A Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses After Colonoscopic Polypectomy

Martı́nez, Marı́a Elena; Baron, John A.; Lieberman, David A.; Schatzkin, Arthur; Lanza, Elaine; Winawer, Sidney J.; Zauber, Ann G.; Jiang, Ruixuan; Ahnen, Dennis J.; Bond, John H.; Church, Timothy R.; Robertson, Douglas J.; Smith‐Warner, Stephanie A.; Jacobs, Elizabeth T.; Alberts, David S.; Greenberg, E. Robert

doi:10.1053/j.gastro.2008.12.007

Cited by 509 publications

(532 citation statements)

References 43 publications

(103 reference statements)

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“…Adenomas with a villous component comprise a minority of colonic polyps but have an increased risk of malignant transformation. 38 An association between KRAS mutation and the presence of a villous component in adenomas has previously been reported by multiple authors. 19,29,39 Interestingly, the majority of contiguous polyps in BRAF-mutated carcinoma from our study were traditional serrated adenoma and tubulovillous adenoma, while none of these tumors demonstrated features of sessile serrated adenoma.…”

Section: Discussionmentioning

confidence: 80%

Colorectal carcinomas with KRAS mutation are associated with distinctive morphological and molecular features

et al. 2013

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KRAS-mutated carcinomas comprise 35-40% of all colorectal carcinomas but little is known about their characteristics. The aim of this study was to examine the pathological and molecular features of KRAS-mutated colorectal carcinomas and to compare them with other carcinoma subgroups. KRAS mutation testing was performed in 776 incident tumors from the Melbourne Collaborative Cohort Study. O 6 -methylguanine DNA methyltransferase (MGMT) status was assessed using both immunohistochemistry and MethyLight techniques. Microsatellite instability (MSI) phenotype and BRAF V600E mutation status were derived from earlier studies. Mutation in KRAS codon 12 or codon 13 was present in 28% of colorectal carcinomas. Compared with KRAS wildtype carcinomas, KRAS-mutated carcinomas were more frequently observed in contiguity with a residual polyp (38 vs 21%; Po0.001), demonstrated mucinous differentiation (46 vs 31%; P ¼ 0.001) and were associated with different MSI status (Po0.001) and with MGMT methylation (47 vs 21%; P ¼ 0.001). Compared with tumors demonstrating neither BRAF nor KRAS mutation, KRAS-mutated carcinomas showed more frequent location in the proximal colon (41 vs 27%; P ¼ 0.001), mucinous differentiation (46 vs 25%; Po0.001), presence of a contiguous polyp (38 vs 22%; Po0.001), MGMT methylation (47 vs 26%; P ¼ 0.01) and loss of MGMT immunohistochemical expression (27 vs 19%; P ¼ 0.02). KRAS-mutated carcinomas were distributed in a bimodal pattern along the proximal-distal axis of the colorectum. Compared with male subjects, female subjects were more likely to have KRAS-mutated carcinoma in the transverse colon and descending colon (39 vs 15%; P ¼ 0.02). No difference in overall survival was observed in patients according to their tumor KRAS mutation status. In summary, KRAS-mutated carcinomas frequently develop in contiguity with a residual polyp and show molecular features distinct from other colorectal carcinomas, in particular from tumors with neither BRAF nor KRAS mutation.

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Section: Discussionmentioning

confidence: 80%

Colorectal carcinomas with KRAS mutation are associated with distinctive morphological and molecular features

et al. 2013

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“…Quellen: [576,617,618] Konsens Hintergrund Nach Abtragung von Adenomen werden bei etwa 50 % der Patienten im Verlauf erneut Adenome detektiert [619]. Kontrolluntersuchungen nach Polypektomie machen etwa 20 % der Koloskopien aus und stellen somit einen wichtigen Kostenfaktor dar [620].…”

Section: Level Of Evidence 3bunclassified

“…Die Festlegung der Untersuchungsintervalle nach Polypektomie hängen vom individuellen Risiko des Patienten ab. Das Risiko hängt entscheidend von der Anzahl, der Größe und Histologie der entfernten Adenome ab [619]. Patienten mit 1 oder 2 kleinen tubulären Adenomen haben kein wesentlich erhöhtes Karzinomrisiko [210,609,610].…”

