Harma Claire L, Jayawardena Thisuri, Ismail Ali G M, Lall Vidit, Kumarasinghe Priyanthi, De Boer Bastiaan, Hemmings Christine, Amanuel Benhur, Kelty Erin, Mirzai Bob, Guo Belinda B, Allcock Richard, Salama Muna, Raftopoulos Spiro, Yusoff Ian, Segarajasingam Dev, Erber Wendy N, Ee Hooi
Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Department of Gastroenterology, Royal Perth Hospital, Perth, Western Australia, Australia.
Intern Med J. 2025 Mar;55(3):444-452. doi: 10.1111/imj.16650. Epub 2025 Feb 11.
Post-colonoscopy colorectal cancer (PCCRC), defined as colorectal cancer (CRC) detected after a cancer-negative colonoscopy, represents a key quality indicator for CRC detection and prevention. While most PCCRC is attributed to missed lesions, few studies examine pathologic and molecular characteristics of PCCRC to assess for possible de novo cancer formation causing PCCRC.
The aim of this study was to identify cases of PCCRC where prior colonoscopy was adequate (A-PCCRC) versus inadequate (I-PCCRC) and compare both subtypes with spontaneous CRC (sCRC) in terms of patient factors, histopathology and molecular characteristics.
This was a 12-year retrospective population-based study using a data set from the Western Australian Cancer Registry between 2000 and 2011. A-PCCRCs were identified by excluding lesions likely missed due to procedural factors or incomplete prior resection at index colonoscopy performed within 3-36 months of cancer diagnosis. Histopathological review and next-generation sequencing were conducted on subsets of patients with A-PCCRC and sCRC. Statistical analysis included univariable and multivariable regression models and chi-squared and Wilcoxon rank sum tests.
A total of 524 (3.81%) cases of PCCRC were identified out of 13 757 cases of CRC; 272 were A-PCCRC (1.98%) and 252 I-PCCRC (1.83%). Female sex, older age and proximal location were associated with A-PCCRC. Mutations in the PIK3CA gene were less common in A-PCCRC compared to sCRC.
A significant percentage of PCCRC occurred despite adequate prior colonoscopy. Missed sessile serrated lesions may contribute to many of these cases; however, further studies are required to examine possible de novo cancer as a cause of PCCRC that may involve unique biological pathways.
结肠镜检查后结直肠癌（PCCRC）定义为在结肠镜检查结果为癌症阴性后检测出的结直肠癌（CRC），是CRC检测和预防的关键质量指标。虽然大多数PCCRC归因于漏诊病变，但很少有研究检查PCCRC的病理和分子特征，以评估是否存在可能导致PCCRC的新发癌症形成。
本研究的目的是识别先前结肠镜检查充分（A-PCCRC）与不充分（I-PCCRC）的PCCRC病例，并在患者因素、组织病理学和分子特征方面将这两种亚型与自发性CRC（sCRC）进行比较。
这是一项基于人群的12年回顾性研究，使用了西澳大利亚癌症登记处2000年至2011年的数据集。通过排除在癌症诊断后3至36个月内进行的初次结肠镜检查中可能因操作因素或先前切除不完全而漏诊的病变来识别A-PCCRC。对A-PCCRC和sCRC患者亚组进行了组织病理学检查和下一代测序。统计分析包括单变量和多变量回归模型以及卡方检验和Wilcoxon秩和检验。
在13757例CRC病例中总共识别出524例（3.81%）PCCRC；272例为A-PCCRC（1.98%）和252例I-PCCRC（1.83%）。女性、老年和近端部位与A-PCCRC相关。与sCRC相比，PIK3CA基因突变在A-PCCRC中较少见。
尽管先前结肠镜检查充分，但仍有相当比例的PCCRC发生。漏诊的无蒂锯齿状病变可能是其中许多病例的原因；然而，需要进一步研究来检查可能作为PCCRC病因的新发癌症，这可能涉及独特的生物学途径。
