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Volume 8, Issue 2 , Pages 174-182, February 2010

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

Christoph Engel
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
- Reprint requests Address requests for reprints to: Christoph Engel, MD, Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany. fax: (49) 341-9716109
Nils Rahner
- Institute of Human Genetics, University of Bonn, Bonn, Germany
Karsten Schulmann
- Medical Department, Knappschaftskrankenhaus, Ruhr University, Bochum, Germany
Elke Holinski–Feder
- Center of Medical Genetics, Munich, and Department of Internal Medicine, Campus Innenstadt, University Hospital of Ludwig-Maximilians-University, Munich, Germany
Timm O. Goecke
- Institute of Human Genetics, Heinrich-Heine-University, Düsseldorf, Germany
Hans K. Schackert
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
Verena Steinke
- Institute of Human Genetics, University of Bonn, Bonn, Germany
Holger Vogelsang
- Department of Surgery, Technical University of Munich, Munich, Germany
Gabriela Möslein
- Department of Surgery, St Josefs Hospital, Bochum-Linden, Germany
Heike Görgens
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
Stefan Dechant
- Department of Surgery, University of Regensburg, Regensburg, Germany
Magnus von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
Josef Rüschoff
- Institute of Pathology Nordhessen and Targos Molecular Pathology GmbH, Kassel, and Institute of Pathology, University of Regensburg, Regensburg, Germany
Nicolaus Friedrichs
- Institute of Pathology, University of Bonn, Bonn, Germany
Reinhard Büttner
- Institute of Pathology, University of Bonn, Bonn, Germany
Markus Loeffler
- Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
Peter Propping
- Institute of Human Genetics, University of Bonn, Bonn, Germany
Wolff Schmiegel
- Medical Department, Knappschaftskrankenhaus, Ruhr University, Bochum, Germany
German HNPCC Consortium

published online 15 October 2009.

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.