Skip to main content
PMC home page
Gut logoLink to Gut
. 1993 Apr;34(4):525–530. doi: 10.1136/gut.34.4.525

Rectal epithelial cell proliferation patterns as predictors of adenomatous colorectal polyp recurrence.

M Anti 1, G Marra 1, F Armelao 1, A Percesepe 1, R Ficarelli 1, G M Ricciuto 1, A Valenti 1, G L Rapaccini 1, I De Vitis 1, G D'Agostino 1, et al.
PMCID: PMC1374315  PMID: 8491402

Abstract

To determine whether proliferative patterns in flat rectal mucosal samples can predict the recurrence of adenomatous colorectal polyps, after polypectomy, biopsy specimens from normal looking rectal mucosa were obtained at endoscopy from 55 patients diagnosed for the first time as having adenomatous colorectal polyps. Epithelial cell proliferation was assessed in biopsy specimens through 3H-thymidine autoradiography. After polypectomy, patients were followed for 24 months and underwent complete colonoscopy every 6 months to detect and remove any metachronous lesions. In 40 patients second biopsy specimens were taken during one of the follow up colonoscopies to evaluate the stability of proliferative indices over time. The ratio of labelled (S phase) to total cells (labelling index) for the entire crypt, as well as ratios for each of the five equal compartments into which the crypt had been divided longitudinally, was calculated for each patient. Mean labelling indices for upper crypt compartments 3 and 4 + 5 in the 22 patients in whom polyps recurred were significantly higher (respectively p < 0.05 and p < 0.01) than those of the 33 without recurrence suggesting that an upward shift of the crypt's replicative compartment is associated with polyp recurrence. Labelling indices remained essentially unchanged in those patients who underwent biopsy twice. Reproducible kinetic parameters such as these might be useful in planning follow up of patients with adenomatous polyps after polypectomy.

