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Arnau-Collell C, Díez-Villanueva A, Bellosillo B, Augé JM, Muñoz J, Guinó E, Moreira L, Serradesanferm A, Pozo À, Torà-Rocamora I, Bonjoch L, Ibañez-Sanz G, Obon-Santacana M, Moratalla-Navarro F, Sanz-Pamplona R, Márquez Márquez C, Rueda Miret R, Pérez Berbegal R, Piquer Velasco G, Hernández Rodríguez C, Grau J, Castells A, Borràs JM, Bessa X, Moreno V, Castellví-Bel S. Evaluating the Potential of Polygenic Risk Score to Improve Colorectal Cancer Screening. Cancer Epidemiol Biomarkers Prev 2022; 31:1305-1312. [PMID: 35511747 PMCID: PMC9355543 DOI: 10.1158/1055-9965.epi-22-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Colorectal cancer has high incidence and associated mortality worldwide. Screening programs are recommended for men and women over 50. Intermediate screens such as fecal immunochemical testing (FIT) select patients for colonoscopy with suboptimal sensitivity. Additional biomarkers could improve the current scenario. METHODS We included 2,893 individuals with a positive FIT test. They were classified as cases when a high-risk lesion for colorectal cancer was detected after colonoscopy, whereas the control group comprised individuals with low-risk or no lesions. 65 colorectal cancer risk genetic variants were genotyped. Polygenic risk score (PRS) and additive models for risk prediction incorporating sex, age, FIT value, and PRS were generated. RESULTS Risk score was higher in cases compared with controls [per allele OR = 1.04; 95% confidence interval (CI), 1.02-1.06; P < 0.0001]. A 2-fold increase in colorectal cancer risk was observed for subjects in the highest decile of risk alleles (≥65), compared with those in the first decile (≤54; OR = 2.22; 95% CI, 1.59-3.12; P < 0.0001). The model combining sex, age, FIT value, and PRS reached the highest accuracy for identifying patients with a high-risk lesion [cross-validated area under the ROC curve (AUROC): 0.64; 95% CI, 0.62-0.66]. CONCLUSIONS This is the first investigation analyzing PRS in a two-step colorectal cancer screening program. PRS could improve current colorectal cancer screening, most likely for higher at-risk subgroups. However, its capacity is limited to predict colorectal cancer risk status and should be complemented by additional biomarkers. IMPACT PRS has capacity for risk stratification of colorectal cancer suggesting its potential for optimizing screening strategies alongside with other biomarkers.
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Affiliation(s)
- Coral Arnau-Collell
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Anna Díez-Villanueva
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Beatriz Bellosillo
- Pathology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Josep M. Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jenifer Muñoz
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Elisabet Guinó
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Anna Serradesanferm
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Internal Medicine and Dermatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,Barcelona, Spain
| | - Àngels Pozo
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Internal Medicine and Dermatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,Barcelona, Spain
| | - Isabel Torà-Rocamora
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Internal Medicine and Dermatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,Barcelona, Spain
| | - Laia Bonjoch
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Gemma Ibañez-Sanz
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Mireia Obon-Santacana
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Ferran Moratalla-Navarro
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Rebeca Sanz-Pamplona
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain
| | - Carmen Márquez Márquez
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Rebeca Rueda Miret
- Pathology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Rocio Pérez Berbegal
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gabriel Piquer Velasco
- Pathology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cristina Hernández Rodríguez
- Unitat de Prevenció i Registre del Càncer, Servei d'Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Jaume Grau
- Department of Preventive Medicine and Epidemiology, Clinical Institute of Internal Medicine and Dermatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona,Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Josep M. Borràs
- Department of Clinical Sciences, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Victor Moreno
- Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Barcelona, Spain.,Corresponding Authors: Victor Moreno, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Avinguda de la Granvia de l'Hospitalet, 199, L'Hospitalet de Llobregat 08908, Barcelona, Spain. Phone: 349-3260-7434; E-mail: ; and Sergi Castellví-Bel, Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Rosselló 149-153, Barcelona 08036, Spain. Phone: 349-3227-5707; E-mail:
| | - Sergi Castellví-Bel
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.,Corresponding Authors: Victor Moreno, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP) and University of Barcelona, Avinguda de la Granvia de l'Hospitalet, 199, L'Hospitalet de Llobregat 08908, Barcelona, Spain. Phone: 349-3260-7434; E-mail: ; and Sergi Castellví-Bel, Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Rosselló 149-153, Barcelona 08036, Spain. Phone: 349-3227-5707; E-mail:
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2
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Carballal S, Sánchez A, Moreira L, Cuellar-Monterrubio JE, Bernuy J, Daca M, Ortiz O, Ocaña T, Rivero-Sánchez L, Jung G, Serradesanferm A, Pozo A, Grau J, Torá I, Zaffalon D, Castells A, Pellisé M, Balaguer F. Prevalence of adenomatous polyposis in a fecal immunochemical test-based colorectal cancer screening program and risk of advanced neoplasia during follow-up. Endoscopy 2022; 54:688-697. [PMID: 34607378 DOI: 10.1055/a-1660-5353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
UNLABELLED BACKGROUND : Current guidelines recommend genetic counseling and intensive colonoscopy surveillance for patients with ≥ 10 colorectal adenomas based on scarce data. We investigated the prevalence of this condition in a fecal immunochemical test (FIT)-based colorectal (CRC) screening program, and the incidence of metachronous lesions during follow-up. METHODS We retrospectively included all FIT-positive participants with ≥ 10 adenomas at index colonoscopy between 2010 and 2018. Surveillance colonoscopies were collected until 2019. Patients with inherited syndromes, serrated polyposis syndrome, total colectomy, or lacking surveillance data were excluded. The cumulative incidence of CRC and advanced neoplasia were analyzed by Kaplan-Meier analysis. Risk factors for metachronous advanced neoplasia were investigated by multivariable logistic regression analysis. RESULTS 215 of 9582 participants (2.2 %) had ≥ 10 adenomas. Germline genetic testing was performed in 92 % of patients with ≥ 20 adenomas, identifying two inherited syndromes (3.3 %). The 3-year cumulative incidence of CRC and advanced neoplasia were 1 % and 16 %, respectively. In 39 patients (24.2 %), no polyps were found on first surveillance colonoscopy. The presence of an advanced adenoma was independently associated with a higher risk of advanced neoplasia at first surveillance colonoscopy (odds ratio 3.91, 95 %CI 1.12-13.62; P = 0.03). Beyond the first surveillance colonoscopy, the risk of metachronous advanced neoplasia was lower. CONCLUSIONS The prevalence of ≥ 10 adenomas in a FIT-based CRC screening program was 2.2 %; a small proportion of inherited syndromes were detected, even amongst those with ≥ 20 adenomas. A low rate of post-colonoscopy CRC was observed and the risk of advanced neoplasia beyond the first surveillance colonoscopy tended to progressively decrease throughout successive follow-ups.
