Engel, Christoph ORCID: 0000-0002-7247-282X, Vasen, Hans F., Seppala, Toni, Aretz, Stefan ORCID: 0000-0002-5228-1890, Bigirwamungu-Bargeman, Marloes, de Boer, Sybrand Y., Bucksch, Karolin, Buttner, Reinhard, Holinski-Feder, Elke, Holzapfel, Stefanie, Hueneburg, Robert, Jacobs, Maarten A. J. M., Jarvinen, Heikki, Kloor, Matthias, Doeberitz, Magnus von Knebel, Koornstra, Jan J., van Kouwen, Mariette, Langers, Alexandra M., van de Meeberg, Paul C., Morak, Monika, Moeslein, Gabriela, Nagengast, Fokko M., Pylvanainen, Kirsi ORCID: 0000-0003-4399-9283, Rahner, Nils, Renkonen-Sinisalo, Laura, Sanduleanu, Silvia, Schackert, Hans K., Schmiegel, Wolff, Schulmann, Karsten, Steinke-Lange, Verena, Strassburg, Christian P., Vecht, Juda, Verhulst, Marie-Louise, Cappel, Wouter de Vos Tot Nederveen, Zachariae, Silke, Mecklin, Jukka-Pekka ORCID: 0000-0003-4895-2249 and Loeffler, Markus (2018). No Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies. Gastroenterology, 155 (5). S. 1400 - 1412. PHILADELPHIA: W B SAUNDERS CO-ELSEVIER INC. ISSN 1528-0012

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Abstract

BACKGROUND & AIMS: Patients with Lynch syndrome are at high risk for developing colorectal cancer (CRC). Regular colonoscopic surveillance is recommended, but there is no international consensus on the appropriate interval. We investigated whether shorter intervals are associated with lower CRC incidence and detection at earlier stages by comparing the surveillance policies in Germany, which evaluates patients by colonoscopy annually, in the Netherlands (patients evaluated at 1-2-year intervals), and Finland (patients evaluated at 2-3-year intervals). METHODS: We collected data from 16,327 colonoscopic examinations (conducted from 1984 through 2015) of 2747 patients with Lynch syndrome (pathogenic variants in the MLH1, MSH2, or MSH6 genes) from the German HNPCC Consortium, the Dutch Lynch Syndrome Registry, and the Finnish Lynch Syndrome Registry. Our analysis included 23,309 person-years of cumulative observation time. Time from the index colonoscopy to incident CRC or adenoma was analyzed using the Kaplan-Meier method; groups were compared using the log-rank test. We performed multivariable Cox regression analyses to identify factors associated with CRC risk (diagnosis of CRC before the index colonoscopy, sex, mutation, age, and presence of adenoma at the index colonoscopy). RESULTS: The 10-year cumulative CRC incidence ranged from 4.1% to 18.4% in patients with low-and high-risk profiles, respectively, and varied with age, sex, mutation, and prior detection of CRC or adenoma. Observed colonoscopy intervals were largely in accordance with the country-specific recommendations. We found no significant differences in cumulative CRC incidence or CRC stage at detection among countries. There was no significant association between CRC stage and [GRAPHICS] time since last colonoscopy. CONCLUSIONS: We did not find a significant reduction in CRC incidence or stage of detection in Germany (annual colonoscopic surveillance) than in countries with longer surveillance intervals (the Netherlands, with 1-2-year intervals, and Finland, with 2-3-year intervals). Overall, we did not find a significant association of the interval with CRC risk, although age, sex, mutation, and prior neoplasia were used to individually modify colonoscopy intervals. Studies are needed to develop and validate risk-adapted surveillance strategies and to identify patients who benefit from shorter surveillance intervals.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Engel, ChristophUNSPECIFIEDorcid.org/0000-0002-7247-282XUNSPECIFIED
Vasen, Hans F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seppala, ToniUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aretz, StefanUNSPECIFIEDorcid.org/0000-0002-5228-1890UNSPECIFIED
Bigirwamungu-Bargeman, MarloesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Boer, Sybrand Y.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bucksch, KarolinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Buttner, ReinhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Holinski-Feder, ElkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Holzapfel, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hueneburg, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jacobs, Maarten A. J. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jarvinen, HeikkiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kloor, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Doeberitz, Magnus von KnebelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koornstra, Jan J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Kouwen, MarietteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Langers, Alexandra M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van de Meeberg, Paul C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Morak, MonikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moeslein, GabrielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nagengast, Fokko M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pylvanainen, KirsiUNSPECIFIEDorcid.org/0000-0003-4399-9283UNSPECIFIED
Rahner, NilsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Renkonen-Sinisalo, LauraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sanduleanu, SilviaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schackert, Hans K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmiegel, WolffUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schulmann, KarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steinke-Lange, VerenaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Strassburg, Christian P.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vecht, JudaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Verhulst, Marie-LouiseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cappel, Wouter de Vos Tot NederveenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zachariae, SilkeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mecklin, Jukka-PekkaUNSPECIFIEDorcid.org/0000-0003-4895-2249UNSPECIFIED
Loeffler, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-166898
DOI: 10.1053/j.gastro.2018.07.030
Journal or Publication Title: Gastroenterology
Volume: 155
Number: 5
Page Range: S. 1400 - 1412
Date: 2018
Publisher: W B SAUNDERS CO-ELSEVIER INC
Place of Publication: PHILADELPHIA
ISSN: 1528-0012
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
MISMATCH REPAIR DEFICIENCY; INTERVAL CANCERS; ADENOMAS; FAMILIES; HNPCC; PREVALENCE; CARCINOMAS; MUTATIONS; MORTALITY; POLYPOSISMultiple languages
Gastroenterology & HepatologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/16689

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