Predictors of advanced colorectal neoplasia in colorectal cancer screening – interim results of multicentric prospective study

Česká verzia

Authors: Grega T. ¹; Vojtěchová G. ¹; Ngo O. ^2,3 ; Ambrožová M. ³; Voška M. ¹; Májek O. ^2,3 ; Jirkovská J. ¹; Zavoral M. ¹; Nek . Sucha S ¹
Authors place of work: Interní klinika 1. LF UK a ÚVN Praha 2 Institut biostatistiky a analýz LF MU, Brno 3 Ústav zdravotnických informací a statistiky ČR, Praha ¹
Published in the journal: Gastroent Hepatol 2020; 74(5): 386-392
Category: Gastrointestinal Oncology: Original Article

Summary

Introduction: The incidence of advanced colorectal neoplasia in the screening population shows great diversity with a prevalence of 3–12 %. Due to the uneven distribution in the population, potential risk factors that would allow the stratification of individuals according to the degree of risk of colorectal neoplasia are searched. Aim: To determine the risk factors associated with the occurrence of advanced colorectal neoplasia in the screening population. Methods: Asymptomatic individuals aged 45–75 years who underwent preventive colonoscopy in 2012–2016 in a multicenter prospective study monitoring metabolic risk factors for CRC (MRF CRC study) were included in the analysis. Data were analyzed using descriptive statistics. The Fisher’s exact test was used to compare the risk factors with the occurrence of advanced colorectal neoplasia. Results: There were 1,108 men (56.3%) and 859 women (43.7%) in the group; the average age of the individuals was 60 years. The majority of subjects were referred for primary screening colonoscopy (1,174 subjects; 59.7%) and 793 subjects (40.3%) underwent FOBT positive colonoscopy. The total number of advanced colorectal neoplasms in the cohort was 11,8% (233 individuals). The independent risk factors significantly associated with advanced colorectal neoplasia included age (p < 0.001), male gender (p = 0.001), smoking (p < 0.001), serum concentrations of triglycerides (p = 0.029; especially concentrations > 2 mmol/l) and low vitamin D (p = 0.033). These are preliminary results which will be specified in the following more detailed data analysis using logistic regression. Conclusion: The strongest risk factors associated with advanced colorectal neoplasia were age, gender and smoking. In addition to these factors, serum triglyceride levels and low vitamin D were significantly associated with advanced colorectal neoplasia. In the individuals with a higher incidence of advanced colorectal neoplasia according to the given factors, primary screening colonoscopy should be considered.

Keywords:

colorectal neoplasia – risk factors – screening – colonoscopy – metabolic syndrome

Zdroje

1. Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (5): E359–E386. doi: 10.1002/ijc.29210.

2. Brenner H, Altenhofen L, Stock C et al. Natural history of colorectal adenomas: birth cohort analysis among 3.6 million participants of screening colonoscopy. Cancer Epidemiol Biomark Prev 2013; 22 (6): 1043–1051. doi: 10.1158/1055-9965.EPI-13-0162.

3. Nishihara R, Wu K, Lochhead P et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013; 369 (12): 1095–1105. doi: 10.1056/NEJMoa1301969.

4. Lansdorp-Vogelaar I, Knudsen AB, Brenner H. Cost-effectiveness of colorectal cancer screening. Epidemiol Rev 2011; 33 (1): 88–100. doi: 10.1093/epirev/mxr004.

5. Yeoh KG, Ho KY, Chiu HM et al. The Asia-Pacific Colorectal Screening score: a validated tool that stratifies risk for colorectal advanced neoplasia in asymptomatic Asian subjects. Gut 2011; 60 (9): 1236–1241. doi: 10.1136/gut.2010.221168.

6. Suchanek S, Grega T, Ngo O et al. How significant is the association between metabolic syndrome and prevalence of colorectal neoplasia? World J Gastroenterol 2016; 22 (36): 8103–8111. doi: 10.3748/wjg.v22.i36.8103.

7. Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120 (16): 1640–1645. doi: 10.1161/CIRCULATIONAHA.109.192644.

8. Falt P, Urban O, Suchanek Š et al. Doporučené postupy České gastroenterologické společnosti ČLS JEP pro diagnostickou a terapeutickou koloskopii. Gastroent Hepatol 2016; 70 (6): 523–538. doi: 10.14735/amgh2016csgh.info19.

9. Sung JJ, Chan FK, Leung WK et al. Screening for colorectal cancer in Chinese: comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. Gastroenterology 2003; 124 (3): 608–614. doi: 10.1053/gast.2003.50090.

10. Soon MS, Kozarek RA, Ayub K et al. Screening colonoscopy in Chinese and Western patients: a comparative study. Am J Gastroenterol 2005; 100 (12): 2749–2755. doi: 10.1111/j.1572-0241.2005.00355.x.

11. Chiu HM, Wang HP, Lee YC et al. A prospective study of the frequency and the topographical distribution of colon neoplasia in asymptomatic average-risk Chinese adults as determined by colonoscopic screening. Gastrointest Endosc 2005; 61 (4): 547–553. doi: 10.1016/s0016-5107 (05) 00121-5.

