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Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis

Background  Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors are associated with pouch dysplasia. Methods  Retrospective analysis of collected data on...

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Autores principales: Patel, Roshani V., Curtius, Kit, Man, Ripple, Fletcher, Jordan, Cuthill, Victoria, Clark, Susan K., von Roon, Alexander C., Latchford, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2023
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465241/
https://www.ncbi.nlm.nih.gov/pubmed/36807005
http://dx.doi.org/10.1055/a-2038-0541
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author Patel, Roshani V.
Curtius, Kit
Man, Ripple
Fletcher, Jordan
Cuthill, Victoria
Clark, Susan K.
von Roon, Alexander C.
Latchford, Andrew
author_facet Patel, Roshani V.
Curtius, Kit
Man, Ripple
Fletcher, Jordan
Cuthill, Victoria
Clark, Susan K.
von Roon, Alexander C.
Latchford, Andrew
author_sort Patel, Roshani V.
collection PubMed
description Background  Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors are associated with pouch dysplasia. Methods  Retrospective analysis of collected data on 249 patients was performed, analyzing potential risk factors for the development of adenomas or advanced lesions ( ≥ 10 mm/high grade dysplasia (HGD)/cancer) in the pouch body and cuff using Cox proportional hazards models. Kaplan–Meier analyses included landmark time-point analyses at 10 years after surgery to predict the future risk of advanced lesions. Results  Of 249 patients, 76 % developed at least one pouch body adenoma, with 16 % developing an advanced pouch body lesion; 18 % developed an advanced cuff lesion. Kaplan–Meier analysis showed a 10-year lag before most advanced lesions developed; cumulative incidence of 2.8 % and 6.4 % at 10 years in the pouch body and cuff, respectively. Landmark analysis suggested the presence of adenomas prior to the 10-year point was associated with subsequent development of advanced lesions in the pouch body (hazard ratio [HR] 4.8, 95 %CI 1.6–14.1; P  = 0.004) and cuff (HR 6.8, 95 %CI 2.5–18.3; P  < 0.001). There were two HGD and four cancer cases in the cuff and one pouch body cancer; all cases of cancer/HGD that had prior surveillance were preceded by ≥ 10-mm adenomas. Conclusions  Pouch adenoma progression is slow and most advanced lesions occur after 10 years. HGD and cancer were rare events. Pouch phenotype in the first decade is associated with the future risk of developing advanced lesions and may guide personalized surveillance beyond 10 years.
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spelling pubmed-104652412023-08-30 Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis Patel, Roshani V. Curtius, Kit Man, Ripple Fletcher, Jordan Cuthill, Victoria Clark, Susan K. von Roon, Alexander C. Latchford, Andrew Endoscopy Background  Long-term pouch surveillance outcomes for familial adenomatous polyposis (FAP) are unknown. We aimed to quantify surveillance outcomes and to determine which of selected possible predictive factors are associated with pouch dysplasia. Methods  Retrospective analysis of collected data on 249 patients was performed, analyzing potential risk factors for the development of adenomas or advanced lesions ( ≥ 10 mm/high grade dysplasia (HGD)/cancer) in the pouch body and cuff using Cox proportional hazards models. Kaplan–Meier analyses included landmark time-point analyses at 10 years after surgery to predict the future risk of advanced lesions. Results  Of 249 patients, 76 % developed at least one pouch body adenoma, with 16 % developing an advanced pouch body lesion; 18 % developed an advanced cuff lesion. Kaplan–Meier analysis showed a 10-year lag before most advanced lesions developed; cumulative incidence of 2.8 % and 6.4 % at 10 years in the pouch body and cuff, respectively. Landmark analysis suggested the presence of adenomas prior to the 10-year point was associated with subsequent development of advanced lesions in the pouch body (hazard ratio [HR] 4.8, 95 %CI 1.6–14.1; P  = 0.004) and cuff (HR 6.8, 95 %CI 2.5–18.3; P  < 0.001). There were two HGD and four cancer cases in the cuff and one pouch body cancer; all cases of cancer/HGD that had prior surveillance were preceded by ≥ 10-mm adenomas. Conclusions  Pouch adenoma progression is slow and most advanced lesions occur after 10 years. HGD and cancer were rare events. Pouch phenotype in the first decade is associated with the future risk of developing advanced lesions and may guide personalized surveillance beyond 10 years. Georg Thieme Verlag KG 2023-05-22 /pmc/articles/PMC10465241/ /pubmed/36807005 http://dx.doi.org/10.1055/a-2038-0541 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Patel, Roshani V.
Curtius, Kit
Man, Ripple
Fletcher, Jordan
Cuthill, Victoria
Clark, Susan K.
von Roon, Alexander C.
Latchford, Andrew
Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title_full Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title_fullStr Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title_full_unstemmed Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title_short Long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
title_sort long-term outcomes of pouch surveillance and risk of neoplasia in familial adenomatous polyposis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465241/
https://www.ncbi.nlm.nih.gov/pubmed/36807005
http://dx.doi.org/10.1055/a-2038-0541
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