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Associations between molecular characteristics of colorectal serrated polyps and subsequent advanced colorectal neoplasia

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Abstract

Purpose

BRAF mutation and DNA hypermethylation have linked sessile serrated adenomas/polyps (SSA/Ps) to serrated colorectal cancer (CRC) in cross-sectional studies, but they have not been evaluated in a longitudinal study. We aimed to evaluate the associations between molecular markers of serrated polyps and subsequent advanced colorectal neoplasia.

Methods

Study subjects included Kaiser Permanente Washington members aged 20–75 years who received an index colonoscopy between 1/1/1998 and 12/31/2007 and had hyperplastic polyps (HPs) or SSA/Ps according to study pathology review. Polyps from index colonoscopies were removed and assayed for BRAF mutation, CpG island methylator phenotype (CIMP), and MLH1 methylation. Pathology reports and biopsies from the subsequent lower gastrointestinal endoscopy through 1/1/2013 were reviewed for advanced colorectal neoplasia. We identified additional incident CRC cases through linkage to the Seattle-Puget Sound Surveillance Epidemiology and End Results registry. We used generalized estimating equations to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for subsequent advanced colorectal neoplasia, comparing index serrated polyps with different molecular markers.

Results

We included 553 individuals with index serrated polyps (420 HPs and 133 SSA/Ps) and 795 subsequent endoscopies. The prevalence of BRAF-mutant, CIMP-high, and MLH1-methylated serrated polyps were 51%, 4%, and 2%, respectively. BRAF and CIMP were not associated with subsequent advanced colorectal neoplasia. MLH1-methylated SSP/As were significantly more likely to have subsequent advanced neoplasia (OR = 4.66, 95% CI 1.06–20.51).

Conclusion

Our results suggest that BRAF-mutant and CIMP-high serrated polyps are not associated with subsequent advanced colorectal neoplasia. Among SSA/Ps, MLH1 methylation may be an important marker to identify high-risk CRC precursors.

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Acknowledgments

We are grateful to the late Jeremey Jass for the development of study protocols, and we thank all study participants and staff for their many contributions to this project. This research is supported in part by the National Institutes of Health, National Cancer Institute (Grant Nos. R01 CA168338, P01 CA074184, R01 CA097325, K07 CA222060, and K05 CA152715).

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Authors and Affiliations

  1. School of Public Health, University of Washington, Seattle, WA, USA

    Xinwei Hua, Polly A. Newcomb & Jessica Chubak

  2. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Xinwei Hua, Polly A. Newcomb, Rachel C. Malen, Michelle A. Wurscher, Sushma S. Thomas, Hana Newman, Sheetal Hardikar & Andrea N. Burnett-Hartman

  3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA

    Jessica Chubak, Rebecca Ziebell, Aruna Kamineni & Lee-Ching Zhu

  4. Department of Pathology, University of Washington, Seattle, WA, USA

    Melissa P. Upton

  5. Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Sheetal Hardikar

  6. Kaiser Permanente Colorado, Institute for Health Research, 2550 S Parker Rd, Suite 200, Waterpark III, 2nd floor, Aurora, CO, 80014, USA

    Andrea N. Burnett-Hartman

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Hua, X., Newcomb, P.A., Chubak, J. et al. Associations between molecular characteristics of colorectal serrated polyps and subsequent advanced colorectal neoplasia. Cancer Causes Control 31, 631–640 (2020). https://doi.org/10.1007/s10552-020-01304-1

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