Advanced Colorectal Neoplasia Research Articles

Cardiovascular Risk Assessment by SCORE2 Predicts Risk for Colorectal Neoplasia and Tumor-Related Mortality.

Objectives: The European Society of Cardiology endorsed SCORE2 to assess cardiovascular risk. The aim of this observational, retrospective study was to assess whether SCORE2 is associated with colorectal neoplasia in an asymptomatic screening population. Further, we evaluated if SCORE2 predicts tumor-related mortality. Methods: We included 3408 asymptomatic patients who underwent a screening colonoscopy. We calculated SCORE2 for each participant and stratified patients according to their predicted 10-year risk of cardiovascular disease: SCORE2 0–4.9%, SCORE2 5–9.9%, and SCORE2 ≥ 10%. We assessed the association between SCORE2 as a continuous variable, the presence of colorectal neoplasia using multilevel logistic regression, and SCORE2 and mortality using Cox regression. Results: In total, 1537 patients had a SCORE2 of 0–4.9%, 1235 a SCORE2 of 5–9.9%, and 636 a SCORE2 ≥ 10%. The respective rates of colorectal neoplasia were 20%, 37%, and 44%. SCORE2 was associated with the presence of any (OR 1.11 95%CI 1.09–1.12; p < 0.001) and advanced colorectal neoplasia (OR 1.06 95%CI 1.08–1.13; p < 0.001) in univariate analysis. After multivariable adjustment (age, sex, family history, and metabolic syndrome) a higher SCORE2 remained associated with higher odds for any (aOR 1.04 95%CI 1.02–1.06; p = 0.001) and advanced (aOR 1.06 95%CI 1.03–1.10; p < 0.001) colorectal neoplasia. SCORE2 was associated with both all-cause (HR 1.11 95%CI 1.09–1.14; p < 0.001) and tumor-related mortality (HR 1.10 95%CI 1.05–1.14; p < 0.001). Conclusions: We found that SCORE2 is associated with the presence of colorectal neoplasia. Clinicians could kill two birds with one stone calculating SCORE2. In patients with a high SCORE2, screening colonoscopy aside from cardiovascular risk mitigation could improve outcomes.

Relationship between BMI, CT-derived body composition and colorectal neoplasia in a bowel screening population.

IntroductionObesity is associated with an increased risk of colorectal cancer (CRC). Unlike the indirect measures such as BMI, CT-Body composition (CT-BC) allows for the assessment of both volume and distribution of adipose tissue. Therefore, the aim of this study was to examine the relationship between host characteristics, BMI, CT-BC measurements and the incidence of colorectal neoplasia.MethodsPatients undergoing CT Colonography (CTC) as part of the Scottish Bowel Screening Programme, between July 2009 and February 2016, were eligible for inclusion. Data were collected including demographic data, clinicopathological variables and CT-BC measurements including skeletal muscle index (SMI), subcutaneous fat index (SFI) and visceral fat area (VFA). CTC, colonoscopy, and pathology reports were used to identify CRC incidence. Associations between demographic data, clinicopathological variables, CT-BC measurements, colorectal neoplasia and advanced colorectal neoplasia were analysed using univariate and multivariate binary logistics regression.Results286 patients met the inclusion criteria. Neoplasia was detected in 105 (37%) of the patients with advanced neoplasia being detected in 72 (69%) of patients. On multivariate analysis sex (p < 0.05) and high VFA (p < 0.001) remained independently associated with colorectal neoplasia. On multivariate analysis a high SFI (p < 0.01) remained independently associated with advanced colorectal neoplasia. BMI was not associated with either colorectal neoplasia or advanced colorectal neoplasia.ConclusionWhen directly compared to BMI, CT derived fat measurements were more closely associated with the degree of neoplasia in patients undergoing colorectal cancer screening. In patients investigated with CT colonography, CT adipose measures may stratify the risk and grade of neoplasia.

Impact of antithrombotic drugs on the accuracy of fecal occult blood testing for advanced colorectal neoplasia screening: a meta-analysis and systematic review.