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Affiliation(s)
- Sabela Carballal
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Jesús Eduardo Cuellar-Monterrubio
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain.,Department of Gastroenterology, Dr. José Eleuterio González University Hospital, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Julio Bernuy
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain.,Department of Gastroenterology, Hospital of Zumarraga, Guipuzkoa, Spain
| | - Maria Daca
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Oswaldo Ortiz
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Gerhard Jung
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, Barcelona, Spain
| | - Angels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, Barcelona, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, Barcelona, Spain
| | - Isabel Torá
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, Barcelona, Spain
| | - Diana Zaffalon
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - María Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
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3
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Duran-Sanchon S, Moreno L, Gómez-Matas J, Augé JM, Serra-Burriel M, Cuatrecasas M, Moreira L, Serradesanferm A, Pozo À, Grau J, Pellisé M, Gironella M, Castells A. Fecal MicroRNA-Based Algorithm Increases Effectiveness of Fecal Immunochemical Test-Based Screening for Colorectal Cancer. Clin Gastroenterol Hepatol 2021; 19:323-330.e1. [PMID: 32113893 DOI: 10.1016/j.cgh.2020.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/07/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS An algorithm based on fecal levels of 2 microRNAs (miR-421 and miR-27a-3p), fecal hemoglobin concentration, and patient age and sex can identify patients with advanced colorectal neoplasia. We investigated whether this algorithm, called miRFec, could increase effectiveness and efficiency of fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening programs. METHODS We obtained data and fecal samples from 767 persons with a positive result from the FIT who then underwent colonoscopy examination while participating a population-based CRC screening program, from March 2011 through May 2017 in Barcelona, Spain. Fecal miRNAs were isolated from the buffer contained in the original FIT collection device and analyzed by quantitative reverse transcription PCR. Aims were to evaluate the usefulness of the miRFec algorithm in identifying persons at greatest risk for CRC who should be prioritized for colonoscopy examination and individuals at low risk for whom colonoscopy could be avoided. RESULTS Of the 767 study subjects, 414 (54.0%) were found by colonoscopy to have advanced colorectal neoplasia (67 with CRC and 347 with advanced adenomas) and 353 (46.0%) were found to have either non-advanced adenomas (n = 136) or a normal examination (n = 217). MiRFec algorithm scores (1-4) were independently associated with the presence of advanced colorectal neoplasia (P < .001). The miRFec algorithm differentiated patients with CRC from those with non-advanced adenomas or normal colonoscopy with an area under the receiver operating characteristic curve of 90% (95% CI, 86-94). Subjects with miRFec scores in the 4th quartile (above 3.09, high-risk group) were 8-fold more likely to have advanced colorectal neoplasia than subjects with miRFec scores in the 1st quartile (below 2.14, low-risk group). Subjects in the low-risk group had a positive predictive value below 30% for detection of advanced colorectal neoplasia. When we used a 50% specificity cut-off value, the miRFec algorithm identified 97% of patients with CRC and would allow 264 subjects (34.4%) to avoid colonoscopy examination. CONCLUSIONS An algorithm based on fecal levels of 2 miRNAs and hemoglobin, patient age and sex (miRFec) differentiated patients with CRC from those with non-advanced adenomas or normal colonoscopy with an area under the receiver operating characteristic curve value of 90% and avoided 34% of colonoscopies. Inclusion of this algorithm in FIT-based CRC screening programs could increase their effectiveness and efficiency.
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Affiliation(s)
- Saray Duran-Sanchon
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Javier Gómez-Matas
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Josep M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Míriam Cuatrecasas
- Pathology Department and Tumour Bank-Biobank, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Àngels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Meritxell Gironella
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
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4
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González-Suárez B, Pagés M, Araujo IK, Romero C, Rodríguez de Miguel C, Ayuso JR, Pozo À, Vila-Casadesús M, Serradesanferm A, Ginès À, Fernández-Esparrach G, Pellisé M, López-Cerón M, Flores D, Córdova H, Sendino O, Grau J, Llach J, Serra-Burriel M, Cárdenas A, Balaguer F, Castells A. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study. BMC Med 2020; 18:255. [PMID: 32943059 PMCID: PMC7500543 DOI: 10.1186/s12916-020-01717-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colon capsule endoscopy (CCE) and CT colonography (CTC) are minimally invasive techniques for colorectal cancer (CRC) screening. Our objective is to compare CCE and CTC for the identification of patients with colorectal neoplasia among participants in a CRC screening programme with positive faecal immunochemical test (FIT). Primary outcome was to compare the performance of CCE and CTC in detecting patients with neoplastic lesions. METHODS The VICOCA study is a prospective, single-centre, randomised trial conducted from March 2014 to May 2016; 662 individuals were invited and 349 were randomised to CCE or CTC before colonoscopy. Endoscopists were blinded to the results of CCE and CTC. RESULTS Three hundred forty-nine individuals were included: 173 in the CCE group and 176 in the CTC group. Two hundred ninety individuals agreed to participate: 147 in the CCE group and 143 in the CTC group. In the intention-to-screen analysis, sensitivity, specificity and positive and negative predictive values for the identification of individuals with colorectal neoplasia were 98.1%, 76.6%, 93.7% and 92.0% in the CCE group and 64.9%, 95.7%, 96.8% and 57.7% in the CTC group. In terms of detecting significant neoplastic lesions, the sensitivity of CCE and CTC was 96.1% and 79.3%, respectively. Detection rate for advanced colorectal neoplasm was higher in the CCE group than in the CTC group (100% and 93.1%, respectively; RR = 1.07; p = 0.08). Both CCE and CTC identified all patients with cancer. CCE detected more patients with any lesion than CTC (98.6% and 81.0%, respectively; RR = 1.22; p = 0.002). CONCLUSION Although both techniques seem to be similar in detecting patients with advanced colorectal neoplasms, CCE is more sensitive for the detection of any neoplastic lesion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02081742 . Registered: September 16, 2013.
