This article is more than 5 years old. Information may no longer be current.
Serrated polyps linked to increased risk for colorectal cancer
Click Here to Manage Email Alerts
Patients with sessile serrated adenomas or polyps and traditional serrated adenomas have an increased risk for developing colorectal cancer, according to the results of a nationwide, Danish population-based, case-control study.
“Before the mid-2000s, most lesions now recognized as serrated polyps were diagnosed as [hyperplastic polyps] and received minimal intervention and little follow-up evaluation after excision or biopsy,” John A. Baron, MD, of the department of clinical epidemiology at Aarhus University Hospital, Denmark, and the department of medicine at University of North Carolina School of Medicine, Chapel Hill, and colleagues wrote. “In Denmark, the availability of nationwide databases and permanent storage of paraffin blocks from diagnostic pathology specimens make it possible to study the association of serrated polyps with subsequent CRC.”
John A. Baron
Using database records from 1977 through 2009, Baron and colleagues identified 272,342 individuals who had colonoscopies, which included 2,045 CRC cases and 8,105 age- and sex-matched controls without CRC in their analysis.
They identified colorectal polyps detected during initial colonoscopy and obtained tissue blocks for hyperplastic lesions, then four expert pathologists reviewed and reclassified the lesions using current terminology for serrated polyps. Then they calculated odds ratios and absolute risks for CRC associated with polyp type.
Overall, 79 (3.9%) CRC cases vs. 142 (1.8%) controls had sessile serrated adenomas or polyps, corresponding to an adjusted OR for CRC of 3.07 (95% CI, 2.3-4.1). The adjusted OR was even higher when cytologic dysplasia was present (aOR = 4.76; 95% CI, 2.59-8.73). Patients with traditional serrated adenomas had an OR of 4.84 (95% CI, 2.36-9.93), whereas the OR for patients with adenomas was 2.5 (95% CI, 2.24-2.8).
The risk for CRC associated with sessile serrated adenomas or polyps was higher for women (OR = 5.05; 95% CI, 3.05-8.37) than men (OR = 2.18; 95% CI, 1.24-3.82).
The highest risk for CRC was observed in patients with sessile serrated adenomas or polyps proximal to the splenic flexure (OR = 12.42; 95% CI, 4.88-31.58).
For the 14 CRC cases vs. the 17 controls with traditional serrated adenomas, the OR for CRC was 4.84 (95% CI, 2.36-9.93); for the 757 vs. 1,698 with conventional adenomas, the OR was 2.51 (95% CI, 2.25-2.8); and for the 55 vs. 235 with hyperplastic polyps, the OR was 1.3 (95% CI, 0.96-1.77).
The estimated crude 10-year risk for CRC ranged from 2.5% to 4.4% for patients with sessile serrated adenomas or polyps with dysplasia, 4.5% for patients with traditional sessile adenomas, and 2.3% for patients with conventional adenomas.
“In conclusion, this nationwide population-based study found that [sessile serrated adenomas or polyps] and [traditional serrated adenomas] are associated with an increased risk for CRC equivalent to or even higher than that for [adenomas],” the researchers wrote. “In general, our findings support existing surveillance guidelines recommending the complete removal of [sessile serrated adenomas or polyps] and [traditional serrated adenomas] and close follow-up evaluation of patients with these lesions.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts