excised lesions. RESULTS Data were extracted from colonoscopies in 2064 patients. Those aged <50 comprised 485 (24%) of the total. CRC precursor lesions (including sessile serrated adenoma/polyps (SSA/P), traditional serrated adenomas, tubular adenomas ≥10 mm or with high-grade dysplasia, and conventional adenomas with villous histology) were seen in 4.3% of patients aged <50 and 12.9% of patients aged ≥50 (P <0.001). Among colonoscopies yielding CRC precursor lesions in patients under 50 years, SSA/P occurred in 52% of procedures (11/21), compared with 27% (55/204) of procedures in patients aged 50 and older (P = 0.02). SSA/P were proximally located in (10/11) 90% of patients aged under 50, and 80% (43/54) of those aged 50 and older (P = 0.46). CONCLUSIONS SSA/P were the most frequently observed CRC precursor lesions in patients aged <50. Most CRCs in this age group are known to arise in the distal colon and rectum suggesting that lesions other than SSA/P may serve as the precursor for the majority of early-onset CRC.
Collapse
Affiliation(s)
- Stephanie Wong
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Ilmars Lidums
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Christophe Rosty
- Envoi Specialist Pathologists, Kelvin Grove 4059, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Herston 4006, Brisbane, QLD, Australia.,Department of Pathology, Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, The University of Melbourne, Parkville 3010, Melbourne, VIC, Australia
| | - Andrew Ruszkiewicz
- Division of Anatomical Pathology, SA Pathology, Adelaide, 5000, South Australia, Australia.,Centre for Cancer Biology, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Susan Parry
- Familial GI Cancer Service and Ministry of Health Bowel Cancer Programme, Auckland City Hospital, Auckland, New Zealand
| | - Aung Ko Win
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville 3010, Melbourne, VIC, Australia
| | - Yoko Tomita
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Sina Vatandoust
- Flinders Medical Centre, Bedford Park 5042, Adelaide, South Australia, Australia
| | - Amanda Townsend
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Dainik Patel
- Flinders Medical Centre, Bedford Park 5042, Adelaide, South Australia, Australia
| | - Jennifer E Hardingham
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, 5000, South Australia, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Eric Smith
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, 5000, South Australia, Australia
| | - Paul Drew
- School of Nursing and Midwifery, Flinders University, Bedford Park 5042, Adelaide, South Australia, Australia.,Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Julie Marker
- Cancer Voices SA, Kensington Park 5068, Adelaide, South Australia, Australia
| | - Wendy Uylaki
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia.,Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Peter Hewett
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia
| | - Daniel L Worthley
- School of Medicine, University of Adelaide, Adelaide, 5000, South Australia, Australia.,Cancer Theme, South Australian Health and Medical Research Institute, Adelaide, 5000, South Australia, Australia
| | - Erin Symonds
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park 5042, Adelaide, South Australia, Australia.,Bowel Health Service, Repatriation General Hospital, Daw Park 5041, Adelaide, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park 5042, Adelaide, South Australia, Australia
| | - Timothy J Price
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, 5000, South Australia, Australia
| | - Joanne P Young
- Department of Haematology and Oncology, The Queen Elizabeth Hospital, Woodville South 5011, Adelaide, South Australia, Australia. .,School of Medicine, University of Adelaide, Adelaide, 5000, South Australia, Australia. .,SAHMRI Colorectal Node, Basil Hetzel Institute, Woodville South, Adelaide, South Australia, 5011, Australia.
| |
Collapse
|
15
|
Kwak JY, Kim KM, Yang HJ, Yu KJ, Lee JG, Jeong YO, Shim SG. Prevalence of colorectal adenomas in asymptomatic young adults: a window to early intervention? Scand J Gastroenterol 2016; 51:731-8. [PMID: 26863602 DOI: 10.3109/00365521.2015.1130163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The prevalence of colorectal adenoma is increasing in the average-risk population. However, little research is available on colorectal adenoma in young adults under age 40. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in 20- to 39-year-old adults. METHODS We evaluated 4286 asymptomatic young adults aged 20 to 39 years who underwent first colonoscopy screening as part of an employer-provided health wellness programme at the Health Promotion Centre of Samsung Changwon Hospital, Korea from January 2011 to December 2013. Logistic regression modelling was used to identify risk factors for colorectal adenoma in asymptomatic young adults. RESULTS The prevalence of colorectal adenoma and advanced adenoma was 11.6% (497/4286) and 0.9% (39/4286), respectively. By age group, the prevalence of colorectal adenoma was 5.4% (33/608) in participants aged 20 to 29 years and 12.6% (464/3678) in participants aged 30 to 39. Colorectal adenoma was found in 13.1% (403/3072) of men and 7.7% (94/1214) of women. Increased risk of colorectal adenoma was associated with age over 30 years (OR, 2.37; 95% CI, 1.64-3.42), current smoker status (OR, 1.48; 95% CI, 1.14-1.91), and alcohol consumption (OR, 1.29; 95% CI, 1.03-1.63). CONCLUSIONS Our findings indicate that even if the prevalence of colorectal adenoma was low in young adults aged 20 to 39, being over 30, cigarette smoking, and alcohol consumption can affect young adults who have no other CRC risks.
