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Metachronous colorectal cancer risk in Lynch syndrome patients—should the endoscopic surveillance be more intensive?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Regular follow-up for patients with Lynch syndrome (LS) is vital due to the increased risk of colorectal (50–80%), endometrial (40–60%), and other cancers. However, there is an ongoing debate concerning the best interval between colonoscopies. Currently, no specific endoscopic follow-up has been decided for LS patients who already have an index colorectal cancer (CRC). The aim of this study was to evaluate the risk of metachronous cancers (MC) after primary CRC in a LS population and to determinate if endoscopic surveillance should be more intensive.

Methods

A prospective cohort of patients with a confirmed diagnosis of hereditary CRC since 2009 was included. Patients with LS and a primary CRC were the cohort of choice.

Results

One hundred twenty-one patients were included with a median age of 44 years(16–70). At least one MC occurred in 39 patients (32.2%), with a median interval of 67 months (6–300) from index cancer. Fifteen (38.5%) developed two or more MCs during follow-up, with a median number of two (2–6) tumors occurring. Metachronous CRC were diagnosed after a median interval of 24 (6–57) months since last colonoscopy and were more commonly seen in MSH2 mutation carriers (58 vs. 35%, p = 0.001). After a median follow-up of 52.9 (3–72) months, no cancer-related deaths were recorded.

Conclusion

Patients with LS have an increased risk of MC, especially CRCs. With a median time period of 24 months between colonoscopy and metachronous CRC, the interval between surveillance colonoscopies following primary CRC should not exceed 18 months, especially in patients with MSH2 mutation.

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Authors and Affiliations

  1. Department of Digestive Surgery, St Antoine Hospital (AP-HP), Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France

    Morgan Anyla, Jérémie H. Lefevre, Clotilde Debove, Najim Chafai, Emmanuel Tiret & Yann Parc

  2. Equipe “Instabilité des Microsatellites et Cancers”, Equipe labellisée par la Ligue Nationale contre le Cancer, INSERM, UMRS 938 - Centre de Recherche Saint-Antoine, 75012, Paris, France

    Jérémie H. Lefevre & Yann Parc

  3. Centre for Colorectal Disease, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    Ben Creavin & Magali Svrcek

  4. Department of Oncogenetics and Angiogenetics, Pitie-Salpetriere Hospital, Sorbonne Université, Paris, France

    Chrystelle Colas

  5. Department of Pathology, St Antoine Hospital (AP-HP), Sorbonne Université, Paris, France

    Chrystelle Colas & Magali Svrcek

  6. Department of Molecular Biology, St Antoine Hospital (AP-HP), Sorbonne Université, Paris, France

    Olivier Lascols

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  1. Morgan Anyla
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  2. Jérémie H. Lefevre
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Correspondence to Jérémie H. Lefevre.

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Anyla, M., Lefevre, J.H., Creavin, B. et al. Metachronous colorectal cancer risk in Lynch syndrome patients—should the endoscopic surveillance be more intensive?. Int J Colorectal Dis 33, 703–708 (2018). https://doi.org/10.1007/s00384-018-3004-z

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  • DOI: https://doi.org/10.1007/s00384-018-3004-z

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