Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer

Christoph Engel, Nils Rahner, Karsten Schulmann, Elke Holinski-Feder, Timm O. Goecke, Hans K. Schackert, Matthias Kloor, Verena Steinke, Holger Vogelsang, Gabriela Möslein, Heike Görgens, Stefan Dechant, Magnus von Knebel Doeberitz, Josef Rüschoff, Nicolaus Friedrichs, Reinhard Büttner, Markus Loeffler, Peter Propping, Wolff Schmiegel

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Abstract

Background & Aims: Individuals with hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome) have a high risk for developing colorectal cancer (CRC). We evaluated the efficacy of annual surveillance colonoscopies to detect adenomas and CRCs. Methods: In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fufilled the Amsterdam criteria without microsatellite instability (MSS group). Results: Compliance to annual intervals was good, with 81% of colonoscopies completed within 15 months. Ninety-nine CRC events were observed in 90 patients. Seventeen CRCs (17%) were detected through symptoms (8 before baseline colonoscopy, 8 at intervals >15 months to the preceding colonoscopy, and 1 interval cancer). Only 2 of 43 CRCs detected by follow-up colonoscopy were regionally advanced. Tumor stages were significantly lower among CRCs detected by follow-up colonoscopies compared with CRCs detected by symptoms (P = .01). Cumulative CRC risk at the age of 60 years was similar in the MUT and MSI groups (23.0% combined; 95% confidence interval [CI], 14.8%-31.2%) but considerably lower in the MSS group (1.8%; 95% CI, 0.0%-5.1%). Adenomas at baseline colonoscopy predicted an earlier occurrence of subsequent adenoma (hazard ratio, 2.6; 95% CI, 1.7-4.0) and CRC (hazard ratio, 3.9; 95% CI, 1.7-8.5), providing information about interindividual heterogeneity of adenomas and kinetics of CRC formation. Conclusions: Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families.

Original languageEnglish (US)
Pages (from-to)174-182
Number of pages9
JournalClinical Gastroenterology and Hepatology
Volume8
Issue number2
DOIs
StatePublished - Feb 1 2010

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Hereditary Nonpolyposis Colorectal Neoplasms
Colonoscopy
Colorectal Neoplasms
Adenoma
Confidence Intervals
Microsatellite Instability
DNA Mismatch Repair
Germ-Line Mutation
Multicenter Studies
Neoplasms
Cohort Studies
Mutation

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Engel, C., Rahner, N., Schulmann, K., Holinski-Feder, E., Goecke, T. O., Schackert, H. K., ... Schmiegel, W. (2010). Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer. Clinical Gastroenterology and Hepatology, 8(2), 174-182. https://doi.org/10.1016/j.cgh.2009.10.003

Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer. / Engel, Christoph; Rahner, Nils; Schulmann, Karsten; Holinski-Feder, Elke; Goecke, Timm O.; Schackert, Hans K.; Kloor, Matthias; Steinke, Verena; Vogelsang, Holger; Möslein, Gabriela; Görgens, Heike; Dechant, Stefan; von Knebel Doeberitz, Magnus; Rüschoff, Josef; Friedrichs, Nicolaus; Büttner, Reinhard; Loeffler, Markus; Propping, Peter; Schmiegel, Wolff.

In: Clinical Gastroenterology and Hepatology, Vol. 8, No. 2, 01.02.2010, p. 174-182.

Research output: Contribution to journalArticle

Engel, C, Rahner, N, Schulmann, K, Holinski-Feder, E, Goecke, TO, Schackert, HK, Kloor, M, Steinke, V, Vogelsang, H, Möslein, G, Görgens, H, Dechant, S, von Knebel Doeberitz, M, Rüschoff, J, Friedrichs, N, Büttner, R, Loeffler, M, Propping, P & Schmiegel, W 2010, 'Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer', Clinical Gastroenterology and Hepatology, vol. 8, no. 2, pp. 174-182. https://doi.org/10.1016/j.cgh.2009.10.003
Engel, Christoph ; Rahner, Nils ; Schulmann, Karsten ; Holinski-Feder, Elke ; Goecke, Timm O. ; Schackert, Hans K. ; Kloor, Matthias ; Steinke, Verena ; Vogelsang, Holger ; Möslein, Gabriela ; Görgens, Heike ; Dechant, Stefan ; von Knebel Doeberitz, Magnus ; Rüschoff, Josef ; Friedrichs, Nicolaus ; Büttner, Reinhard ; Loeffler, Markus ; Propping, Peter ; Schmiegel, Wolff. / Efficacy of Annual Colonoscopic Surveillance in Individuals With Hereditary Nonpolyposis Colorectal Cancer. In: Clinical Gastroenterology and Hepatology. 2010 ; Vol. 8, No. 2. pp. 174-182.
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AU - Rahner, Nils

AU - Schulmann, Karsten

AU - Holinski-Feder, Elke

AU - Goecke, Timm O.

AU - Schackert, Hans K.

AU - Kloor, Matthias

AU - Steinke, Verena

AU - Vogelsang, Holger

AU - Möslein, Gabriela

AU - Görgens, Heike

AU - Dechant, Stefan

AU - von Knebel Doeberitz, Magnus

AU - Rüschoff, Josef

AU - Friedrichs, Nicolaus

AU - Büttner, Reinhard

AU - Loeffler, Markus

AU - Propping, Peter

AU - Schmiegel, Wolff

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N2 - Background & Aims: Individuals with hereditary nonpolyposis colorectal cancer (HNPCC; Lynch syndrome) have a high risk for developing colorectal cancer (CRC). We evaluated the efficacy of annual surveillance colonoscopies to detect adenomas and CRCs. Methods: In a prospective, multicenter cohort study, 1126 individuals underwent 3474 colonoscopies. We considered individuals from 3 groups of HNPCC families: those with a pathogenic germline mutation in a mismatch repair gene (MUT group), those without a mutation but with microsatellite instability (MSI group), and those who fufilled the Amsterdam criteria without microsatellite instability (MSS group). Results: Compliance to annual intervals was good, with 81% of colonoscopies completed within 15 months. Ninety-nine CRC events were observed in 90 patients. Seventeen CRCs (17%) were detected through symptoms (8 before baseline colonoscopy, 8 at intervals >15 months to the preceding colonoscopy, and 1 interval cancer). Only 2 of 43 CRCs detected by follow-up colonoscopy were regionally advanced. Tumor stages were significantly lower among CRCs detected by follow-up colonoscopies compared with CRCs detected by symptoms (P = .01). Cumulative CRC risk at the age of 60 years was similar in the MUT and MSI groups (23.0% combined; 95% confidence interval [CI], 14.8%-31.2%) but considerably lower in the MSS group (1.8%; 95% CI, 0.0%-5.1%). Adenomas at baseline colonoscopy predicted an earlier occurrence of subsequent adenoma (hazard ratio, 2.6; 95% CI, 1.7-4.0) and CRC (hazard ratio, 3.9; 95% CI, 1.7-8.5), providing information about interindividual heterogeneity of adenomas and kinetics of CRC formation. Conclusions: Annual colonoscopic surveillance is recommended for individuals with HNPCC. Less intense surveillance might be appropriate for MSS families.

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