Gesundheitswesen 2017; 79(08/09): 656-804
DOI: 10.1055/s-0037-1605807
Vorträge
Georg Thieme Verlag KG Stuttgart · New York

No clinical benefit of annual colonoscopy intervals in Lynch syndrome: A combined data analysis from Germany, the Netherlands, and Finland

C Engel
1   Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig
,
HF Vasen
2   Leiden University Medical Centre, Department of Gastroenterology and Hepatology, Leiden
,
T Seppälä
3   Helsinki University Hospital, Department of Abdominal Surgery, Helsinki
,
K Bucksch
1   Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig
,
M Löffler
1   Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig
› Author Affiliations
Further Information

Publication History

Publication Date:
01 September 2017 (online)

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Introduction:

Lynch Syndrome (LS) is associated with a high risk of developing colorectal cancer (CRC). No comparative studies have so far investigated the impact of different durations of colonoscopic surveillance intervals on CRC incidence or tumor stages. We have therefore conducted a pooled analysis of prospective colonoscopy data from LS registries in Germany (G), the Netherlands (N), and Finland (F), each recommending different intervals ranging from 1 to 3 years. We sought to determine whether shorter intervals are associated with a lower CRC incidence, lower adenoma detection rate, and more favourable tumor stages.

Methods:

All patients were carriers of pathogenic germline mutations in MLH1, MSH2, or MSH6. Prospective observation started (ended) at the first (last) colonoscopy after registration. Patients were either CRC-free at start of observation, or had already CRC before. Colonoscopies were conducted according to national standards.

Results:

The data set comprised 2747 patients from G (1027), N (806), and F (914), with a total of 18021 colonoscopies and 25358 person-years of prospective observation time. 1710 patients (62%) did not have any CRC diagnosis before study entry (cohort 1), while 1037 patients (38%) already had a previous CRC diagnosis (cohort 2). Colonoscopy intervals were significantly different between countries, reflecting the country-specific surveillance policies. The cumulative CRC incidence was 9% (cohort 1) and 14% (cohort 2) after 10 year follow-up. No significant differences in cumulative CRC incidence and CRC stages between countries were found. There was also no significant association between CRC stages and time since last colonoscopy.

Conclusion:

The study revealed no benefit of shorter colonoscopy intervals on CRC incidence and tumor stage distribution. The findings might be explained by an accelerated adeno-carcinoma sequence but slow progression of CRC.