Full text

PDF
525

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alberts D. S., Einspahr J., Rees-McGee S., Ramanujam P., Buller M. K., Clark L., Ritenbaugh C., Atwood J., Pethigal P., Earnest D. Effects of dietary wheat bran fiber on rectal epithelial cell proliferation in patients with resection for colorectal cancers. J Natl Cancer Inst. 1990 Aug 1;82(15):1280–1285. doi: 10.1093/jnci/82.15.1280. [DOI] [PubMed] [Google Scholar]
  2. Anti M., Marra G., Armelao F., Bartoli G. M., Ficarelli R., Percesepe A., De Vitis I., Maria G., Sofo L., Rapaccini G. L. Effect of omega-3 fatty acids on rectal mucosal cell proliferation in subjects at risk for colon cancer. Gastroenterology. 1992 Sep;103(3):883–891. doi: 10.1016/0016-5085(92)90021-p. [DOI] [PubMed] [Google Scholar]
  3. Atkin W. S., Morson B. C., Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med. 1992 Mar 5;326(10):658–662. doi: 10.1056/NEJM199203053261002. [DOI] [PubMed] [Google Scholar]
  4. Bedenne L., Faivre J., Boutron M. C., Piard F., Cauvin J. M., Hillon P. Adenoma--carcinoma sequence or "de novo" carcinogenesis? A study of adenomatous remnants in a population-based series of large bowel cancers. Cancer. 1992 Feb 15;69(4):883–888. doi: 10.1002/1097-0142(19920215)69:4<883::aid-cncr2820690408>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  5. Biasco G., Paganelli G. M., Miglioli M., Brillanti S., Di Febo G., Gizzi G., Ponz de Leon M., Campieri M., Barbara L. Rectal cell proliferation and colon cancer risk in ulcerative colitis. Cancer Res. 1990 Feb 15;50(4):1156–1159. [PubMed] [Google Scholar]
  6. Cannon-Albright L. A., Skolnick M. H., Bishop D. T., Lee R. G., Burt R. W. Common inheritance of susceptibility to colonic adenomatous polyps and associated colorectal cancers. N Engl J Med. 1988 Sep 1;319(9):533–537. doi: 10.1056/NEJM198809013190902. [DOI] [PubMed] [Google Scholar]
  7. Deschner E. E., Godbold J., Lynch H. T. Rectal epithelial cell proliferation in a group of young adults. Influence of age and genetic risk for colon cancer. Cancer. 1988 Jun 1;61(11):2286–2290. doi: 10.1002/1097-0142(19880601)61:11<2286::aid-cncr2820611124>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  8. Deschner E. E., Lipkin M. Proliferative patterns in colonic mucosa in familial polyposis. Cancer. 1975 Feb;35(2):413–418. doi: 10.1002/1097-0142(197502)35:2<413::aid-cncr2820350217>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  9. Fearon E. R., Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990 Jun 1;61(5):759–767. doi: 10.1016/0092-8674(90)90186-i. [DOI] [PubMed] [Google Scholar]
  10. Fenoglio-Preiser C. M., Hutter R. V. Colorectal polyps: pathologic diagnosis and clinical significance. CA Cancer J Clin. 1985 Nov-Dec;35(6):322–344. doi: 10.3322/canjclin.35.6.322. [DOI] [PubMed] [Google Scholar]
  11. Goodlad R. A., Levi S., Lee C. Y., Mandir N., Hodgson H., Wright N. A. Morphometry and cell proliferation in endoscopic biopsies: evaluation of a technique. Gastroenterology. 1991 Nov;101(5):1235–1241. doi: 10.1016/0016-5085(91)90072-s. [DOI] [PubMed] [Google Scholar]
  12. Gregoire R. C., Stern H. S., Yeung K. S., Stadler J., Langley S., Furrer R., Bruce W. R. Effect of calcium supplementation on mucosal cell proliferation in high risk patients for colon cancer. Gut. 1989 Mar;30(3):376–382. doi: 10.1136/gut.30.3.376. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Griffioen G., Bosman F. T., Verspaget H. W., Sier K. F., Biemond I., Lamers C. B. Comparative evaluation of carcinoembryonic antigen, secretory component, and mucins in index and metachronous adenomas of the colorectum. Gastroenterology. 1991 Oct;101(4):919–926. doi: 10.1016/0016-5085(91)90716-x. [DOI] [PubMed] [Google Scholar]
