Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers

Govindarajan, Anand; Rabeneck, Linda; Yun, Lingsong; Tinmouth, Jill; Paszat, Lawrence; Baxter, Nancy N.

doi:10.1136/gutjnl-2014-308578

Cited by 21 publications

(23 citation statements)

References 26 publications

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“…Significantly more in situ tumors were found in the PCCRC group. This in contrast to other studies 18 , where a higher likelihood of stage IV disease was found.…”

Section: Discussioncontrasting

confidence: 99%

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Post-colonoscopy colorectal cancer in Belgium: characteristics and influencing factors

Macken

Dongen

Brabander³

et al. 2019

Endosc Int Open

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Background and study aims Post-colonoscopy colorectal cancer (PCCRC) is an important quality parameter of colonoscopy. Most studies have shown that the risk for colorectal cancer is reduced after an index colonoscopy for screening or diagnostic purposes with or without polypectomy. In this study, we aimed to quantify and describe PCCRC in Belgium, including the possible relationships with patient, physician, and colonoscopy characteristics. Patients and methods Reimbursement data on colorectal related medical procedures from the Intermutualistic Agency (IMA-AIM) were linked with data on clinical and pathological staging of colorectal cancer (CRC) available at the Belgian Cancer Registry (BCR) over a period covering 9 years (2002 – 2010). Results In total, 63 518 colorectal cancers were identified in 61 616 patients between 2002 and 2010. We calculated a mean PCCRC rate of 7.6 %. PCCRC was significantly higher in older people and correlated significantly with polyp detection rate and the number of resections and procedures performed per year per physician. Conditional observed survival, given still alive 3 years since first colonoscopy, for PCCRC was worse than for CRC. Older patients and patients with invasive carcinomas had a worse outcome. Conclusions Although no quality register exists in Belgium, we were able to demonstrate that PCCRC in Belgium is directly related to the experience of the physician performing the procedure. In the absence of a quality register, utilization of population-based data sources proved to be a valuable tool to identify quality parameters.

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“…Significantly more in situ tumors were found in the PCCRC group. This in contrast to other studies 18 , where a higher likelihood of stage IV disease was found.…”

Section: Discussioncontrasting

confidence: 99%

“…We demonstrated that conditional survival for PCCRC was worse than for CRC. This outcome was also reported by Govindarajan et al 18 who found that PCCRCs were associated with a significantly worse oncological outcome. Most other studies, however, showed no difference in survival between individuals with PCCRC and controls 6 13 22 23 .…”

Section: Discussionsupporting

confidence: 86%

Post-colonoscopy colorectal cancer in Belgium: characteristics and influencing factors

Macken

Dongen

Brabander³

et al. 2019

Endosc Int Open

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“…Similar to PCCRC, tumours developing through the MMR pathway are more likely to be found in proximal locations and in older patients. These cancers may grow more quickly than tumours from the classic chromosomal instability pathway, without the slow progression from adenoma to carcinoma [39][40][41] has therefore been partly attributed to lead time bias [45,46]; once adjusted for, the survival difference between patients with PCCRC and detected cancers attenuates [47] This study is population-based and thus results reflect the general population of patients diagnosed with CRC after undergoing colonoscopy in Ontario. Further, we have included only patients with confirmed PCCRC.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, several studies have demonstrated similar survival among patients with PCCRC and detected cancers. In a Danish population‐based study of 982 patients with PCCRC and 35 704 patients who did not undergo colonoscopy prior to the diagnostic procedure, the adjusted 2–5‐year mortality rate ratio was 1.0 (95% CI 0.88–1.20) [14] Similarly, in a Korean population‐based study that included 6130 patients with PCCRC and 72 030 patients with detected cancers, both groups demonstrated similar unadjusted 5‐year survival (78.0% vs. 76.8%, respectively) [18] Unadjusted 5‐year survival was also similar in a single‐institution study of 51 patients with PCCRC matched to 112 patients with detected cancers (44% vs. 41%, respectively) [29] Although one study reported patients with PCCRC to have better overall survival than those with detected cancers (HR 0.63; 95% CI 0.49–0.81) [27] a subsequent study from the same group that matched patients by age, sex and hospital site did not find differences in survival between groups [42] Poorer survival may be expected given the aetiology of PCCRC; however, multiple studies report these cancers actually present at earlier stages than detected cancers [6,19,27] The poorer survival seen in some studies has therefore been partly attributed to lead time bias [45,46]; once adjusted for, the survival difference between patients with PCCRC and detected cancers attenuates [47]…”

