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000141669 0247_ $$2doi$$a10.1053/j.gastro.2018.07.030
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000141669 1001_ $$aEngel, Christoph$$b0
000141669 245__ $$aNo Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies.
000141669 260__ $$aPhiladelphia, Pa. [u.a.]$$bSaunders$$c2018
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000141669 520__ $$aPatients 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).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).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 time since last colonoscopy.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.
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000141669 7001_ $$aVasen, Hans F$$b1
000141669 7001_ $$aSeppälä, Toni$$b2
000141669 7001_ $$aAretz, Stefan$$b3
000141669 7001_ $$aBigirwamungu-Bargeman, Marloes$$b4
000141669 7001_ $$ade Boer, Sybrand Y$$b5
000141669 7001_ $$aBucksch, Karolin$$b6
000141669 7001_ $$aBüttner, Reinhard$$b7
000141669 7001_ $$aHolinski-Feder, Elke$$b8
000141669 7001_ $$aHolzapfel, Stefanie$$b9
000141669 7001_ $$aHüneburg, Robert$$b10
000141669 7001_ $$aJacobs, Maarten A J M$$b11
000141669 7001_ $$aJärvinen, Heikki$$b12
000141669 7001_ $$0P:(DE-HGF)0$$aKloor, Matthias$$b13
000141669 7001_ $$0P:(DE-He78)11747cd1dc061b9333c0e3a3ff31bf2f$$avon Knebel Doeberitz, Magnus$$b14$$udkfz
000141669 7001_ $$aKoornstra, Jan J$$b15
000141669 7001_ $$avan Kouwen, Mariette$$b16
000141669 7001_ $$aLangers, Alexandra M$$b17
000141669 7001_ $$avan de Meeberg, Paul C$$b18
000141669 7001_ $$aMorak, Monika$$b19
000141669 7001_ $$aMöslein, Gabriela$$b20
000141669 7001_ $$aNagengast, Fokko M$$b21
000141669 7001_ $$aPylvänäinen, Kirsi$$b22
000141669 7001_ $$aRahner, Nils$$b23
000141669 7001_ $$aRenkonen-Sinisalo, Laura$$b24
000141669 7001_ $$aSanduleanu, Silvia$$b25
000141669 7001_ $$aSchackert, Hans K$$b26
000141669 7001_ $$aSchmiegel, Wolff$$b27
000141669 7001_ $$aSchulmann, Karsten$$b28
000141669 7001_ $$aSteinke-Lange, Verena$$b29
000141669 7001_ $$aStrassburg, Christian P$$b30
000141669 7001_ $$aVecht, Juda$$b31
000141669 7001_ $$aVerhulst, Marie-Louise$$b32
000141669 7001_ $$ade Vos Tot Nederveen Cappel, Wouter$$b33
000141669 7001_ $$aZachariae, Silke$$b34
000141669 7001_ $$aMecklin, Jukka-Pekka$$b35
000141669 7001_ $$aLoeffler, Markus$$b36
000141669 7001_ $$aGerman HNPCC Consortium, the Dutch Lynch Syndrome Collaborative Group, and the Finnish Lynch Syndrome Registry$$b37$$eCollaboration Author
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