  14. Grossman S., Milos M. L., Tekawa I. S., Jewell N. P. Colonoscopic screening of persons with suspected risk factors for colon cancer: II. Past history of colorectal neoplasms. Gastroenterology. 1989 Feb;96(2 Pt 1):299–306. doi: 10.1016/0016-5085(89)91551-5. [DOI] [PubMed] [Google Scholar]
  15. Jass J. R. Do all colorectal carcinomas arise in preexisting adenomas? World J Surg. 1989 Jan-Feb;13(1):45–51. doi: 10.1007/BF01671153. [DOI] [PubMed] [Google Scholar]
  16. Kashtan H., Gregoire R. C., Bruce W. R., Hay K., Stern H. S. Effects of sodium sulfate on fecal pH and proliferation of colonic mucosa in patients at high risk for colon cancer. J Natl Cancer Inst. 1990 Jun 6;82(11):950–952. doi: 10.1093/jnci/82.11.950. [DOI] [PubMed] [Google Scholar]
  17. Lipkin M. Biomarkers of increased susceptibility to gastrointestinal cancer: new application to studies of cancer prevention in human subjects. Cancer Res. 1988 Jan 15;48(2):235–245. [PubMed] [Google Scholar]
  18. Lipkin M., Blattner W. A., Gardner E. J., Burt R. W., Lynch H., Deschner E., Winawer S., Fraumeni J. F., Jr Classification and risk assessment of individuals with familial polyposis, Gardner's syndrome, and familial non-polyposis colon cancer from [3H]thymidine labeling patterns in colonic epithelial cells. Cancer Res. 1984 Sep;44(9):4201–4207. [PubMed] [Google Scholar]
  19. Lipkin M., Blattner W. E., Fraumeni J. F., Jr, Lynch H. T., Deschner E., Winawer S. Tritiated thymidine (phi p, phi h) labeling distribution as a marker for hereditary predisposition to colon cancer. Cancer Res. 1983 Apr;43(4):1899–1904. [PubMed] [Google Scholar]
  20. Lipkin M., Newmark H. Effect of added dietary calcium on colonic epithelial-cell proliferation in subjects at high risk for familial colonic cancer. N Engl J Med. 1985 Nov 28;313(22):1381–1384. doi: 10.1056/NEJM198511283132203. [DOI] [PubMed] [Google Scholar]
  21. Lipkin M. Phase 1 and phase 2 proliferative lesions of colonic epithelial cells in diseases leading to colonic cancer. Cancer. 1974 Sep;34(3):suppl–suppl:888. doi: 10.1002/1097-0142(197409)34:3+<878::aid-cncr2820340715>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  22. Lynch P. M., Wargovich M. J., Lynch H. T., Palmer C., Lanspa S., Drouhard T., Lynch J. A follow-up study of colonic epithelial proliferation as a biomarker ina Native-American family with hereditary nonpolyposis colon cancer. J Natl Cancer Inst. 1991 Jul 3;83(13):951–954. doi: 10.1093/jnci/83.13.951. [DOI] [PubMed] [Google Scholar]
  23. Matek W., Guggenmoos-Holzmann I., Demling L. Follow-up of patients with colorectal adenomas. Endoscopy. 1985 Sep;17(5):175–181. doi: 10.1055/s-2007-1018494. [DOI] [PubMed] [Google Scholar]
  24. Muto T., Bussey H. J., Morson B. C. The evolution of cancer of the colon and rectum. Cancer. 1975 Dec;36(6):2251–2270. doi: 10.1002/cncr.2820360944. [DOI] [PubMed] [Google Scholar]
  25. Nava H., Carlsson G., Petrelli N. J., Herrera L., Mittelman A. Follow-up colonoscopy in patients with colorectal adenomatous polyps. Dis Colon Rectum. 1987 Jun;30(6):465–468. doi: 10.1007/BF02556498. [DOI] [PubMed] [Google Scholar]
  26. Neugut A. I., Johnsen C. M., Forde K. A., Treat M. R. Recurrence rates for colorectal polyps. Cancer. 1985 Apr 1;55(7):1586–1589. doi: 10.1002/1097-0142(19850401)55:7<1586::aid-cncr2820550729>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  27. Paganelli G. M., Biasco G., Brandi G., Santucci R., Gizzi G., Villani V., Cianci M., Miglioli M., Barbara L. Effect of vitamin A, C, and E supplementation on rectal cell proliferation in patients with colorectal adenomas. J Natl Cancer Inst. 1992 Jan 1;84(1):47–51. doi: 10.1093/jnci/84.1.47. [DOI] [PubMed] [Google Scholar]