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Affiliation(s)
- Begoña González-Suárez
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
| | - Mario Pagés
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isis Karina Araujo
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Romero
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Juan Ramón Ayuso
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Àngels Pozo
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Maria Vila-Casadesús
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Anna Serradesanferm
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Glòria Fernández-Esparrach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Flores
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Henry Córdova
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Oriol Sendino
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jaume Grau
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Llach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economic, Pompeu Fabra University, Barcelona, Spain
| | - Andrés Cárdenas
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
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Duran-Sanchon S, Moreno L, Augé JM, Serra-Burriel M, Cuatrecasas M, Moreira L, Martín A, Serradesanferm A, Pozo À, Costa R, Lacy A, Pellisé M, Lozano JJ, Gironella M, Castells A. Identification and Validation of MicroRNA Profiles in Fecal Samples for Detection of Colorectal Cancer. Gastroenterology 2020; 158:947-957.e4. [PMID: 31622624 DOI: 10.1053/j.gastro.2019.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Screening for colorectal cancer (CRC) is effective in the population at average risk. The most extended strategy in organized programs involves the fecal immunochemical test, which is limited by low sensitivity for the detection of advanced adenomas (AAs). We aimed to identify microRNA (miRNA) signatures in fecal samples that identify patients with AAs or CRC and might be used in noninvasive screening. METHODS Our study comprised 4 stages. In the discovery phase, we performed genome-wide miRNA expression profiling of 124 fresh, paired colorectal tumor and nontumor samples (30 CRC; 32 AAs) from patients in Spain. In the technical validation stage, miRNAs with altered expression levels in tumor vs nontumor tissues were quantified by reverse-transcription polymerase chain reaction in fecal samples from a subset of patients included in the discovery phase (n = 39) and individuals without colorectal neoplasms (controls, n = 39). In the clinical validation stage, the miRNAs found to be most significantly up-regulated by quantitative reverse transcription polymerase chain reaction analysis were measured in an independent set of fecal samples (n = 767) from patients with positive results from fecal immunochemical tests in a CRC screening program. Finally, we developed a model to identify patients with advanced neoplasms (CRCs or AAs) based on their miRNA profiles, using findings from colonoscopy as the reference standard. RESULTS Among 200 and 324 miRNAs significantly deregulated in CRC and AA tissues, respectively, 7 and 5 of these miRNAs were also found to be deregulated in feces (technical validation). Of them, MIR421, MIR130b-3p, and MIR27a-3p were confirmed to be upregulated in fecal samples from patients with advanced neoplasms. In our model, the combination of fecal level of MIR421, MIR27a-3p, and hemoglobin identified patients with CRC with an area under the curve (AUC) of 0.93, compared with an AUC of 0.67 for fecal hemoglobin concentration alone. CONCLUSIONS We found that increased levels of 2 miRNAs and hemoglobin in feces can identify patients with AAs or CRC more accurately than fecal hemoglobin concentration alone. Assays for these miRNAs might be added to fecal tests for the detection of CRC or AAs.
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Affiliation(s)
- Saray Duran-Sanchon
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Josep M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Míriam Cuatrecasas
- Pathology Department and Tumour Bank-Biobank, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Agatha Martín
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Àngels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Rosa Costa
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Antonio Lacy
- Gastrointestinal Surgery Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Juan José Lozano
- Bioinformatics Platform, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Meritxell Gironella
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.
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6
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Rivero-Sánchez L, Grau J, Augé JM, Moreno L, Pozo A, Serradesanferm A, Díaz M, Carballal S, Sánchez A, Moreira L, Balaguer F, Pellisé M, Castells A. Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program. Endosc Int Open 2018; 6:E1140-E1148. [PMID: 30211305 PMCID: PMC6133669 DOI: 10.1055/a-0650-4296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Colorectal cancer (CRC) risk after a positive fecal immunochemical test (FIT) and negative colonoscopy is unknown. We aimed to ascertain the cumulative incidence of post-colonoscopy colorectal cancer (PCCRC) and the manifestation of other lesions that could explain the test positivity in individuals with a negative colonoscopy in a population screening program. Patients and method Observational study in participants from the first round of a CRC screening program (2010 - 2012) with positive-FIT (≥ 20 μg/g of feces) and negative colonoscopy (without neoplasia). A 42- to 76-month follow-up was performed searching in the National Health Service database and by a brief structured telephonic interview. Results Of 2659 FIT-positive individuals who underwent colonoscopy, 811 (30.5 %) had a negative colonoscopy. Three PCCRC (0.4 %) were detected within 11 - 28 months and accelerated carcinogenesis was ruled out. Among those with normal colonoscopy, 32 (5 %) relevant lesions were detected at follow-up. One-third of them (11/32) were significant neoplasias: a gastric cancer, a small-bowel lymphoma, six advanced colorectal adenomas, and the three PCCRC. The 21 remaining lesions were inflammatory, vascular disorders, or non-advanced colorectal adenomas. Conclusions The vast majority (95 %) of individuals did not present any subsequent lesion that could explain the FIT positivity. The very low incidence (0.4 %) and characteristics of PCCRC observed in our cohort reinforce the concept that, although a positive FIT preselects high risk individuals, a high quality colonoscopy is the paramount factor in preventing PCCRC. Improving quality standards of colonoscopy are required to strengthen the current CRC screening strategies.
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Affiliation(s)
- Liseth Rivero-Sánchez
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Josep María Augé
- Biochemistry Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Angels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Mireia Díaz
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Corresponding author Dr María Pellisé Department of GastroenterologyHospital ClínicVillarroel 17008036 BarcelonaCataloniaSpain+34-93-2275589
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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7
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Egoavil C, Juárez M, Guarinos C, Rodríguez-Soler M, Hernández-Illán E, Alenda C, Payá A, Castillejo A, Serradesanferm A, Bujanda L, Fernández-Bañares F, Cubiella J, de-Castro L, Guerra A, Aguirre E, Herreros-de-Tejada A, Bessa X, Herráiz M, Marín-Gabriel JC, Balmaña J, Piñol V, Rodríguez Moranta F, Nicolás-Pérez D, Cuatrecasas M, Balaguer F, Castells A, Soto JL, Zapater P, Jover R. Increased Risk of Colorectal Cancer in Patients With Multiple Serrated Polyps and Their First-Degree Relatives. Gastroenterology 2017; 153:106-112.e2. [PMID: 28400194 DOI: 10.1053/j.gastro.2017.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Cecilia Egoavil
- Research Laboratory, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Miriam Juárez
- Research Laboratory, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Carla Guarinos
- Research Laboratory, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - María Rodríguez-Soler
- Service of Digestive Medicine, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Eva Hernández-Illán
- Research Laboratory, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Cristina Alenda
- Pathology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Artemio Payá
- Pathology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Adela Castillejo
- Molecular Genetics Laboratory, Elche University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Anna Serradesanferm
- Institut de Malaties Digestives i Metabòliques, CIBERehd, Hospital Clínic, Barcelona, Spain
| | - Luis Bujanda
- Gastroenterology Department, Hospital Donostia, Centros de Investigación Biomédica en Red de enfermedades hepáticas y digestivas, Universidad del País Vasco, San Sebastián, Spain
| | | | - Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Luisa de-Castro
- Gastroenterology Department, Complexo Hospitalario de Vigo, Vigo, Spain
| | - Ana Guerra
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elena Aguirre
- Oncology Department, Hospital Arnau de Vilanova, Lleida, Spain
| | | | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Maite Herráiz
- Gastroenterology Department, Clínica Universitaria de Navarra, Pamplona, Spain
| | | | - Judith Balmaña
- Oncology Department, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Virginia Piñol
- Gastroenterology Department, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | - David Nicolás-Pérez
- Gastroenterology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Francesc Balaguer
- Institut de Malaties Digestives i Metabòliques, CIBERehd, Hospital Clínic, Barcelona, Spain
| | - Antoni Castells
- Institut de Malaties Digestives i Metabòliques, CIBERehd, Hospital Clínic, Barcelona, Spain
| | - José-Luis Soto
- Molecular Genetics Laboratory, Elche University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Rodrigo Jover
- Research Laboratory, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Service of Digestive Medicine, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
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8
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Valentín F, Guarinos C, Juárez M, Rodríguez-Soler M, Serradesanferm A, Rodriguez-Moranta F, Nicolas-Perez D, Bujanda L, Herraiz M, De-Castro L, Fernández-Bañares F, Herreros-de-Tejada A, Martínez F, Aguirre E, Ferrández Á, Díaz-Tasende J, Piñol V, Paya A, Egoavil C, Alenda C, Castells A, Jover R, Cubiella J. Endoscopic surveillance in patients with multiple (10-100) colorectal polyps. Endoscopy 2016; 48:56-61. [PMID: 26165738 DOI: 10.1055/s-0034-1392515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic surveillance in patients with multiple colorectal polyps aims to reduce colorectal cancer (CRC) incidence and mortality, as well as the need for colorectal surgery. The aim of this study was to determine the risk of developing CRC or the need for surgery during endoscopic surveillance in a cohort of patients with multiple (10 - 100) colorectal polyps. PATIENTS AND METHODS This was a multicentrer, longitudinal, observational study in 15 CRC high risk clinics in Spain, carried out between January 2009 and December 2010. Patients who were included in the EPIPOLIP trial and had at least 1 year of follow-up were included in the study. The primary outcome of interest was the incidence of CRC at least 1 year following the initial colonoscopy. The secondary outcome was the need for colorectal surgery. RESULTS A total of 265 patients were followed for a median of 3.8 years. Patients underwent a median of 5 colonoscopies, and 17 patients (6.4 %) were diagnosed with CRC. A total of 32 patients (12.1 %) underwent surgery, including 15 (5.7 %) for prophylaxis without a diagnosis of CRC. The corresponding incidence density rates for CRC and colorectal surgery were 1.4 (95 % confidence interval [CI] 0.7 to 2.1) and 2.7 (95 %CI 1.7 to 3.6) per 100 patient-years, respectively. Only the presence of symptoms at first colonoscopy was independently associated with CRC diagnosis (hazard ratio [HR] 7.7, 95 %CI 1.1 to 59.3) and colorectal surgery (HR 4.6, 95 %CI 1.02 to 20.6). CONCLUSIONS Patients with more than 10 neoplastic polyps required frequent colonoscopies within a short follow-up period. More than 10 % of patients required colorectal surgery within 4 years, more than half for incident CRC.
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Affiliation(s)
- Fátima Valentín
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Carla Guarinos
- Unidad de Investigación, Hospital General Universitario de Alicante, Alicante, Spain
| | - Miriam Juárez
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - María Rodríguez-Soler
- Unidad de Investigación, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - David Nicolas-Perez
- Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Donostia Hospital/Biodonostia Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Basque Country (UPV/EHU), San Sebastián, Spain
| | - Maite Herraiz
- Department of Gastroenterology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Luisa De-Castro
- Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | - Alberto Herreros-de-Tejada
- Department of Gastroenterology, IDIPHIM, Hospital Universitario Puerta De Hierro, Majadahonda, Madrid, Spain
| | - Fernando Martínez
- Department of Gastroenterology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Elena Aguirre
- Department of Oncology, Hospital Arnau de Vilanova, Lleida, Spain
| | - Ángel Ferrández
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza, Spain
| | - José Díaz-Tasende
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Virginia Piñol
- Department of Gastroenterology, Hospital Josep Trueta, Girona, Spain
| | - Artemio Paya
- Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Cecilia Egoavil
- Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Cristina Alenda
- Department of Pathology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
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Rodríguez de Miguel C, Serradesanferm A, López-Cerón M, Carballal S, Pozo A, Balaguer F, Cárdenas A, Fernández-Esparrach G, Ginés A, González-Suárez B, Moreira L, Ordás I, Ricart E, Sendino O, Vaquero E, Ubré M, del Manzano S, Grau J, Llach J, Castells A, Pellisé M. Ascorbic acid PEG-2L is superior for early morning colonoscopies in colorectal cancer screening programs: A prospective non-randomized controlled trial. Gastroenterología y Hepatología 2015; 38:62-70. [DOI: 10.1016/j.gastrohep.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 01/10/2023]
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Castells A, Quintero E, Álvarez C, Bujanda L, Cubiella J, Salas D, Lanas A, Carballo F, Morillas JD, Hernández C, Jover R, Hijona E, Portillo I, Enríquez-Navascués JM, Hernández V, Martínez-Turnes A, Menéndez-Villalva C, González-Mao C, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Sopeña F, González-Rubio F, Seoane-Urgorri A, Grau J, Serradesanferm A, Pozo À, Pellisé M, Balaguer F, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, Carrillo-Palau M, de la Vega-Prieto M, Iglesias R, Amador J, Blanco JM, Sastre R, Ferrándiz J, González-Hernández MJ, Andreu M, Bessa X. Rate of detection of advanced neoplasms in proximal colon by simulated sigmoidoscopy vs fecal immunochemical tests. Clin Gastroenterol Hepatol 2014; 12:1708-16.e4. [PMID: 24681078 DOI: 10.1016/j.cgh.2014.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS We compared the ability of biennial fecal immunochemical testing (FIT) and one-time sigmoidoscopy to detect colon side-specific advanced neoplasms in a population-based, multicenter, nationwide, randomized controlled trial. METHODS We identified asymptomatic men and women, 50-69 years old, through community health registries and randomly assigned them to groups that received a single colonoscopy examination or biennial FIT. Sigmoidoscopy yield was simulated from results obtained from the colonoscopy group, according to the criteria proposed in the UK Flexible Sigmoidoscopy Trial for colonoscopy referral. Patients who underwent FIT and were found to have ≥75 ng hemoglobin/mL were referred for colonoscopy. Data were analyzed from 5059 subjects in the colonoscopy group and 10,507 in the FIT group. The main outcome was rate of detection of any advanced neoplasm proximal to the splenic flexure. RESULTS Advanced neoplasms were detected in 317 subjects (6.3%) in the sigmoidoscopy simulation group compared with 288 (2.7%) in the FIT group (odds ratio for sigmoidoscopy, 2.29; 95% confidence interval, 1.93-2.70; P = .0001). Sigmoidoscopy also detected advanced distal neoplasia in a higher percentage of patients than FIT (odds ratio, 2.61; 95% confidence interval, 2.20-3.10; P = .0001). The methods did not differ significantly in identifying patients with advanced proximal neoplasms (odds ratio, 1.17; 95% confidence interval, 0.78-1.76; P = .44). This was probably due to the lower performance of both strategies in detecting patients with proximal lesions (sigmoidoscopy detected these in 19.1% of patients and FIT in 14.9% of patients) vs distal ones (sigmoidoscopy detected these in 86.8% of patients and FIT in 33.5% of patients). Sigmoidoscopy, but not FIT, detected proximal lesions in lower percentages of women (especially those 50-59 years old) than men. CONCLUSIONS Sigmoidoscopy and FIT have similar limitations in detecting advanced proximal neoplasms, which depend on patients' characteristics; sigmoidoscopy underperforms for women 50-59 years old. Screening strategies should be designed on the basis of target population to increase effectiveness and cost-effectiveness. ClinicalTrials.gov number: NCT00906997.
