Endoscopy 2018; 50(04): S15
DOI: 10.1055/s-0038-1637069
ESGE Days 2018 oral presentations
20.04.2018 – Colon: Improving detection
Georg Thieme Verlag KG Stuttgart · New York

IDENTIFICATION OF CLINICAL, GENETIC AND ENDOSCOPIC PREDICTORS OF INCIDENT COLORECTAL CANCER IN LYNCH SYNDROME UNDER COLONOSCOPY SCREENING

A Sanchez Garcia
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
M Navarro
2   Institut Català d'Oncologia, Barcelona, Spain
,
L Moreno
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
T Ocaña
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
F Rodríguez-Moranta
3   Hospital Universitari de Bellvitge, Barcelona, Spain
,
L Rodríguez-Alonso
3   Hospital Universitari de Bellvitge, Barcelona, Spain
,
A Soriano
3   Hospital Universitari de Bellvitge, Barcelona, Spain
,
T Ramon y Cajal
4   Hospital de la Santa Creu i San Pau, Barcelona, Spain
,
G Llort
5   Corporació Sanitària Parc Tauli i Consorci Sanitari de Terrasa, Sabadell i Terrasa, Spain
,
C Yagüe
5   Corporació Sanitària Parc Tauli i Consorci Sanitari de Terrasa, Sabadell i Terrasa, Spain
,
MD Picó
6   Hospital General Universitario de Alicante, Alicante, Spain
,
R Jover
6   Hospital General Universitario de Alicante, Alicante, Spain
,
A Lopez-Fernandez
7   Hospital Universitari Vall d'Hebron, Barcelona, Spain
,
E Martinez Castro
8   Hospital Universitario Marques de Valdecilla, Santander, Spain
,
C Alvarez
9   Hospital del Mar, Barcelona, Spain
,
X Bessa
9   Hospital del Mar, Barcelona, Spain
,
L Rivas
10   Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
J Cubiellas
10   Complexo Hospitalario Universitario de Ourense, Ourense, Spain
,
D Rodriguez-Alcalde
11   Hospital Universitario de Móstoles, Mostoles, Spain
,
A Dacal
12   Hospital Universitario Lucus Augusti, Lugo, Spain
,
M Herraiz
13   Clinica Universitaria de Navarra, Pamplona, Spain
,
C Garau
14   Hospital de Son Llatzer, Palma de Mallorca, Spain
,
L Bujanda
15   Hospital Universitario de Donostia, Donostia, Spain
,
L Cid
16   Hosptial Álvaro Cunqueiro de Vigo, Vigo, Spain
,
C Poves
17   Hospital Clínico de San Carlos, Madrid, Spain
,
M Garzon
18   Hospital Universitario Virgen del Rocío, Sevilla, Spain
,
A Pizarro
18   Hospital Universitario Virgen del Rocío, Sevilla, Spain
,
I Salces
19   Hospital Universitario 12 de Octubre, Madrid, Spain
,
M Ponce
20   Hospital Universitari i Politècnic de la Fe de València, Tenerife, Spain
,
M Carrillo-Palau
21   Hospital Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
,
E Aguirre
22   Hospital Quiron de Zaragoza, Zaragoza, Spain
,
E Saperas
23   Hospital General de Catalunya, Barcelona, Spain
,
A Suarez
24   Hospital Universitario Central de Asturias, Oviedo, Spain
,
V Piñol
25   Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
,
R Lleuger
25   Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
,
E Martinez-Bauer
26   Hospital Parc Taulí, Sabadell, Spain
,
C Romero
27   Consorci Sanitari de Terrasa, Terrasa, Spain
,
A Gisbert
4   Hospital de la Santa Creu i San Pau, Barcelona, Spain
,
G Jung
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
S Carballal
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
L Rivero
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
M Pellisé
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
J Balmaña
7   Hospital Universitari Vall d'Hebron, Barcelona, Spain
,
J Brunet
25   Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
,
A Castells
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
G Capellà
2   Institut Català d'Oncologia, Barcelona, Spain
,
L Moreira
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
,
M Serra
28   Universitat de Barcelona Centre de Recerca en Economia i Salut (Cres-UPF), Barcelona, Spain
,
F Balaguer
1   Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

Lynch syndrome (LS) families have a high risk of colorectal cancer (CRC) development. Colonoscopy every < 3 years decreases CRC incidence and mortality. However, recent studies show that up to 40% develop CRC during colonoscopy follow-up. Our aim is to assess the clinic-pathological, genetic and endoscopy quality measures that are predictors of CRC during colonoscopy surveillance in LS carriers.

Methods:

Multicenter nation-wide study with retrospective collection of prospectively observed data from high-risk clinics. Demographic, genetic, family and personal cancer history, and surveillance protocols data were collected between 2015 – 2017. First prospectively colonoscopy planned as LS screening was considered as date of inclusion. Cumulative incidence of the first CRC diagnosed under screening was calculated by gene/gender. CRCs diagnosed prior or within the first colonoscopy (prevalent cancers) were excluded. Additionally, endoscopic factors of CRC were analyzed.

Results:

We included 1,108 LS cases, 631 (56.9%) female, median age of 53 years (SD: 15.4), and a median follow-up of 58.4 months (SD: 53.7). Distribution per gene was: 449 (40.4%) MLH1, 372 (33.6%) MSH2, 197 (17.9%) MSH6 and 23 (2.1%) EPCAM. The prevalence of CRC was 38.4% (426). Healthy carriers (649) with proven endoscopic surveillance were selected (n = 539) observing 17/539 (3.15%) incident CRC during endoscopic screening: 7/192 MLH1, 9/192 MSH2, 1/113 MSH6, 0/37 PMS2 and 0/5 EPCAM. Inadequate endoscopic follow-up was present in 7/17 incident CRC including longer than 3 years interval (n = 4) or inadequate bowel-cleansing (n = 3). Cumulative CRC incidence at 70 years under endoscopic follow-up was calculate per gen: 13.8% (95% CI: 5.9 – 10.4%) for MLH1; 18.5% (95% CI: 8.8 – 36.4%) for MSH2 and 1% (95% CI: 0.15 – 7.1%) for MSH6; and gender: 16.7% (95% CI: 8 – 21.1%) males and 8.7% (95% CI: 3.9 – 19%) females.

Conclusions:

A preliminary analysis of this large multicenter study, reveals that cumulative incidence of a first CRC under screening colonoscopy is lower than previously published. Our results suggest that colonoscopy is highly effective for CRC prevention in LS, and that high quality endoscopic standards are key for its effectiveness.