Section: Discussionmentioning

confidence: 99%

Clinical and endoscopist factors associated with post‐colonoscopy colorectal cancer in a population‐based sample

et al. 2020

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Aim: Factors associated with verified post-colonoscopy colorectal cancers (PCCRC) have not been well defined and survival for these patients is not well described. We aimed to assess the association of patient, tumour and endoscopist characteristics with PCCRC. Methods: Using population-based data, we identified individuals diagnosed with CRC from 1 January 2000 to 31 December 2005 who underwent a colonoscopy within 3 years prior to diagnosis. Detected cancers were those diagnosed ≤6 months following colonoscopy; PCCRC were diagnosed >6 months to ≤3 years following colonoscopy. Post-colonoscopy and detected cancers were verified through chart review using a hospital-based simple random sampling frame. We used multivariable conditional logistic regression to determine the association of patient, tumour and endoscopist factors with PCCRC and compared overall survival using Cox proportional hazard models. Results: Using the random sampling frame, we identified 498 patients with PCCRC and 498 with detected CRC; we obtained records and confirmed 367 patients with PCCRC and 412 with detected cancers. In multivariable analysis, patient age (OR 1.01; 95% CI 1.00-1.03) and tumour location (distal vs. proximal OR 0.36; 95% CI 0.25-0.53

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“…28 However, this finding is not universal; in a population-based study of PCCRC from Ontario, Canada they reported that PCCRC had a higher likelihood of stage IV disease, worse overall survival, and emergency presentation compared with cancer detected at colonoscopy. 29 Studies of CRC have suggested a survival benefit for those with MSI tumors, 30,31 whereas conflicting reports exist on the effect of CIMP status on patient survival. PCCRC studies from Minnesota also did not find any survival benefits associated with molecular markers CIMP or MSI and actually reported a survival disadvantage in those patients with MSI tumors.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers

Samadder

Neklason

Snow

et al. 2019

Clinical Gastroenterology and Hepatology

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BACKGROUND & AIMS:Post-colonoscopy colorectal cancers (PCCRCs) may arise from missed lesions or due to molecular features of tumors that allow them to grow rapidly. We aimed to compare clinical, pathology, and molecular features of PCCRCs (those detected within 6-60 months of colonoscopy) and detected CRCs (those detected within 6 months of a colonoscopy). METHODS:Within a population-based cross-sectional study of incident CRC cases in Utah (from 1995 through 2009), we identified PCCRCs (those cancers that developed within 5 years of a colonoscopy) and matched the patients by age, sex, and hospital site to patients with detected CRC.Archived specimens were retrieved and tested for microsatellite instability (MSI), CpG island methylation, and mutations in KRAS and BRAF. There were 2659 cases of CRC diagnosed within the study window; 6% of these (n [ 159) were defined as PCCRCs; 84 of these cases had tissue available and were matched to 84 subjects with detected CRC. RESULTS:Higher proportions of PCCRCs than detected CRCs formed in the proximal colon (64% vs 44%; P [ .016) and were of an early stage (86% vs 69%; P [ .040). MSI was observed in 32% of PCCRCs compared with 13% of detected CRCs (P [ .005). The other molecular features were found in similar proportions of PCCRCs and detected CRCs. In a multivariable logistic regression, MSI (odds ratio, 4.20; 95% CI, 1.58-11.14) was associated with PCCRC. There was no difference in 5-year survival between patients with PCCRCs vs detected CRCs. CONCLUSION:In this population-based cross-sectional study of incident CRC cases in Utah, we found PCCRCs to be more likely to arise in the proximal colon and demonstrate MSI, so PCCRCs and detected CRC appear to have different features or processes of tumorigenesis. Additional studies are needed to determine if post-colonoscopy cancers arise through a specific genetic pathway. P ost-colonoscopy colorectal cancers (PCCRCs) are a small but clinically important subset of colorectal cancers (CRCs) that refer to cancers that are diagnosed after a colonoscopy in which no cancer is diagnosed. 1 The reported prevalence of PCCRC in various population-based studies across the world range from 3% to 9%, with an estimated pool prevalence of 3.7%. 2 The pathogenesis of PCCRC is likely multifactorial, including cancers and precursor adenomas that are missed or incompletely excised at colonoscopy or unique molecular pathways. Several patient factors (female gender, diverticulosis) and endoscopist factors (non-gastroenterologist physician, rural facility, low adenoma detection rate) have emerged as risk factors for PCCRC. 2-5 However, certain tumor characteristics Abbreviations used in this paper:

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Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers

Abstract: Compared with CRC detected by colonoscopy, PCCRCs are associated with a higher risk of emergent presentation, a lower likelihood of surgical resection and most notably, significantly worse oncological outcomes. However, they have better outcomes than patients with no recent colonoscopy.

Cited by 21 publications

References 26 publications

Post-colonoscopy colorectal cancer in Belgium: characteristics and influencing factors

Post-colonoscopy colorectal cancer in Belgium: characteristics and influencing factors

Clinical and endoscopist factors associated with post‐colonoscopy colorectal cancer in a population‐based sample

Clinical and Molecular Features of Post-Colonoscopy Colorectal Cancers

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