12. Schneiderová M, Bencko V. Colorectal cancer – contemporary view on risk and protective factors, chances of prevention. Onkologie 2015; 9 (4): 178–182.

13. Nguyen SP, Bent S, Chen YH et al. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009; 7 (6): 676–681. doi: 10.1016/j.cgh.2009.01.008.

14. Brenner H, Hoffmeister M, Arndt V et al. Gender differences in colorectal cancer: implications for age at initiation of screening. Br J Cancer 2007; 96 (5): 828–831. doi: 10.1038/sj.bjc.6603628.

15. Regula J, Rupinski M, Kraszewska E et al. Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia. N Engl J Med 2006; 355 (18): 1863–1872. doi: 10.1056/ NEJMoa054967.

16. Schoenfeld P, Cash B, Flood A et al. Colonoscopic screening of average-risk women for colorectal neoplasia. N Engl J Med 2005; 352 (20): 2061–2068. doi: 10.1056/NEJMoa042 990.

17. Botteri E, Iodice S, Raimondi S et al. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology 2008; 134 (2): 388–395. doi: 10.1053/j.gastro.2007.11.007.

18. Ozasa K, Ito Y, Suzuki K et al. Glucose intolerance and colorectal cancer risk in a nested case-control study among Japanese People. J Epidemiol 2005; 15 (Suppl 2): S180–S184. doi: 10.2188/jea.15. s180.

19. Colangelo LA, Gapstur SM, Gann PH et al. Colorectal cancer mortality and factors related to the insulin resistance syndrome. Cancer Epidemiol Biomarkers Prev 2002; 11 (4): 385–391.

20. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst 2005; 97 (22): 1679–1687. doi: 10.1093/jnci/dji375.

21. Jee SH, Ohrr H, Sull JW et al. Fasting serum glucose level and cancer risk in Korean men and women. JAMA 2005; 293 (2): 194–202. doi: 10.1001/jama.293.2.194.

22. Saydah SH, Platz EA, Rifai N et al. Association of markers of insulin and glucose control with subsequent colorectal cancer risk. Cancer Epidemiol Biomarkers Prev 2003; 12 (5): 412–418.

23. Rinaldi S, Rohrmann S, Jenab M et al. Glycosylated hemoglobin and risk of colorectal cancer in men and women, the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2008; 17 (11): 3108–3115. doi: 10.1158/1055-9965.EPI-08- 0495.

24. Hsu YC, Chi HM, Liou JM et al. Glycated hemoglobin A1c is superior to fasting plasma glucose as an independent risk factor for colorectal neoplasia. Cancer Causes Control 2011; 23 (2): 321–328. doi: 10.1007/s10552-011-9 880-y.

25. Tsushima M, Nomura AM, Lee J et al. Prospective study of the association of serum triglyceride and glucose with colorectal cancer. Dig Dis Sci 2005; 50 (3): 499–505. doi: 10.1007/s10620-005- 2464-5.

26. Borena W, Stocks T, Jonsson H et al. Serum triglycerides and cancer risk in the metabolic syndrome and cancer (Me-Can) collaborative study. Cancer Causes Control 2011; 22 (2): 291–299. doi: 10.1007/s10552-010-9697-0.

27. Siddiqui AA. Metabolic syndrome and its association with colorectal cancer: a review. Am J Med Sci 2011; 341 (3): 227–231. doi: 10.1097/MAJ.0b013e3181df9055.

28. van Duijnhoven FJ, Bueno-De-Mesquita HB, Calligaro M et al. Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Gut 2011; 60 (8): 1094–1102. doi: 10.1136/gut.2010.225011.

29. Wei MY, Garland CF, Gorham ED et al. Vitamin D and prevention of colorectal adenoma: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2008; 17 (11): 2958–2969. doi: 10.1158/1055-9965.EPI-08-0402.

30. Wu K, Feskanich D, Fuchs C et al. A nested case-control study on plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. J Natl Cancer Inst 2007; 99 (14): 1120–1129. doi: 10.1093/jnci/djm038.

31. Renehan AG, Tyson M, Egger M et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371 (9612): 569–578. doi: 10.1016/S0140-6736 (08) 60269-X.

32. Garcia-Albeniz X, Chan AT. Aspirin for the prevention of colorectal cancer. Best Pract Res Clin Gastroenterol 2011; 25 (4–5): 461–472. doi: 10.1016/j.bpg.2011.10.015.

33. Lochhead P, Chan AT. Statins and colorectal cancer. Clin Gastroenterol Hepatol 2013; 11 (2): 109–118. doi: 10.1016/j.cgh.2012.08.037.

34. Higurashi T, Nakajima A. Metformin and Colorectal Cancer. Front Endocrinol (Lausanne) 2018; 9: 622. doi: 10.3389/fendo.2018.00622.

35. Chan AT. Metformin for cancer prevention: a reason for optimism. Lancet Oncol 2016; 17 (4): 407–409. doi: 10.1016/S1470-2045 (16) 00 006-1.

36. Bu WJ, Song L, Zhao DY et al. Insulin therapy and the risk of colorectal cancer in patients with type 2 diabetes: a meta-analysis of observational studies. Br J Clin Pharmacol. 2014; 78 (2): 301–309. doi: 10.1111/bcp.12350.