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Affiliation(s)
- Antoni Castells
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia.
| | - Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife.
| | - Cristina Álvarez
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Luis Bujanda
- Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense
| | - Dolores Salas
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Fernando Carballo
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia
| | | | - Cristina Hernández
- Department of Epidemiology and Evaluation, Parc de Salut Mar, IMIM, Barcelona, Catalonia
| | - Rodrigo Jover
- Gastroenterology Unit, Hospital General Universitario de Alicante, Alicante
| | - Elizabeth Hijona
- Department of Gastroenterology, Donostia Hospital-Instituto Biodonostia, CIBERehd, University of Basque Country (UPV/EHU), San Sebastián
| | - Isabel Portillo
- Centro Coordinador del Programa de Cribado de Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, Bilbao
| | - José M Enríquez-Navascués
- Centro Coordinador del Programa de Cribado de Cáncer Colorrectal, Organización Central de Osakidetza-Servicio Vasco de Salud, Bilbao; Department of Surgery, Hospital Donostia-Instituto Biodonostia, University of Basque Country (UPV/EHU), San Sebastián
| | - Vicent Hernández
- Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Vigo
| | | | | | - Carmen González-Mao
- Department of Clinical Analysis, Complexo Hospitalario Universitario de Vigo, Vigo
| | - Teresa Sala
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario La Fe, Valencia
| | - Mercedes Andrés
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Gloria Teruel
- Colorectal Cancer Screening Program, Dirección General de Salud Pública, Conselleria de Sanitat, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region FISABIO, Valencia
| | - Antonio Peris
- Department of Gastroenterology, Consorcio Hospitalario de Castellón, Castellón
| | - Federico Sopeña
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Francisca González-Rubio
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, CIBERehd, Zaragoza
| | - Agustín Seoane-Urgorri
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Jaume Grau
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Anna Serradesanferm
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Àngels Pozo
- Unitat d'Avaluació, Suport i Preventiva, Hospital Clínic, Barcelona, Catalonia
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), IDIBAPS, University of Barcelona, Barcelona, Catalonia
| | - Akiko Ono
- Unidad de Gestión Clínica de Digestivo, Hospital Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, Murcia
| | - José Cruzado
- Colorectal Cancer Prevention Program of the Región de Murcia, Instituto Murciano de Investigación Biosanitaria, Servicio Murciano de Salud, Murcia
| | - Francisco Pérez-Riquelme
- Colorectal Cancer Prevention Program of the Región de Murcia, Instituto Murciano de Investigación Biosanitaria, Dirección General de Salud Pública, Consejería de Sanidad y Política Social, Murcia
| | - Inmaculada Alonso-Abreu
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife
| | | | | | | | | | | | - Juan Ferrándiz
- Subdirección de Calidad, Dirección General Atención al Paciente, SERMAS, Madrid
| | | | - Montserrat Andreu
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
| | - Xavier Bessa
- Department of Gastroenterology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Pompeu Fabra University, Barcelona, Catalonia
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Auge JM, Pellise M, Escudero JM, Hernandez C, Andreu M, Grau J, Buron A, López-Cerón M, Bessa X, Serradesanferm A, Piracés M, Macià F, Guayta R, Filella X, Molina R, Jimenez W, Castells A. Risk stratification for advanced colorectal neoplasia according to fecal hemoglobin concentration in a colorectal cancer screening program. Gastroenterology 2014; 147:628-636.e1. [PMID: 24937264 DOI: 10.1053/j.gastro.2014.06.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The latest generation of fecal immunochemical tests (FIT) allows for quantitation of hemoglobin in feces, allowing for selection of optimal cut-off concentrations. We investigated whether individuals with positive results from quantitative FITs, in combination with other factors, could be identified as being at greatest risk for advanced colorectal neoplasia. METHODS In a retrospective study, we analyzed data from a consecutive series of 3109 participants with positive results from FITs (≥20 μg/g of feces) included in the first round of the Barcelona colorectal cancer screening program, from December 2009 through February 2012. All participants underwent colonoscopy and were assigned to groups with any advanced colorectal neoplasia or with nonadvanced colorectal neoplasia (but with another diagnosis or normal examination findings). RESULTS Median fecal hemoglobin concentrations were significantly higher in participants with advanced colorectal neoplasia (105 μg/g; interquartile range, 38-288 μg/g) compared with participants with nonadvanced colorectal neoplasia (47 μg/g; interquartile range, 23-119 μg/g) (P < .001). Positive predictive values for advanced colorectal neoplasia, determined using arbitrary fecal hemoglobin concentrations, differed with sex and age. Multivariate logistic regression analysis identified sex (men: odds ratio [OR], 2.07; 95% confidence interval, 1.78-2.41), age (60-69 y: OR, 1.24; 95% confidence interval, 1.07-1.44), and fecal hemoglobin concentration (>177 μg/g: OR, 3.80; 95% confidence interval, 3.07-4.71) as independent predictive factors for advanced colorectal neoplasia. Combining these factors, we identified 16 risk categories associated with different probabilities of identifying advanced colorectal neoplasia. Risk for advanced colorectal neoplasia increased 11.46-fold among individuals in the highest category compared with the lowest category; positive predictive values ranged from 21.3% to 75.6%. CONCLUSIONS Fecal hemoglobin concentration, in addition to sex and age, in individuals with positive results from FITs can be used to stratify probability for the detection of advanced colorectal neoplasia. These factors should be used to prioritize individuals for colonoscopy examination.
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Affiliation(s)
- Josep M Auge
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain.
| | - Maria Pellise
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - José M Escudero
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Cristina Hernandez
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | | | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Andrea Buron
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mercè Piracés
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - Rafael Guayta
- Council of Colleges of Pharmacists in Catalonia, Barcelona, Spain
| | - Xavier Filella
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Rafael Molina
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Wladimiro Jimenez
- Biochemistry and Molecular Genetics Department, Hospital Clínic, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
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12
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Guarinos C, Juárez M, Egoavil C, Rodríguez-Soler M, Pérez-Carbonell L, Salas R, Cubiella J, Rodríguez-Moranta F, de-Castro L, Bujanda L, Serradesanferm A, Nicolás-Pérez D, Herráiz M, Fernández-Bañares F, Herreros-de-Tejada A, Aguirre E, Balmaña J, Rincón ML, Pizarro A, Polo-Ortiz F, Castillejo A, Alenda C, Payá A, Soto JL, Jover R. Prevalence and characteristics of MUTYH-associated polyposis in patients with multiple adenomatous and serrated polyps. Clin Cancer Res 2014; 20:1158-68. [PMID: 24470512 DOI: 10.1158/1078-0432.ccr-13-1490] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The present study aimed to determine the prevalence of MUTYH mutations in patients with multiple colonic polyps and to explore the best strategy for diagnosing MUTYH-associated polyposis (MAP) in these patients. EXPERIMENTAL DESIGN This study included 405 patients with at least 10 colonic polyps each. All cases were genetically tested for the three most frequent MUTYH mutations. Whole-gene analysis was performed in heterozygous patients and in 216 patients lacking the three most frequent mutations. Polyps from 56 patients were analyzed for the KRAS-Gly12Cys and BRAF V600E somatic mutations. RESULTS Twenty-seven (6.7%) patients were diagnosed with MAP, of which 40.8% showed serrated polyps. The sensitivity of studying only the three common variants was 74.1%. Of 216 patients without any monoallelic mutation in common variants, whole-gene analysis revealed biallelic pathogenic mutation in only one. G396D mutation was associated with serrated lesions and older age at diagnosis. There was a strong association between germinal MUTYH mutation and KRAS Gly12Cys somatic mutation in polyps. BRAF V600E mutation was found in 74% of serrated polyps in MUTYH-negative patients and in none of the polyps of MAP patients. CONCLUSIONS We observed a low frequency of MUTYH mutations among patients with multiple adenomatous and serrated polyps. The MAP phenotype frequently included patients with serrated polyps, especially when G396D mutation was involved. Our results show that somatic molecular markers of polyps can be useful in identifying MAP cases and support the need for the complete MUTYH gene analysis only in patients heterozygous for recurrent variants.
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Affiliation(s)
- Carla Guarinos
- Authors' Affiliations: Unidad de Investigación, Departments of Pathology, and Gastroenterology, Hospital General Universitario, Alicante; Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Ourense; Department of Gastroenterology, Bellvitge University Hospital; Institut de Malaties Digestives i Metabòliques, CIBERehd, Hospital Clínic; Department of Oncology, Hospital Vall d'Hebrón, Barcelona; Gastroenterology Department, Complexo Hospitalario de Vigo, Vigo; Department of Gastroenterology, Hospital Donostia, CIBERehd, Universidad del País Vasco, San Sebastián; Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Tenerife; Department of Gastroenterology, Clínica Universitaria de Navarra, Pamplona; Department of Gastroenterology, Hospital Mútua de Terrassa, Terrassa; Department of Gastroenterology, Hospital Puerta de Hierro, Madrid; Department of Oncology, Hospital Arnau de Vilanova, Lleida; Department of Gastroenterology, Hospital Bidasoa, Irún; Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla; Department of Gastroenterology, Hospital Basurto, Bilbao; Department of Molecular Genetics, Hospital General Universitario, Elche, Spain; and Gastrointestinal Cancer Research Laboratory, Baylor Research Institute, Baylor University Medical Center, Dallas, Texas
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13
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Álvarez C, Andreu M, Castells A, Quintero E, Bujanda L, Cubiella J, Salas D, Lanas Á, Carballo F, Morillas JD, Hernández C, Jover R, Sarasqueta C, Enriquéz-Navascués JM, Hernández V, Estévez P, Macenlle R, Sala T, Balaguer F, Pellisé M, Moreira L, Gil I, Peris A, González-Rubio F, Ferrández A, Poves C, Ponce M, Grau J, Serradesanferm A, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, Carrillo-Palau M, Santander C, Díaz Tasende J, Herreros A, Cacho G, Barranco LE, Bessa X. Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals. Gastrointest Endosc 2013; 78:333-341.e1. [PMID: 23623039 DOI: 10.1016/j.gie.2013.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 03/04/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (≥10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia. OBJECTIVE To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm. DESIGN Multicenter, randomized, controlled trial. SETTING The ColonPrev study, a population-based, multicenter, nationwide, randomized, controlled trial. PATIENTS A total of 5059 asymptomatic men and women aged 50 to 69 years. INTERVENTION Colonoscopy. MAIN OUTCOME MEASUREMENTS Prevalence of serrated polyps and their association with synchronous advanced neoplasia. RESULTS Advanced neoplasia was detected in 520 individuals (10.3%) (CRC was detected in 27 [0.5%] and advanced adenomas in 493 [9.7%]). Serrated polyps were found in 1054 individuals (20.8%). A total of 329 individuals (6.5%) had proximal serrated polyps, and 90 (1.8%) had LSPs. Proximal serrated polyps or LSPs were associated with male sex (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.76-4.45 and OR 1.65, 95% CI, 1.31-2.07, respectively). Also, LSPs were associated with advanced neoplasia (OR 2.49, 95% CI, 1.47-4.198), regardless of their proximal (OR 4.15, 95% CI, 1.69-10.15) or distal (OR 2.61, 95% CI, 1.48-4.58) locations. When we analyzed subtypes of serrated polyps, proximal hyperplasic polyps were related to advanced neoplasia (OR 1.61, 95% CI, 1.13-2.28), although no correlation with the location of the advanced neoplasia was observed. LIMITATIONS Pathology criteria for the diagnosis of serrated polyps were not centrally reviewed. The morphology of the hyperplasic polyps (protruded or flat) was not recorded. Finally, because of the characteristics of a population-based study carried out in average-risk patients, the proportion of patients with CRC was relatively small. CONCLUSION LSPs, but not proximal serrated polyps, are associated with the presence of synchronous advanced neoplasia. Further studies are needed to determine the risk of proximal hyperplastic polyps.