The current meta-analysis was conducted to determine whether antithrombotic drug use would affect the diagnostic accuracy of fecal occult blood testing for advanced colorectal neoplasia. Articles published between 2000 and 2019 were systematically retrieved and screened according to the inclusion and exclusion criteria by two reviewers independently. Pooled analyses were conducted with a fixed-effect model if no apparent heterogeneity (I2 ≥ 50%) was found between studies; otherwise, the random effects model would be used. Sensitivity analysis and subgroup analysis were also conducted using Review Manager 5.3. Pooled analysis revealed that aspirin and nonsteroidal anti-inflammatory drugs were associated with a decrease in the positive predictive value of fecal occult blood testing for advanced colorectal neoplasia screening, with a RR of 0.89 (95% CI: 0.84-0.94) and 0.88 (95% CI: 0.84-0.93, p<0.001) respectively. Subgroup analysis based on data limited to high-quality studies, fecal immunochemical testing, or in Caucasians also showed that the use of aspirin/NSAID drugs decreased the accuracy for advanced colorectal neoplasia screening. Aspirin/NSAIDs and direct oral anticoagulants rather than warfarin may decrease the diagnostic accuracy of fecal occult blood testing for advanced colorectal neoplasia screening.

One-sample quantitative and two-sample qualitative faecal immunochemical tests for colorectal cancer screening: a cross-sectional study in China

ObjectivesQuantitative faecal immunochemical tests (FITs) are widely used for colorectal cancer (CRC) screening in the Western countries, whereas qualitative FITs are preferred in China. The present study aimed to compare...

Increased Colorectal Neoplasia Risk in Patients with Inflammatory Bowel Disease and Serrated Polyps with Dysplasia

BackgroundThe impact of serrated polyps on the advanced colorectal neoplasia (CRN) risk in inflammatory bowel disease (IBD) patients is unknown. Serrated polyps are histologically categorized as hyperplastic polyps (HPs), sessile serrated lesions (SSLs), and traditional serrated adenomas (TSAs).AimsWe aimed (1) to characterize the serrated polyps in IBD patients, (2) to identify factors associated with the presence of serrated polyps in IBD, and (3) to assess the CRN risk in IBD patients with serrated polyps.MethodsWe established a retrospective cohort of IBD patients with and without colonic serrated polyps. Cox-regression analysis with time-dependent variables was used to compare advanced CRN risk in IBD patients with and without serrated polyps.ResultsOf the 621 enrolled IBD patients, 198 had a serrated polyp (92 HPs, 88 SSLs without dysplasia, 13 SSLs with dysplasia, and 5 TSAs). Independent factors associated with serrated polyps were ulcerative colitis (UC) (odds ratio (OR) 1.77, 95% confidence interval (CI) 1.19–2.62, p = 0.005), male gender (OR 1.63, 95% CI 1.11–2.40, p = 0.013), and older age (per year increase, OR 1.06, 95%CI 1.05–1.08, p < 0.001). TSAs and SSLs with dysplasia were risk factors for subsequent advanced CRN (HR 13.51, 95% CI 3.11–58.68, p < 0.001), while HPs (HR 1.98, 95% CI 0.46–8.60, p = 0.36) and SSLs without dysplasia (HR 0.87, 95% CI 0.11–6.88, p-0.89) did not impact the subsequent advanced CRN risk.ConclusionsUC, male gender and older age were associated with the presence of serrated polyps. The majority of serrated polyps (91%) were HPs and SSL without dysplasia and did not affect the CRC risk. However TSAs and SSLs with dysplasia, representing a small subgroup of serrated polyps (9%), were associated with subsequent advanced CRN.

Risk of developing metachronous colorectal neoplasia after the resection of proximal versus distal adenomas.

Current post-polypectomy guidelines do not consider adenoma location. We compared the risk of metachronous colorectal neoplasia (CRN) according to adenoma location. We collected data from 9710 patients who underwent follow-up colonoscopy after adenoma removal. Patients were classified according to baseline adenoma location: distal only (n=4665), proximal only (n=3827), and both sides (n=1218). The risk of metachronous CRN in patients with proximal only adenomas was higher than that in those with distal only adenomas (adjusted hazard ratio [aHR]=1.12, 95% confidence interval [CI]=1.04-1.21), while the risk of metachronous advanced CRN (ACRN) was not different between the two groups. Among patients aged <50 years, the risk of metachronous CRN in those with proximal only non-advanced adenomas (NAAs) was higher than that in those with only distal NAAs, while among patients aged ≥50 years, the risk in those with proximal only advanced adenomas (AAs) was higher than that in those with distal only AAs. However, the risk of metachronous ACRN did not differ based on adenoma location in patients aged <50 and ≥50 years. Proximal adenoma was associated with an increased risk of metachronous CRN, but not with an increased risk of metachronous ACRN, supporting the current guidelines recommending the same surveillance interval for distal and proximal adenoma without discrimination by adenoma location.