Section: Level Of Evidence 3bunclassified

“…Grundlage für diese Empfehlung sind die Daten der National Polyp Study, in der eine Untersuchung nach 3 Jahren eine ähnliche Rate an fortgeschrittenen Neoplasien ergab wie nach 1 Jahr [611]. Patienten mit 5 oder mehr Adenomen haben ein deutlich erhöhtes Risiko für eine fortgeschrittene Neoplasie von 24,9 % in einer gepoolten Analyse [619], vor allem, wenn 1 der Adenome ≥ 10 mm ist [622]. Daher erscheint in diesen Fällen ein kürzeres Untersuchungsintervall angezeigt (▶ Tab.…”

Section: Level Of Evidence 3bunclassified

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S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…12,13 Previous studies on CRC disparity by race have focused on prevalence of colorectal neoplasia 1,6,7,14,15 and recurrence of adenoma following polypectomy. [16][17][18] However, blacks may be more susceptible to CRC due to an increased risk of developing incident neoplasia. Therefore, we evaluated racial differences in subsequent development of adenoma and advanced adenoma among 22,525 non-Hispanic whites (whites) and non-Hispanic blacks (blacks) in the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO) who had negative flexible sigmoidoscopy (FSG) at baseline and underwent repeat FSG 3 or 5 years later.…”

Section: Introductionmentioning

confidence: 99%

Occurrence of Distal Colorectal Neoplasia Among Whites and Blacks Following Negative Flexible Sigmoidoscopy: An Analysis of PLCO Trial

et al. 2015

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BACKGROUND:It is unclear whether the higher rate of colorectal cancer (CRC) among non-Hispanic blacks (blacks) is due to lower rates of CRC screening or greater biologic risk. OBJECTIVE: We aimed to evaluate whether blacks are more likely than non-Hispanic whites (whites) to develop distal colon neoplasia (adenoma and/or cancer) after negative flexible sigmoidoscopy (FSG). DESIGN: We analyzed data of participants with negative FSGs at baseline in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial who underwent repeat FSGs 3 or 5 years later. Subjects with polyps or masses were referred to their physicians for diagnostic colonoscopy. We collected and reviewed the records of diagnostic evaluations. PARTICIPANTS: Our analytic cohort consisted of 21,550 whites and 975 blacks. MAIN MEASURES: We did a comparison by race (whites vs. blacks) in the findings of polyps or masses at repeat FSG, the follow-up of abnormal test results and the detection of colorectal neoplasia at diagnostic colonoscopy. KEY RESULTS: At the follow-up FSG examination, 304 blacks (31.2 %) and 4183 whites (19.4 %) had abnormal FSG, [adjusted relative risk (RR)=1.00; 95 % confidence interval (CI), 0.90-1.10]. However, blacks were less likely to undergo diagnostic colonoscopy (76.6 % vs. 83.1 %; RR=0.90; 95 % CI, 0.84-0.96). Among all included patients, blacks had similar risk of any distal adenoma (RR=0.86; 95 % CI, 0.65-1.14) and distal advanced adenoma (RR=1.01; 95 % CI, 0.60-1.68). Similar results were obtained when we restricted our analysis to compliant subjects who underwent diagnostic colonoscopy (RR=1.01; 95 % CI, 0.80-1.29) for any distal adenoma and (RR=1.18; 95 % CI, 0.73-1.92) for distal advanced adenoma. CONCLUSIONS: We did not find any differences between blacks and whites in the risk of distal colorectal adenoma 3-5 years after negative FSG. However, follow-up evaluations were lower among blacks.

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A Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses After Colonoscopic Polypectomy

Cited by 509 publications

References 43 publications

Colorectal carcinomas with KRAS mutation are associated with distinctive morphological and molecular features

Colorectal carcinomas with KRAS mutation are associated with distinctive morphological and molecular features

S3-Leitlinie – Kolorektales Karzinom

Occurrence of Distal Colorectal Neoplasia Among Whites and Blacks Following Negative Flexible Sigmoidoscopy: An Analysis of PLCO Trial

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