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Affiliation(s)
- Cristina Álvarez
- Department of Gastroenterology, Hospital del Mar. Cancer Research Program, IMIM Hospital del Mar Medical Research Institute, Universitat Autònoma de Barcelona Pompeu Fabra University, Barcelona, Catalonia, Spain
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Castells A, Bessa X, Quintero E, Bujanda L, Cubiella J, Salas D, Lanas Á, Carballo F, Morillas JD, Hernández C, Jover R, Montalvo I, Arenas J, Cosme Á, Hernández V, Iglesias B, Castro I, Cid L, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Roncales MP, González-Rubio F, Seoane-Urgorri A, Grau J, Serradesanferm A, Pellisé M, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, Carrillo-Palau M, de la Vega-Prieto M, Iglesias R, Amador J, Blanco JM, Sastre R, Ferrándiz J, González-Hernández MJ, Andreu M. Risk of Advanced Proximal Neoplasms According to Distal Colorectal Findings: Comparison of Sigmoidoscopy-Based Strategies. J Natl Cancer Inst 2013; 105:878-886. [DOI: 10.1093/jnci/djt117] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Moreira L, Pellisé M, Carballal S, Bessa X, Ocaña T, Serradesanferm A, Grau J, Macià F, Andreu M, Castells A, Balaguer F. High prevalence of serrated polyposis syndrome in FIT-based colorectal cancer screening programmes. Gut 2013; 62:476-7. [PMID: 22982987 DOI: 10.1136/gutjnl-2012-303496] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Jover R, Herráiz M, Alarcón O, Brullet E, Bujanda L, Bustamante M, Campo R, Carreño R, Castells A, Cubiella J, García-Iglesias P, Hervás AJ, Menchén P, Ono A, Panadés A, Parra-Blanco A, Pellisé M, Ponce M, Quintero E, Reñé JM, Sánchez del Río A, Seoane A, Serradesanferm A, Soriano Izquierdo A, Vázquez Sequeiros E. Clinical practice guidelines: quality of colonoscopy in colorectal cancer screening. Endoscopy 2012; 44:444-51. [PMID: 22438159 DOI: 10.1055/s-0032-1306690] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Rodríguez De Miguel C, Serradesanferm A, Del Manzano S, Cárdenas A, Fernández-Esparrach G, Ginés A, Ricart E, Sendino O, González-Suárez B, López-Cerón M, Llach J, Grau J, Castells A, Pellisé M. [Timing of polyethylene glycol administration is a key factor in the tolerability and efficacy of colon preparation in colorectal cancer screening]. Gastroenterol Hepatol 2012; 35:236-42. [PMID: 22445938 DOI: 10.1016/j.gastrohep.2012.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The quality and tolerability of antegrade gut lavage bowel preparation are key elements in the success of population-based colorectal cancer screening. OBJECTIVES To evaluate cleansing quality and tolerability according to the timing of polyethylene glycol administration in persons undergoing colorectal cancer screening. METHOD Participants in colorectal cancer screening were randomized to two groups: a) control group (colonoscopy scheduled at 9-12 h); preparation with polyethylene glycol on the previous afternoon; b) study group (colonoscopy scheduled at 12-15 h): preparation with polyethylene glycol on the morning of the colonoscopy, with the option of a split dose. The quality of cleansing was evaluated with the Boston scale and tolerability through a questionnaire. RESULTS A total of 282 participants were included: preparation was carried out the day before the procedure in 134 and on the same day in 148, of which 26 received a split dose. Cleansing was adequate in 95% (n=268) of the participants. The quality of cleansing was higher in the study group (P=.045). The interval between the end of administration and the beginning of the procedure was inversely correlated with the Boston scale score (P=.036; r=-0.125). Tolerability was unrelated to the time of administration (P>.2). Acceptance of the timing of administration was lower in the study group than in the control group (26% vs 10%, respectively; P=.001). CONCLUSIONS Preparation as close as possible to the colonoscopy improves the quality of cleansing with no detrimental effects on tolerability, although this option is less comfortable.
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Affiliation(s)
- Cristina Rodríguez De Miguel
- Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic, Barcelona, España
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Quintero E, Castells A, Bujanda L, Cubiella J, Salas D, Lanas Á, Andreu M, Carballo F, Morillas JD, Hernández C, Jover R, Montalvo I, Arenas J, Laredo E, Hernández V, Iglesias F, Cid E, Zubizarreta R, Sala T, Ponce M, Andrés M, Teruel G, Peris A, Roncales MP, Polo-Tomás M, Bessa X, Ferrer-Armengou O, Grau J, Serradesanferm A, Ono A, Cruzado J, Pérez-Riquelme F, Alonso-Abreu I, de la Vega-Prieto M, Reyes-Melian JM, Cacho G, Díaz-Tasende J, Herreros-de-Tejada A, Poves C, Santander C, González-Navarro A. Colonoscopy versus fecal immunochemical testing in colorectal-cancer screening. N Engl J Med 2012; 366:697-706. [PMID: 22356323 DOI: 10.1056/nejmoa1108895] [Citation(s) in RCA: 583] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonoscopy and fecal immunochemical testing (FIT) are accepted strategies for colorectal-cancer screening in the average-risk population. METHODS In this randomized, controlled trial involving asymptomatic adults 50 to 69 years of age, we compared one-time colonoscopy in 26,703 subjects with FIT every 2 years in 26,599 subjects. The primary outcome was the rate of death from colorectal cancer at 10 years. This interim report describes rates of participation, diagnostic findings, and occurrence of major complications at completion of the baseline screening. Study outcomes were analyzed in both intention-to-screen and as-screened populations. RESULTS The rate of participation was higher in the FIT group than in the colonoscopy group (34.2% vs. 24.6%, P<0.001). Colorectal cancer was found in 30 subjects (0.1%) in the colonoscopy group and 33 subjects (0.1%) in the FIT group (odds ratio, 0.99; 95% confidence interval [CI], 0.61 to 1.64; P=0.99). Advanced adenomas were detected in 514 subjects (1.9%) in the colonoscopy group and 231 subjects (0.9%) in the FIT group (odds ratio, 2.30; 95% CI, 1.97 to 2.69; P<0.001), and nonadvanced adenomas were detected in 1109 subjects (4.2%) in the colonoscopy group and 119 subjects (0.4%) in the FIT group (odds ratio, 9.80; 95% CI, 8.10 to 11.85; P<0.001). CONCLUSIONS Subjects in the FIT group were more likely to participate in screening than were those in the colonoscopy group. On the baseline screening examination, the numbers of subjects in whom colorectal cancer was detected were similar in the two study groups, but more adenomas were identified in the colonoscopy group. (Funded by Instituto de Salud Carlos III and others; ClinicalTrials.gov number, NCT00906997.).
