Metachronous colorectal cancers

Fajobi, Olu A.; Yiu, CY; SenGupta, Sioban; Boulos, P B

doi:10.1046/j.1365-2168.1998.00800.x

Cited by 54 publications

(47 citation statements)

References 70 publications

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“…1,2,25 The identification of patients at risk for the development of metachronous neoplasms might have important clinical implications. First, the identification of these lesions in an early stage could improve their management and treatment.…”

Section: Discussionmentioning

confidence: 99%

Detection of Metachronous Neoplasms in Colorectal Cancer Patients: Identification of Risk Factors

Ballesté¹,

Bessa²,

Piñol³

et al. 2007

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 99%

Detection of Metachronous Neoplasms in Colorectal Cancer Patients: Identification of Risk Factors

Ballesté¹,

Bessa²,

Piñol³

et al. 2007

Diseases of the Colon &Amp; Rectum

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“…We assumed that the Dukes' stage on diagnosis would be independent of age, sex, LS status and whether it was the first (index) CRC or a metachronous CRC (Fajobi and colleagues 169 conclude that Dukes' stages for metachronous CRC are no worse than for index CRC, and there was no consensus on whether or not they might be better). We also assumed that Dukes' stage on diagnosis of metachronous CRC was independent of the stage of the index CRC and that the Dukes' stage was independent of the CRC site.…”

Section: Dukes' Stage On Diagnosismentioning

confidence: 99%

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

106

234

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BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…1 Patients who have previously undergone resection of colorectal cancer (CRC) are at increased risk of developing a second metachronous tumor. 2 The magnitude of this risk is difficult to evaluate and, depending on the length of follow-up, has been estimated to range from 1.1 percent to 3.5 percent. 3,4 This slightly increased risk, however, has important clinical implications, such as performance of routine postoperative endoscopic surveillance after curative resection of a first instance of CRC.…”

mentioning

confidence: 99%

Proximal Location of Colon Cancer Is a Risk Factor for Development of Metachronous Colorectal Cancer: A Population-Based Study

Gervaz

Bucher

Neyroud-Caspar

et al. 2005

Diseases of the Colon &Amp; Rectum

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Patients with a first tumor located within the proximal colon are at twice the risk for developing metachronous colorectal cancer. From an epidemiologic standpoint, these data are in accordance with 1) the increasing incidence and 2) the better prognosis of proximal colon cancer in various populations. Our results confirm that proximal colon cancer is a distinct entity, which justifies the reporting of cases of colon cancer according to their location proximal or distal to the splenic flexure.

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Metachronous colorectal cancers

Abstract: Preoperative colonoscopy and postoperative colonoscopic surveillance are essential in identifying patients at risk of metachronous colorectal cancer. A total colectomy and ileorectal anastomosis should be considered for some patients, certainly for those with HNPCC.

Cited by 54 publications

References 70 publications

Detection of Metachronous Neoplasms in Colorectal Cancer Patients: Identification of Risk Factors

Detection of Metachronous Neoplasms in Colorectal Cancer Patients: Identification of Risk Factors

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Proximal Location of Colon Cancer Is a Risk Factor for Development of Metachronous Colorectal Cancer: A Population-Based Study

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