  28. Paganelli G. M., Biasco G., Santucci R., Brandi G., Lalli A. A., Miglioli M., Barbara L. Rectal cell proliferation and colorectal cancer risk level in patients with nonfamilial adenomatous polyps of the large bowel. Cancer. 1991 Dec 1;68(11):2451–2454. doi: 10.1002/1097-0142(19911201)68:11<2451::aid-cncr2820681121>3.0.co;2-4. [DOI] [PubMed] [Google Scholar]
  29. Ponz de Leon M., Roncucci L., Di Donato P., Tassi L., Smerieri O., Amorico M. G., Malagoli G., De Maria D., Antonioli A., Chahin N. J. Pattern of epithelial cell proliferation in colorectal mucosa of normal subjects and of patients with adenomatous polyps or cancer of the large bowel. Cancer Res. 1988 Jul 15;48(14):4121–4126. [PubMed] [Google Scholar]
  30. Potten C. S., Kellett M., Rew D. A., Roberts S. A. Proliferation in human gastrointestinal epithelium using bromodeoxyuridine in vivo: data for different sites, proximity to a tumour, and polyposis coli. Gut. 1992 Apr;33(4):524–529. doi: 10.1136/gut.33.4.524. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Potten C. S., Kellett M., Roberts S. A., Rew D. A., Wilson G. D. Measurement of in vivo proliferation in human colorectal mucosa using bromodeoxyuridine. Gut. 1992 Jan;33(1):71–78. doi: 10.1136/gut.33.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Risio M., Lipkin M., Candelaresi G., Bertone A., Coverlizza S., Rossini F. P. Correlations between rectal mucosa cell proliferation and the clinical and pathological features of nonfamilial neoplasia of the large intestine. Cancer Res. 1991 Apr 1;51(7):1917–1921. [PubMed] [Google Scholar]
  33. Roncucci L., Scalmati A., Ponz de Leon M. Pattern of cell kinetics in colorectal mucosa of patients with different types of adenomatous polyps of the large bowel. Cancer. 1991 Aug 15;68(4):873–878. doi: 10.1002/1097-0142(19910815)68:4<873::aid-cncr2820680433>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  34. Rozen P., Fireman Z., Fine N., Chetrit A., Lubin F. Rectal epithelial proliferation characteristics of first degree relatives of sporadic colon cancer patients. Cancer Lett. 1990 May 30;51(2):127–132. doi: 10.1016/0304-3835(90)90047-2. [DOI] [PubMed] [Google Scholar]
  35. Rozen P., Fireman Z., Fine N., Chetrit A., Zajicek G. Rectal epithelial proliferation in persons post sporadic colorectal neoplasia. Cancer Lett. 1991 Jul 26;59(1):1–8. doi: 10.1016/0304-3835(91)90128-5. [DOI] [PubMed] [Google Scholar]
  36. Rozen P., Fireman Z., Fine N., Wax Y., Ron E. Oral calcium suppresses increased rectal epithelial proliferation of persons at risk of colorectal cancer. Gut. 1989 May;30(5):650–655. doi: 10.1136/gut.30.5.650. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. SLAUGHTER D. P., SOUTHWICK H. W., SMEJKAL W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer. 1953 Sep;6(5):963–968. doi: 10.1002/1097-0142(195309)6:5<963::aid-cncr2820060515>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  38. Scalmati A., Roncucci L., Ghidini G., Biasco G., Ponz de Leon M. Epithelial cell kinetics in the remaining colorectal mucosa after surgery for cancer of the large bowel. Cancer Res. 1990 Dec 15;50(24):7937–7941. [PubMed] [Google Scholar]
  39. Spiro H. M. Surveillance for colonic polyps. Mt Sinai J Med. 1988 May;55(3):251–255. [PubMed] [Google Scholar]
  40. Terpstra O. T., van Blankenstein M., Dees J., Eilers G. A. Abnormal pattern of cell proliferation in the entire colonic mucosa of patients with colon adenoma or cancer. Gastroenterology. 1987 Mar;92(3):704–708. doi: 10.1016/0016-5085(87)90021-7. [DOI] [PubMed] [Google Scholar]
  41. Waye J. D., Braunfeld S. Surveillance intervals after colonoscopic polypectomy. Endoscopy. 1982 May;14(3):79–81. doi: 10.1055/s-2007-1021585. [DOI] [PubMed] [Google Scholar]
  42. Winawer S. J., Schottenfeld D., Flehinger B. J. Colorectal cancer screening. J Natl Cancer Inst. 1991 Feb 20;83(4):243–253. doi: 10.1093/jnci/83.4.243. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES