Abstract
BackgroundEvidence regarding the benefit of therapy to prevent the post-polypectomy recurrence of colorectal adenoma is limited. Endoscopic recurrence is the main outcome according to an evaluation of trials involving recurrence prevention.AimTo estimate the recurrence rates of post-polypectomy colorectal adenoma in placebo-controlled arms of randomized clinical trials and to identify the prognostic factors influencing these rates.MethodsWe combined data from all randomized controlled trials evaluating therapies for colorectal adenoma using placebo from 1988 to 2016. The data were combined in a random-effects model. Primary outcomes were endoscopic adenoma and advanced adenoma recurrence of colorectal adenoma.ResultsThe pooled estimates of the adenoma recurrence rates were 37% (95% confidence interval [CI], 33%-41%; range, 33%-52%) at 1 year, 47% (95% CI, 41%-54%; range, 46%-51%) at 2 years, 41% (95% CI, 33%-48%; range, 20%-61%) at 3 years, 48% (95% CI, 38%-57%; range, 37%-53%) at 4 years, and 60% (95% CI, 52%-68%; range, 48%-68%) at 5 years. The pooled estimates of the advanced adenoma recurrence rates were 10% (95% CI, 6%-15%; range, 7%-13%) at 1 year, 12% (95% CI, 8%-16%; range, 3%-19%) at 3 years, 14% (95% CI, 10%-18%; range, 13%-16%) at 4 years, and 14% (95% CI, 10%-19%; range, 9%-21%) at 5 years. Significant heterogeneity among the randomized clinical trials (P < 0.001) was observed for each recurrence rate.ConclusionsThis meta-analysis confirms the heterogeneity of recurrence rates among post-polypectomy colorectal adenoma patients who received placebo. No single design variable was identified that might explain the heterogeneity.
Highlights
As a malignant neoplasm, colorectal cancer is common worldwide, and its prevalence and case fatality are increasing [1]
The pooled estimates of the advanced adenoma recurrence rates were 10% at 1 year, 12% at 3 years, 14% at 4 years, and 14% at 5 years
Significant heterogeneity among the randomized clinical trials (P < 0.001) was observed for each recurrence rate. This meta-analysis confirms the heterogeneity of recurrence rates among post-polypectomy colorectal adenoma patients who received placebo
Summary
Colorectal cancer is common worldwide, and its prevalence and case fatality are increasing [1]. Several large multicentre randomized doubleblinded placebo-controlled trials have assessed the possible preventive effect of various agents on the recurrence of colorectal adenoma after polypectomy, including antioxidant vitamins, calcium, fibre, ursodeoxycholic acid, folic acid, difluoromethylornithine, metformin, and non-steroidal anti-inflammatory drugs, such as aspirin and selective COX-2 inhibitors [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27] Among those randomized controlled trials (RCTs) evaluating drugs for the chemoprevention of recurrence, both adenoma and advanced adenoma recurrence after polypectomy were evaluated as main outcomes. Endoscopic recurrence is the main outcome according to an evaluation of trials involving recurrence prevention
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