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Description
The current application aims at launching EPoS IV trial. In EPoS IV we will analyze for the first time several histopathological biomarkers to predict the risk of recurrence after endoscopic treatment of malignant colorectal polyps. As part of our study, we want to assess clinical significance of poorly differentiated clusters, tumor budding, lymphovascular invasion, tumor infiltrating lymphocytes, epithelialmesenchymal transition CDX2 and ALCAM protein expression. These biomarkers will be identified during histopathological assessment using additional immunohistochemistry assays. All histopathological slides will be scanned and uploaded to digital platform, enabling blinded assessment for establishing inter- and intra-observer variability and to create future e-learning tool. All patients will undergo regular colonoscopy surveillance at 1, 3, 5 and 10 years, to detect local recurrence and metachronous lesions. The risk of metachronous lesions at 3 years follow-up will be compared between the EPoS IV trial and one of the arms of EPoS II trial. Top class European researchers from the field of gastroenterology and gastroenterological histopathology, already involved in the remaining EPoS trials, will be a warranty of high quality research standards also in the EPoS IV study. International cooperation is also necessary to shorten the recruitment time and ensure the sufficient number of participants. The risk factors for colorectal cancer recurrence after removal of early stage cancerous polyps remain poorly studied. Providing answer to this burning research question will likely change the way of histopathological assessment of malignant polyps, and help optimizing surveillance after screening colonoscopy.