Association between the age and the development of colorectal cancer in patients with familial adenomatous polyposis: a multi-institutional study
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To investigate the incidence of colorectal cancer among familial adenomatous polyposis (FAP) patients by phenotype using the latest modalities.
We collected data on 303 patients who underwent surgery for FAP at one of 23 institutions between 2000 and 2012. The incidence of colorectal cancer was investigated by phenotype.
Colorectal cancer was diagnosed in 115 (38.0 %) of the 303 patients. Overall, colorectal cancer with the attenuated, sparse, and profuse phenotypes was diagnosed at 30, 31, and 28 years of age, respectively, in 10 % of the patients and at 59, 48, and 41 years of age, respectively, in 50 % of the patients (P = 0.013). The patients with colorectal cancer were older than those without colorectal cancer for all phenotypes. The optimal cut-off age for predicting the development of colorectal cancer in the attenuated, sparse, and profuse phenotypes was 46, 31, and 27 years, respectively.
Patients with profuse and sparse phenotypes should undergo prophylactic proctocolectomy before their mid-to-late 20 s. On the other hand, the timing and type of surgery for patients with attenuated FAP (AFAP) should be decided individually with reference to the colonoscopic findings.
KeywordsFamilial adenomatous polyposis Cancer development Phenotype
We acknowledge all the patients in this study and their families. In addition to the investigators in the author list, we acknowledge the following investigators who contributed to this study: Koji Komori, Department of Gastroenterological Surgery Aichi Cancer Center Hospital, Aichi; Kenjiro Kotake, Department of Surgery, Tochigi Cancer Center, Tochigi; Takeshi Nagasaka, Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama; Hirotoshi Hasegawa, Department of Surgery, Keio University School of Medicine, Tokyo; Motoi Koyama, Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Aomori; Yoshito Akagi, Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka; Toshimasa Yatsuoka, Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama; Masataka Ikeda, Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka; Kensuke Kumamoto, Department of Organ Regulatory Surgery, Fukushima Medical University School of Medicine, Fukushima; Kiyotaka Kurachi, Department of Surgery 2, Hamamatsu University School of Medicine, Shizuoka; Kohji Tanakaya, Department of Surgery, Iwakuni Clinical Center, Yamaguchi; Kazuhiko Yoshimatsu, Department of Surgery, Tokyo Women’s Medical University Medical Center East, Tokyo. This study was supported in part by a Grant-in-aid for Cancer Research from the Ministry of Health, Labor, and Welfare, and by the Japanese Society for Cancer of the Colon and Rectum.
Compliance with ethical standards
Conflict of interest
Hirotoshi Kobayashi and his co-authors have no conflicts of interest.
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