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Affiliation(s)
- Enrique Quintero
- Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain.
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Vilella A, Serrano B, Marcos MA, Serradesanferm A, Mensa J, Hayes E, Anton A, Rios J, Pumarola T, Trilla A. Pandemic influenza A(H1N1) outbreak among a group of medical students who traveled to the Dominican Republic. J Travel Med 2012; 19:9-14. [PMID: 22221806 DOI: 10.1111/j.1708-8305.2011.00580.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND From the beginning of the influenza pandemic until the time the outbreak described here was detected, 77,201 cases of pandemic influenza A(H1N1) with 332 deaths had been reported worldwide, mostly in the United States and Mexico. All of the cases reported in Spain until then had a recent history of travel to Mexico, the Dominican Republic, or Chile. We describe an outbreak of influenza among medical students who traveled from Spain to the Dominican Republic in June 2009. METHODS We collected diagnostic samples and clinical histories from consenting medical students who had traveled to the Dominican Republic and from their household contacts after their return to Spain. RESULTS Of 113 students on the trip, 62 (55%) developed symptoms; 39 (45%) of 86 students tested had laboratory evidence of influenza A(H1N1) infection. Most students developed symptoms either just before departure from the Dominican Republic or within days of returning to Spain. The estimated secondary attack rate of influenza-like illness among residential contacts of ill students after return to Spain was 2.1%. CONCLUSIONS The attack rate of influenza A(H1N1) can vary widely depending on the circumstances of exposure. We report a high attack rate among a group of traveling medical students but a much lower secondary attack rate among their contacts after return from the trip. These findings may aid the development of recommendations to prevent influenza.
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Affiliation(s)
- Anna Vilella
- Preventive Medicine and Epidemiology Department, Hospital Clinic, Barcelona, Spain
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Gonzalo V, Petit A, Castellví-Bel S, Pellisé M, Muñoz J, Piñol C, Rodríguez-Moranta F, Clofent J, Balaguer F, Giráldez MD, Ocaña T, Serradesanferm A, Grau J, Reñé JM, Panés J, Castells A. Telomerase mRNA expression and immunohistochemical detection as a biomarker of malignant transformation in patients with inflammatory bowel disease. Gastroenterología y Hepatología 2010; 33:288-96. [DOI: 10.1016/j.gastrohep.2009.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/23/2009] [Accepted: 12/23/2009] [Indexed: 12/25/2022]
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Gonzalo V, Lozano JJ, Muñoz J, Balaguer F, Pellisé M, de Miguel CR, Andreu M, Jover R, Llor X, Giráldez MD, Ocaña T, Serradesanferm A, Alonso-Espinaco V, Jimeno M, Cuatrecasas M, Sendino O, Castellví-Bel S, Castells A. Aberrant gene promoter methylation associated with sporadic multiple colorectal cancer. PLoS One 2010; 5:e8777. [PMID: 20098741 PMCID: PMC2808250 DOI: 10.1371/journal.pone.0008777] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Accepted: 12/23/2009] [Indexed: 12/17/2022] Open
Abstract
Background Colorectal cancer (CRC) multiplicity has been mainly related to polyposis and non-polyposis hereditary syndromes. In sporadic CRC, aberrant gene promoter methylation has been shown to play a key role in carcinogenesis, although little is known about its involvement in multiplicity. To assess the effect of methylation in tumor multiplicity in sporadic CRC, hypermethylation of key tumor suppressor genes was evaluated in patients with both multiple and solitary tumors, as a proof-of-concept of an underlying epigenetic defect. Methodology/Principal Findings We examined a total of 47 synchronous/metachronous primary CRC from 41 patients, and 41 gender, age (5-year intervals) and tumor location-paired patients with solitary tumors. Exclusion criteria were polyposis syndromes, Lynch syndrome and inflammatory bowel disease. DNA methylation at the promoter region of the MGMT, CDKN2A, SFRP1, TMEFF2, HS3ST2 (3OST2), RASSF1A and GATA4 genes was evaluated by quantitative methylation specific PCR in both tumor and corresponding normal appearing colorectal mucosa samples. Overall, patients with multiple lesions exhibited a higher degree of methylation in tumor samples than those with solitary tumors regarding all evaluated genes. After adjusting for age and gender, binomial logistic regression analysis identified methylation of MGMT2 (OR, 1.48; 95% CI, 1.10 to 1.97; p = 0.008) and RASSF1A (OR, 2.04; 95% CI, 1.01 to 4.13; p = 0.047) as variables independently associated with tumor multiplicity, being the risk related to methylation of any of these two genes 4.57 (95% CI, 1.53 to 13.61; p = 0.006). Moreover, in six patients in whom both tumors were available, we found a correlation in the methylation levels of MGMT2 (r = 0.64, p = 0.17), SFRP1 (r = 0.83, 0.06), HPP1 (r = 0.64, p = 0.17), 3OST2 (r = 0.83, p = 0.06) and GATA4 (r = 0.6, p = 0.24). Methylation in normal appearing colorectal mucosa from patients with multiple and solitary CRC showed no relevant difference in any evaluated gene. Conclusions These results provide a proof-of-concept that gene promoter methylation is associated with tumor multiplicity. This underlying epigenetic defect may have noteworthy implications in the prevention of patients with sporadic CRC.
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Affiliation(s)
- Victoria Gonzalo
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Juan José Lozano
- Plataforma de Bioinformática, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain
| | - Jenifer Muñoz
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Cristina Rodríguez de Miguel
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Montserrat Andreu
- Gastroenterology Department, Hospital del Mar, Barcelona, Catalonia, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Xavier Llor
- Section of Digestive Diseases and Nutrition, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - M. Dolores Giráldez
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Epidemiology Unit, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Virginia Alonso-Espinaco
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Mireya Jimeno
- Department of Pathology, Centre de Diagnòstic Biomèdic; Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Department of Pathology, Centre de Diagnòstic Biomèdic; Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Oriol Sendino
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Sergi Castellví-Bel
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Department of Gastroenterology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
- * E-mail:
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