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Molecular pathways in post-colonoscopy versus detected colorectal cancers: results from a nested case-control study
Roel M M Bogie1, Chantal M C le Clercq1, Quirinus J M Voorham2
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
British Journal of Cancer
|December 16, 2021
Summary
Post-colonoscopy colorectal cancers (PCCRCs) are often proximal and poorly differentiated. Improving detection of sessile serrated lesions and non-polypoid neoplasms is key to reducing PCCRCs.
Area of Science:
- Gastroenterology
- Oncology
- Molecular Biology
Background:
- Post-colonoscopy colorectal cancers (PCCRCs) present clinical challenges.
- PCCRCs arise from both procedural and biological factors.
- Understanding PCCRC characteristics is crucial for improving patient outcomes.
Purpose of the Study:
- To compare clinical and molecular features of PCCRCs and detected colorectal cancers (DCRCs).
- To identify factors contributing to the development of PCCRCs.
- To inform strategies for reducing PCCRC incidence.
Main Methods:
- A nested case-control study design.
- Analysis of whole-genome chromosomal copy number changes using low-coverage WGS.
- Targeted sequencing for common CRC gene mutations, MSI, and CIMP status determination.
Main Results:
- PCCRCs were more frequently proximal, non-polypoid, early-stage, and poorly differentiated than DCRCs.
- PCCRCs exhibited significantly less 18q loss compared to DCRCs.
- PCCRCs were more often CIMP high and MSI, with less 18q loss remaining significant after adjustment.
Conclusions:
- PCCRCs share molecular features with sessile serrated lesions (SSLs) and non-polypoid colorectal neoplasms (CRNs).
- SSLs and non-polypoid CRNs are likely contributors to PCCRC development.
- Enhanced detection and endoscopic removal of SSLs and non-polypoid CRNs are recommended.