Collapse
Affiliation(s)
- Ji Yeong Kwak
- a Health Promotion Centre, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Kwang Min Kim
- b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Hae Jin Yang
- c Department of Medicine , Hanheart Hospital , Changwon , Korea
| | - Kil Jong Yu
- b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Jae Gon Lee
- b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Yeon Oh Jeong
- b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| | - Sang Goon Shim
- b Department of Medicine , Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon , Korea
| |
Collapse
|
16
|
Loss of Mismatch Repair Protein Expression in Unselected Endometrial Adenocarcinoma Precursor Lesions. Int J Gynecol Cancer 2016; 26:228-32. [PMID: 26807560 DOI: 10.1097/igc.0000000000000606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The benefit of evaluating the precursor of endometrial carcinoma, endometrial hyperplasia (intraepithelial neoplasia [EIN]), for loss of mismatch repair (MMR) protein expression and Lynch syndrome has yet to be determined. The present study aims to establish the incidence and type of loss of MMR protein expression in unselected premalignant lesions of endometrial adenocarcinoma, as well as the agreement of immunohistochemical staining in pretreatment endometrial biopsy (EMB) specimens with subsequent uterine resections. METHODS A retrospective review identified 112 endometrial biopsies meeting criteria for endometrial EIN. Slides made from tissue microarray blocks were evaluated using antibodies against MLH1, PMS2, MSH2, and MSH6. Cases with a deficit in MLH1 were evaluated for gene promoter hypermethylation by polymerase chain reaction analysis. Fifty-four subsequent hysterectomy specimens were retrieved and assessed for MMR protein expression. RESULTS Of the 112 endometrial biopsies with EIN, 4.5% (5/112) exhibited loss of MMR protein expression. The majority (4/5) demonstrated a deficit of MLH1, of which all exhibited inactivation via promoter hypermethylation. A single case displayed an absence of MSH6. Age was not significantly associated with MMR deficiency. There was no significant association between MMR status in the EMB and a subsequent diagnosis of cancer. Immunohistochemical staining in all successive hysterectomy cases was concordant with the pattern observed in the EMB specimen. CONCLUSIONS Sporadic hypermethylation of MLH1 seems to be the primary mechanism underlying defective MMR protein expression in EIN. Among our cohort, only 1 patient (<1%) had a mutation suggestive of a hereditary inheritance. Hence, the utility of evaluating EIN for MMR protein expression as a screen for Lynch syndrome is limited, regardless of age.
Collapse
|
17
|
A Practical Approach to the Evaluation of Gastrointestinal Tract Carcinomas for Lynch Syndrome. Am J Surg Pathol 2016; 40:e17-34. [DOI: 10.1097/pas.0000000000000620] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
18
|
Park SK, Kim NH, Jung YS, Kim WH, Eun CS, Ko BM, Seo GS, Cha JM, Park JJ, Kim KO, Moon CM, Jung Y, Kim ES, Jeon SR, Lee CK, Park DI. Risk of developing advanced colorectal neoplasia after removing high-risk adenoma detected at index colonoscopy in young patients: A KASID study. J Gastroenterol Hepatol 2016; 31:138-44. [PMID: 26404417 DOI: 10.1111/jgh.13167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Advanced adenoma (> 10 mm in diameter, villous structure, or high-grade dysplasia) in young patients may have different characteristics and prognosis compared with those in older patients. We aimed to compare the incidence of colorectal neoplasms in young patients with older patients after removing high-risk adenoma (advance adenoma or ≥ 3 adenomas). METHODS A retrospective, multicenter study was conducted at 13 university hospitals in Korea. The 1479 patients who removed high-risk adenoma at index colonoscopy and followed by surveillance colonoscopy ≥ 2.5 years after were included. The cumulative incidence of overall and advanced colorectal neoplasms was compared according to the age groups (group 1: < 50 years, group 2: 50-70 years, and group 3: ≥ 70 years). RESULTS The prevalence of advance adenoma detected at index colonoscopy was significantly higher in group 1 than in groups 2 and 3 (85.4%, 78.1%, and 77.2%, respectively; P = 0.035). The 5 years cumulative incidence of overall and advanced colorectal neoplasms were 61.9%, 67.9%, and 74.7% (P < 0.001), and 11.7%, 17.9%, and 27.1% (P = 0.001) in groups 1, 2, and 3, respectively. In multivariate analysis, age > 70 years was a significant risk factor for developing overall (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.12-1.82, P = 0.004) and advanced colorectal neoplasms (HR = 2.56, 95% CI 1.43-4.59, P = 0.002). CONCLUSION The cumulative incidence of overall and advanced colorectal neoplasms was significantly higher in older patients than in young patient groups. Age was a significant risk factor for developing colorectal neoplasms after removing high-risk adenoma.
Collapse
Affiliation(s)
- Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Nam Hee Kim
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri
| | - Bong Min Ko
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon
| | - Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong
| | - Jae Jun Park
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine
| | - Chang Mo Moon
- Department of Internal Medicine, School of Medicine, Ewha Womans University
| | - Yoonho Jung
- Department of Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul
| | - Chang Kyun Lee
- Department of Internal Medicine, Kyung Hee University School of Medicine
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | | |
Collapse
|
19
|
Ma C, Pai RK. Predictive value of immunohistochemistry in pre-malignant lesions of the gastrointestinal tract. Semin Diagn Pathol 2015; 32:334-43. [DOI: 10.1053/j.semdp.2015.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|