Clinicopathologic and biomolecular features of interval colorectal cancers in Korean patients: A KASID multicenter prospective study

doi:10.3748/wjg.127120

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2027. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 14, 2027; 33(2): 127120
Published online Jan 14, 2027. doi: 10.3748/wjg.127120

Clinicopathologic and biomolecular features of interval colorectal cancers in Korean patients: A KASID multicenter prospective study

Joo Hye Song, Jeong Eun Shin, Dae Sung Kim, Yoo Jin Lee, Hee Chan Yang, Kyeong Ok Kim, Jae Hyun Kim, Gyeong Hoon Kang, Sung Ryul Shim, Kyu Chan Huh

Joo Hye Song, Internal Medicine, Konkuk University Medical Center, Seoul 03050, South Korea

Jeong Eun Shin, Internal Medicine, Dankook University College of Medicine, Cheonan 03050, South Korea

Dae Sung Kim, Department of Gastroenterology, Konyang University College of Medicine, Daejeon 05505, South Korea

Yoo Jin Lee, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea

Hee Chan Yang, Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital and Medical School, Jeonju-si 54907, Jeollabuk-do, South Korea

Kyeong Ok Kim, Internal Medicine, Yeungnam University College of Medicine, Daegu 42115, South Korea

Jae Hyun Kim, Internal Medicine, Kosin University College of Medicine, Busan 03050, South Korea

Gyeong Hoon Kang, Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea

Sung Ryul Shim, Biomedical Informatics, Konyang University, Daejeon 03050, South Korea

Kyu Chan Huh, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon 03050, South Korea

Kyu Chan Huh, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon 03050, South Korea

Author contributions: Song JH contributed to study concept and design, data analysis and interpretation, and drafting of the manuscript; Shin JE, Kim DS, Lee YJ, Yang HC, Kim KO, and Kim JH contributed to data acquisition and critical revision of the manuscript for important intellectual content; Kang GH contributed to data analysis, material support, and critical revision of the manuscript for important intellectual content; Shim SR contributed to data and statistical analysis; Huh KC contributed to study concept and design, data acquisition, analysis and interpretation, drafting of the manuscript, and study supervision.

AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.

Supported by the National Research Foundation of Korea grant funded by the Korea government, No. NRF-2017R1A2B2006514.

Institutional review board statement: This study was approved by the Institutional Review Boards of Konyang University Hospital (IRB No. 2017-06-007) and the remaining five participating hospitals.

Clinical trial registration statement: This study conformed to the ethical guidelines of the 1975 Declaration of Helsinki. This study was an observational study and did not involve prospective assignment of interventions to human subjects. Therefore, it did not meet the ICMJE criteria requiring clinical trial registration.

Informed consent statement: Informed consent was obtained from all patients.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: Data are available from the corresponding author on reasonable request.

Corresponding author: Kyu Chan Huh, MD, PhD, Professor, Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 03050, South Korea. kchuh@kyuh.ac.kr

Received: August 24, 2026
Revised: September 22, 2026
Accepted: October 29, 2026
Published online: January 14, 2027
Processing time: 82 Days and 0.4 Hours

Abstract

BACKGROUND

Interval colorectal cancer (CRC) refers to CRC diagnosed after an index colonoscopy before the next recommended surveillance examination. Our previous multicenter retrospective study showed that, unlike Western studies, interval CRCs developed more often in men and on the left side. Few studies on interval CRC in Asia have focused on its biomolecular features.

AIM

To identify the clinicopathological and biomolecular features of Korean patients with interval CRCs.

METHODS

A prospective multicenter cohort study involving 107 patients newly diagnosed with sporadic or interval CRC from six referral hospitals in Korea was conducted. Propensity score weighting was used to balance patient characteristics.

RESULTS

In contrast with Western studies, Korean interval CRCs were more common in male patients and in the left colon. The most commonly suspected etiology of CRCs is missed lesions, followed by incomplete resection, incomplete colonoscopy, and newly developed cancer. In multivariable Cox proportional hazard analysis, advanced stages [stage III: Adjusted hazard ratio (aHR), 9.58; 95% confidence interval (CI): 1.97-46.51, stage IV: AHR, 25.36; 95%CI: 4.09-157.10 vs stage I] and CpG island methylator phenotype (+) (aHR, 45.15; 95%CI: 8.09-251.9) were risk factors for survival. On the other hand, body mass index (aHR, 0.82; 95%CI: 0.70-0.96), microsatellite instability (aHR, 1.27e^-8; 95%CI: 2.00e^-9-8.12e^-8), BRAF (+) (aHR, 0.08; 95%CI: 0.01-0.44) were protective factors for survival.

CONCLUSION

To the best of our knowledge, this is the first study on the clinicopathological and biomolecular features of Korean interval CRCs. There were several differences in the clinicopathological and biomolecular features of interval CRCs between Korean and Western populations. Further large-scale multicenter studies are required.

Keywords: Interval colorectal neoplasm; Etiology; Colonoscopy; CpG island methylator phenotype; Asia

Core Tip: This is the first study regarding the clinicopathological and biomolecular features of Korean patients with interval colorectal cancers (CRC). In our study, interval CRC were more common in males and located in the left colon, consistent with previous Asian, but in contrast to Western studies. The risk factors associated with survival were advanced stages and CpG island methylator phenotype (CIMP) (+). On the other hand, microsatellite instability (MSI) and BRAF (+) were protective factors for survival. Similar to western studies, CIMP was higher in interval CRCs. However, MSI, and BRAF mutations were not higher in interval CRCs, than sporadic CRCs, in contrast to Western studies.