Clinicopathological features and risk factors for developing colorectal neoplasia in Hodgkin lymphoma survivors.

OBJECTIVES Hodgkin lymphoma (HL) survivors treated with abdominal radiotherapy and/or procarbazine have an increased risk of developing colorectal neoplasia. We evaluated clinicopathological characteristics and risk factors for developing (advanced) neoplasia (AN) in HL survivors. METHODS 101 HL survivors (median age 51 years, median age of HL diagnosis 25 years) underwent colonoscopy and 350 neoplasia and 44 AN (classified as advanced adenomas/serrated lesions or colorectal cancer), mostly right-sided, were detected, as published previously. An average-risk asymptomatic cohort who underwent screening colonoscopy were controls (median age 60 years). Clinicopathological characteristics of AN were evaluated in both groups. Mismatch repair (MMR) status was assessed using immunohistochemistry (MLH1/MSH2/MSH6/PMS2). Logistic regression analysis was performed to evaluate risk factors for AN in HL survivors, including age at HL diagnosis and interval between HL and colonoscopy. RESULTS In 101 colonoscopies in HL survivors, AN was primarily classified based on polyp size ≥10 mm, whereas (high-grade-)dysplasia was more often seen in AN in controls. An interval between HL diagnosis and colonoscopy >26 years was associated with more (advanced) neoplasia compared with interval of <26 years, with an odds ratio for advanced neoplasia of 3.8 (95% confidence interval 1.4-9.1) (p<0.01)). All 39 AN that were assessed, were MMR proficient. CONCLUSIONS Colorectal neoplasia in HL survivors differ from average-risk controls; Classification AN was primarily based on polyp size (≥10 mm) in HL survivors. Longer follow-up between HL diagnosis and colonoscopy was associated with a higher prevalence of (advanced) neoplasia in HL survivors.