Head-to-head comparison of a risk-adapted screening strategy using various risk prediction models in detecting colorectal neoplasm.

The risk-adapted screening strategy showed satisfying colorectal cancer (CRC) screening yield and efficiency. We therefore further explored the diagnostic performance variation of this strategy using different risk prediction models. A literature search was conducted to identify studies evaluating risk models for advanced colorectal neoplasm (ACN). The included models were retrospectively validated in a subset sample (N=3219) from a population-based CRC screening trial in China. Diagnosis-related indictors were compared between the risk-adapted screening strategy using different models and the fecal immunochemical test (FIT)-only strategy. For simulated populations with ACN prevalence of 3% to 12%, the trade-off of additional false positives for each additional true positive were calculated. We included 14 eligible risk models with the area under the curves ranging 0.570 to 0.652 in the validation set. The overall sensitivities of the risk-adapted screening strategy using different risk models for ACN varied from 46.0% to 69.8%, higher than FIT (21.9%), but at the expense of specificities (51.6% to 78.3% vs 97.1%). For population having ACN prevalence of 3%, risk-adapted screening strategies needed 20.5 to 31.1 additional false positives for each additional true positive compared with FIT, and respective number would substantially reduce (4.7 to 7.1) as the ACN prevalence increased to 12%. Risk-adapted screening strategy using the current risk models showed improved sensitivity for ACN compared with FIT, at the cost of increased colonoscopy workload. The optimal strategy for screening practice should be tailored considering the disease burden and availability of healthcare resources.

Total polyp number may be more important than size and histology of polyps for prediction of metachronous high-risk colorectal neoplasms

BackgroundTo evaluate whether the risk of metachronous high-risk colorectal neoplasm (HR-CRN) differs according to the indication for surveillance colonoscopy.MethodsPatients who underwent polypectomy or endoscopic resection of colorectal neoplasms were enrolled and classified into three groups according to the indication for surveillance colonoscopy: advanced colorectal neoplasm (ACRN: adenoma ≥ 10 mm, adenoma with high-degree dysplasia and/or villous component), advanced serrated polyps (ASP: hyperplastic polyp or sessile serrated lesion ≥ 10 mm, traditional serrated polyp), and high-risk polyps (HRP: 3 or more adenomas or serrated polyps). The primary outcome was the development of metachronous HR-CRN, defined as ACRN, ASP, or HRP at the first follow-up colonoscopy.ResultsIn total, 367 patients were enrolled (ACRN group: N = 264; ASP group: N = 33; HRP group: N = 70). Among the 160 patients who underwent follow-up colonoscopy, 28 (18%) had HR-CRN. In univariable analysis, indication for surveillance colonoscopy was not found to be associated with the development of metachronous HR-CRN. Instead, the total polyp number at index colonoscopy showed a positive association with the risk of metachronous HR-CRN in trend analysis (p = 0.001). In multivariable analysis, the presence of 5 or more polyps at index colonoscopy was found to be associated with the risk of metachronous HR-CRN (OR, 2.575, p = 0.049) after adjusting for risk factors, such as obesity, diabetes, and smoking.ConclusionsThe risk of metachronous HR-CRN did not differ according to the main indications for surveillance colonoscopy. The presence of 5 or more polyps at index colonoscopy was the only risk factor for metachronous HR-CRN.

Risk of Metachronous Colorectal Advanced Neoplasia and Cancer in Patients With 3-4 Nonadvanced Adenomas at Index Colonoscopy: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluated the available evidence on the risk of metachronous advanced neoplasia (AN) and colorectal cancer (CRC) in patients with 3-4 nonadvanced adenomas (NAAs). We searched MEDLINE, EMBASE, and Cochrane Library databases up to January 2021 for studies evaluating metachronous AN and CRC risk by comparing 3 groups (1-2 vs 3-4 vs ≥5 NAAs) at index colonoscopy. The estimates for risk of metachronous AN and CRC were evaluated using random-effects models. Fifteen studies (n = 36,375) were included. The risk of metachronous AN was significantly higher in the 3-4 NAAs group than in the 1-2 NAAs group (relative risk [RR] 1.264, 95% confidence interval [CI] 1.053-1.518, P = 0.012; I2 = 0%); there was no difference between the ≥ 5 NAAs and 3-4 NAAs groups (RR 1.962, 95% CI 0.972-3.958, P = 0.060; I2 = 68%). The risks of metachronous CRC between the 1-2 NAAs and 3-4 NAAs groups (RR 2.663, 95% CI 0.391-18.128, P = 0.317; I2 = 0%) or the 3-4 NAAs and ≥ 5 NAAs groups (RR 1.148, 95% CI 0.142-9.290, P = 0.897; I2 = 0%) were not significantly different. Although the risk of metachronous AN was greater in the 3-4 NAAs group than in the 1-2 NAAs group, the risk of metachronous AN and CRC between the 3-4 NAAs and ≥ 5 NAAs groups was not different. This suggests that further studies on metachronous AN and CRC risk in the 3-4 NAAs group are warranted to confirm a firm ≥5-year interval surveillance colonoscopy.

CRC-PREVENT: Clinical validation trial to show expedited and diverse recruitment for the non-invasive RNA-FIT test that can detect advanced colorectal neoplasia with high sensitivity.

23 Background: Prevailing methods for patient recruitment in large prospective studies can be time consuming, expensive, and introduce selection bias against patients with low health literacy or reduced access to healthcare. Previous clinical trials have reported low recruitment of women, minorities, and individuals who face socioeconomic barriers; a concern which has been exacerbated by the COVID-19 pandemic. Here we describe a novel recruitment strategy that helps to address healthcare disparities. This study will support a pre-market approval application to the FDA for a multi-factor RNA-FIT assay for detection of colorectal neoplasia in average-risk individuals between the ages of 45-75. Methods: A decentralized clinical trial (CRC-PREVENT) was launched through a digital campaign (https://www.colonscreeningstudy.com/; NCT04739722) after the RNA-FIT test system entered design-lock. Online advertisements were published on multiple social media sites and engagement with materials directed patients to an online screener. Participants who completed the screener were considered eligible for enrollment if they met CRC-PREVENT inclusion/ exclusion criteria and were willing to complete all components of the clinical trial, including providing a stool sample prior to an optical colonoscopy. Results: After 3 months of active enrollment, 51,588 individuals have engaged with digital advertisements and completed pre-screener surveys to determine eligibility. In total, 35,280 individuals were deemed eligible based on survey response, and 13,294 eligible individuals also expressed interest in the CRC-PREVENT clinical trial. Of these individuals, 48% were female and 34% were over the age of 60 years old. Regarding race, interested individuals directly represented the intended use population: 17% were Black or African American, 2.7% were Asian, and 1.3% were Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native. With respect to ethnicity, 8.4% identified as Hispanic or Latinx. The decentralized approach also permitted access to individuals with socioeconomic healthcare inequities: 27% had income under $29,999 and 14% were on Medicaid. Individuals were derived from all 48 continental United States, and of those who reported their residential location, approximately 3% were from rural areas. Conclusions: Use of a decentralized recruitment strategy permitted highly successful enrollment in the face of challenges associated with COVID-19. With respect to race, ethnicity, socioeconomic status, and geography, all metrics represented significantly more diverse populations than observed in traditional clinical studies. Decentralized enrollment mitigated selection bias, and will result in data more reflective of the intended use population. Clinical trial information: NCT04739722.

Determining frequency and reasons associated to refusal of colorectal cancer screening at a reference center in Mexico.

67 Background: in Mexico, Colorectal Cancer (CRC) is a leading cause of cancer death, yet population-based screening programs are lacking. In our center, a cohort was created to validate a risk calculator to detect advanced colorectal neoplasia, and to understand barriers to implement a CRC screening program. We aimed to determine frequency and reasons associated to rejection of CRC screening in our population. Methods: from August 2019 to March 2020 (early close owing to COVID-19 pandemic) asymptomatic individuals between 50 and 75 years-old with standard-risk for CRC, without previous screening for CRC, from the outpatient internal medicine clinic at a tertiary care center in Mexico City, received standardized information on the importance of CRC screening and were invited to perform both Fecal Immunochemical Test and a screening colonoscopy within a clinical study at no cost. Individuals who rejected participation were given a 10-item questionnaire to select reasons for refusal, as many items as applied. Here we present two groups: 1) individuals who refused to receive information and to perform screening studies, and 2) individuals who refused to participate after receiving information. Results: 162 patients were invited to participate, 77 (47%) refused: 48 rejected immediately (group 1) and provided 51 reasons, and 29 declined after having received standardized information about CRC screening (group 2) and provided 30 reasons. Demographics for 77 patients were: 54 (70.1%) women, median age 66 (IQR 58-71) years. Main reasons for rejection in both groups were: “I do not have time” in 24 (29.6%) times, “I am not interested” in 23 (28.4%) times, and “I am scared” in 14 (17.3%) times (Table). Conclusions: in our cohort, we identified that nearly half of the population invited to participate in a CRC screening program refused. Main reasons were lack of time, lack of interest and fear. This may translate poor understanding on the importance of measures to prevent CRC, and absence of education programs to recall its importance. In order to increment participation in CRC screening, education and awareness campaigns should be implemented.[Table: see text]

Prevention of colorectal cancer through multiomics blood testing: The PREEMPT CRC study.

TPS208 Background: The USPSTF recently recommended colorectal cancer (CRC) screening for adults aged 45 to 49 years in addition to those aged 50 to 75 years. This guideline update, which increases the number of screen-eligible individuals by ̃19 million, is similar to the recommendation in 2018 by the American Cancer Society (ACS) and is based on the modeling studies that reflect rising CRC incidence rates in younger adults. Currently, only 67% of average-risk individuals over the age of 50 years are up-to-date on CRC screening, and adherence to screening is lower in younger individuals (e.g., 50-54 years). Despite the non-invasive nature of existing stool-based CRC tests, barriers remain to adoption, including a dislike for manipulating stool and a requirement for substantial navigational support. Blood tests may overcome these barriers through ease of sample collection and integration into routine blood work. Methods: Here we describe our prospective, multi-center registrational study for validating a blood-based multiomics test for average-risk CRC screening: PREEMPT CRC. Eligible participants include those aged 45-85 with no known history of CRC or colorectal adenomas who are undergoing CRC screening by colonoscopy. The target enrollment is 25,000 participants, and primary outcome measures are sensitivity for CRC and specificity for advanced colorectal neoplasia, which includes CRC and advanced adenomas. Secondary outcome measures include positive predictive value for CRC, negative predictive value for advanced colorectal neoplasia, and sensitivity for advanced adenomas. Novel recruitment methods have been implemented by combining traditional, site-based recruitment and virtual recruitment using an online web portal, coupled with mobile phlebotomy, to make participation broadly accessible, especially during the COVID-19 pandemic. Participants have been enrolled from 40 states as of August 2021, and virtual recruitment has enabled widespread participation, potentially from any zip code in the continental US. To ensure adequate representation of the intended use population, community organizations, federally qualified health centers (FQHCs), and universities have been engaged to reach underserved and minority patient populations. The study was initiated in May 2020 and to our knowledge will be the largest prospective, multi-center registrational validation study of an average-risk CRC screening test to date. Clinical trial information: NCT04369053.

P288 Recurrence rates of advanced neoplasia after endoscopic or surgical resection in Inflammatory Bowel Disease patients: a retrospective cohort study

Abstract Background Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (AN) including high grade dysplasia (HGD) and colorectal cancer (CRC). Historically, a (sub)total colectomy was recommended in these patients, but alternatively, endoscopic resection or partial colectomy can be considered as well. We aimed (1) to identify factors associated with AN treatment choice and (2) to assess AN recurrence rates following different treatment modalities. Methods In this retrospective multi-center cohort study we used the Dutch nationwide histopathology registry (PALGA) to identify ulcerative colitis (UC), Crohn’s disease (CD) and IBD-unclassified patients diagnosed with colonic AN between 1991 and 2020 in seven hospitals in the Netherlands. Exclusion criteria were familial CRC or AN prior to IBD diagnosis. Data regarding the first (index) AN, treatment and endoscopic and surgical follow-up were collected. Recurrence was defined as colorectal AN (independent of colonic location) detected after treatment of index AN. Multinomial logistic regression and cox regression analysis were used to assess in respective associations with treatment choice and recurrence free survival. Results We included 189 patients with index AN (n=81 HGD, n=108 CRC) with a median follow up of 27 months (IQR 7–69 months). (Sub)total colectomy was performed in 79 patients (41.8%; n=33 HGD, n=46 CRC), whereas 55 patients (29.1%; n=12 HGD, n=43 CRC) had a partial colectomy. Endoscopic resection was performed in 38 patients (20.1%; n=35 HGD, n=3 CRC), of which EMR/ESD n=12 (6.3%). Seventeen lesions (8.9%; n=1 HGD, n=16 CRC) were not removed, due to comorbidity or metastatic disease. CRC, primary sclerosing cholangitis (PSC), extensive disease and younger age at time of index AN were associated with (sub)total colectomy (Table 1). Twenty-one patients (12.2%) developed recurrence AN (n=12 HGD, n=9 CRC), after a median of 24 months (IQR 14–48; figure 1). Endoscopic resection was associated with recurrence (adjusted hazard ratio 4.0, confidence interval [1.3–12.2], p=0.02), as 14/21 patients (66.7%) with recurrence were initially (for index AN) treated with endoscopic resection. In addition, 3 patients (14.3%) were treated with partial colectomy and 4 (19.0%) with (sub)total colectomy. In 11/21 patients (52.4%) recurrence was treated with surgical resection. Conclusion Factors associated with AN treatment with (sub)total colectomy were CRC, PSC, extensive disease and younger age. After AN treatment, 1 out of 10 IBD patients developed recurrence of AN, mainly after endoscopic resection. This underlines the importance of stringent endoscopic surveillance following treatment of AN, especially after endoscopic resection with residual colon in place.

Diagnostic variability in the histopathological assessment of advanced colorectal adenomas and early colorectal cancer in a screening population.

AimThe aim of this study was to evaluate interobserver variability between individual pathologists and a panel of pathologists in the histopathological assessment of advanced colorectal neoplasms in the Dutch bowel cancer screening population.Methods and resultsHistological slides of adenomas with high‐grade dysplasia and early colorectal carcinomas (CRC) from 20 different laboratories were reviewed by the pathology panel of the Dutch bowel screening programme. Interobserver variability was reported by descriptive statistics. In addition, potential clinical consequences of discrepancies were evaluated. A total of 104 cases of adenomas with high‐grade dysplasia and 83 early CRCs were reviewed. Discrepancies were observed in 41 of 104 (39.4%) adenoma cases, which potentially had clinical consequences in 16 (15.4%) cases. For CRC, discrepancies were shown in 44 of 83 cases (53.0%) and would have potentially led to alternative treatment strategies in 25 (30.1%) cases. Most frequently, discrepancies were observed in the assessment of lymphovascular invasion (23 of 73 cases, 31.5%).ConclusionThis study showed that considerable interobserver variability is present in the histopathological assessment of advanced colorectal neoplasia, which may impact upon treatment choices. Additional stains and education, as well as intercollegial consultation, might decrease this variability.

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital.

Current postpolypectomy surveillance guidelines are based primarily on data from non-Hispanic Whites (NHWs); thus, generalizability to non-Hispanic Blacks (NHBs) remains unknown. Hence, the primary objective of this study was to assess the validity of these guidelines for NHBs by comparing the prevalence of metachronous advanced colorectal neoplasia (ACN) between NHWs and NHBs undergoing surveillance colonoscopy. This was a retrospective cross-sectional study of NHWs (N= 1500) and NHBs (N= 1260) aged 40-75 years who underwent surveillance colonoscopy at an academic safety net hospital between 2007 and 2017. The primary outcome measure was the prevalence of metachronous ACN, defined as an advanced adenoma, advanced sessile polyp, or invasive cancer. Multivariate logistic regression was used to measure associations between race/ethnicity and ACN prevalence after adjustment for potential confounding factors. Overall, the prevalence of metachronous ACN was similar for NHBs and NHWs (6.8% vs 7.4%, respectively; P= .60). The prevalence of metachronous cancers (0.2% vs 0.1%;P= .48), advanced adenomas (2.8% vs 3.8%; P= .14), advanced serrated polyps (3.5% vs 3.3%; P= .82), and large hyperplastic polyps ≥10mm (0.2% vs 0.6%, P= .24) were also similar between the 2 groups. Moreover, race was not a determinant of metachronous ACN after adjustment for age, sex, education, type of insurance, indication (screen/surveillance) for baseline colonoscopy, surveillance interval, and findings at baseline colonoscopy (adjusted odds ratio, 0.96; 95% confidence interval, 0.70-1.30; P= .78). Our study finds no significant difference in the prevalence of metachronous ACN between NHWs and NHBs undergoing appropriate postpolypectomy surveillance at an urban safety net hospital, suggesting that current guidelines are appropriate for both NHWs and NHBs.

High Positive Predictive Value of Multitarget Stool DNA After Aerodigestive Tract Radiotherapy.

BACKGROUND AND AIMS:Multitarget stool DNA (mt-sDNA) is approved for average-risk colorectal cancer screening; test performance in persons with prior radiation therapy (RT) has not been studied. RT can induce gastrointestinal bleeding and alter DNA methylation, which may affect mt-sDNA accuracy. Among patients previously treated with RT, we aimed to measure the positive predictive value (PPV) of mt-sDNA and compare these results to historical estimates of mt-sDNA PPV among average-risk patients.METHODS:After institutional review board approval, we conducted a retrospective cohort study of a multisite academic and community-based practice. Patients with RT and subsequent mt-sDNA use during the study period (2014–2016) were identified. The findings at diagnostic colonoscopy were compared with published reports among average-risk patients. Nominal P values were generated by 2-tailed Fisher’s exact testing in comparisons of colorectal neoplasia (CRN) rates between groups.RESULTS:There were 220 patients who had RT before mt-sDNA testing. RT was delivered along the aerodigestive tract in 108 patients. Mt-sDNA tests were positive in 45 of 220 patients (20%), and colonoscopy findings were available for 42; 31 of 42 patients (74%) had CRN. PPV by mt-sDNA was similar when stratified by site of prior RT (along vs outside the aerodigestive tract; P = 1.00). Detection of advanced CRN (36%) was nominally higher than previously published retrospective (27%) and prospective (20%) studies. The median time from the start of RT to mt-sDNA use was 7 (interquartile range, 3–14) years.CONCLUSION:With a test positivity rate and PPV for CRN similar to reports among average-risk patients, prior RT does not appear to adversely affect mt-sDNA performance.

Tumor Macroscopic Morphology Is an Important Prognostic Factor in Predicting Chemotherapeutic Efficacy and Clinical Outcomes of Patients With Colorectal Neuroendocrine Neoplasms, One Multicenter Retrospective Cohort Study.

Background and AimsLocally advanced and metastatic colorectal neuroendocrine neoplasm (NEN) is a rare disease with a dismal prognosis. We aimed to explore the value of the macroscopic morphology of NENs in the management of TNM stage II-IV colorectal NENs, which has not been fully elucidated in previous reports.MethodsWe retrospectively enrolled 125 eligible patients with TNM stage II-IV colorectal NENs who were diagnosed between 2000 and 2020 from three Chinese hospitals. All were categorized into either protruding or ulcerative NEN groups through endoscopic evaluation of their macroscopic morphology. Clinicopathological data were collected and compared between the two groups. Survival analysis was performed to assess the survival outcomes between the two groups.ResultsA total of 77 and 48 patients had protruding and ulcerative NENs, respectively. Patients with ulcerative NENs had a larger median tumor size (P<0.001) and higher median Ki-67 index (P<0.001), and a larger proportion of these patients had grade G3 disease (P=0.001) and poorly differentiated neoplasms (P=0.001), as well as higher frequencies of T3 and T4 tumors (P=0.006) than patients with protruding NENs. In addition, patients with ulcerative NENs showed a much lower response to first-line chemotherapy [50% (95% CI: 27.3% - 72.7%) versus 20% (95% CI: 3.1% - 36.9%), P=0.03] and a worse 3-year progression-free survival (PFS) rate [19.7% (95% CI: 7.2% - 32.2%) versus 49.5% (95% CI: 37.5% - 61.5%), P=0.001] and 3-year overall survival (OS) rate [30.7% (95% CI: 15.6% - 45.8%) versus 76.9% (95% CI: 66.5% - 87.3%), P<0.001] than those with protruding NENs. The multivariate analysis results indicated that the macroscopic shape of NENs was an independent prognostic factor affecting both PFS (HR = 1.760, 95% CI: 1.024 – 3.026, P = 0.04) and OS (HR = 2.280, 95% CI: 1.123 – 4.628, P = 0.02).ConclusionsUlcerative NENs were more malignant and chemotherapy resistant than protruding NENs. Tumor macroscopic morphology is a valuable prognostic factor for stage II-IV colorectal NENs.

Prevalence and associated risk of advanced colorectal neoplasia in adults with sarcopenia.

Background/AimsAlthough several studies have shown that sarcopenia is associated with poor outcomes in colorectal cancer patients, the impact of sarcopenia on the development of colorectal neoplasia remains unclear. We aimed to evaluate the prevalence and association of colorectal neoplasia, especially advanced colorectal neoplasia, in adults with sarcopenia.MethodsWe retrospectively analyzed the data for 10,676 adults who underwent first-time colonoscopy and bioelectrical impedance analysis (BIA) on the same day in a health screening program at a single center. Sarcopenia was diagnosed using established BIA-based criteria as adjusted appendicular skeletal muscle mass (ASM) divided by body mass index (BMI) (ASM/BMI), height (ASM/height2), or weight (ASM/weight). Prevalence of overall and advanced colorectal neoplasia and their association with sarcopenia, as established by the aforementioned diagnostic criteria, were evaluated.ResultsAmong 10,676 subjects, 583 were diagnosed with sarcopenia using ASM/BMI. Subjects with sarcopenia had a higher prevalence of colorectal neoplasia than those without. In the multivariate analysis after adjusting for confounding factors, sarcopenia was an independent risk factor for any colorectal neoplasia (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.09 to 1.56) and advanced colorectal neoplasia (OR, 1.97; 95% CI, 1.27 to 3.06). The association between sarcopenia and advanced colorectal neoplasia remained significant for all sarcopenia measures including ASM/height2 (OR, 2.19; 95% CI, 1.24 to 3.85) and ASM/weight (OR, 2.41; 95% CI, 1.54 to 3.77).ConclusionsPrevalence of overall and advanced colorectal neoplasia was higher in subjects with sarcopenia than in those without. Sarcopenia was a significant risk factor for colorectal neoplasia, especially for advanced colorectal neoplasia.

Faecal immunochemical test to triage patients with possible colorectal cancer symptoms: meta-analysis.

This review evaluated the utility of single quantitative faecal immunochemical test (FIT) as a triaging tool for patients with symptoms of possible colorectal cancer, the effect of symptoms on FIT accuracy, and the impact of triaging incorporating FIT on service provision. Five databases were searched. Meta-analyses of the extracted FIT sensitivities and specificities for detection of colorectal cancer at reported f-Hb thresholds were performed. Secondary outcomes included sensitivity and specificity of FIT for advanced colorectal neoplasia and serious bowel disease. Subgroup analysis by FIT brand and symptoms was undertaken. Fifteen prospective cohort studies, including 28 832 symptomatic patients were included. At the most commonly reported f-Hb positivity threshold of ≥ 10 µg Hb/g faeces (n=13), the summary sensitivity was 88.7% (95% c.i. 85.2 to 91.4) and the specificity was 80.5% (95% c.i. 75.3 to 84.8) for colorectal cancer. At lower limits of detection of ≥ 2 µg Hb/g faeces, the summary sensitivity was 96.8% (95% c.i. 91.0 to 98.9) and the specificity was 65.6% (95% c.i. 59.0 to 71.6). At the upper f-Hb positivity thresholds of ≥ 100 µg Hb/g faeces and ≥ 150 µg Hb/g faeces, summary sensitivities were 68.1% (95% c.i. 59.2 to 75.9) and 66.3% (95% c.i. 52.2 to 78.0), with specificities of 93.4% (95% c.i. 91.3 to 95.1) and 95.1% (95% c.i. 93.6 to 96.3) respectively. FIT sensitivity was comparable between different assay brands. FIT sensitivity may be higher in patients reporting rectal bleeding. Single quantitative FIT at lower f-Hb positivity thresholds can adequately exclude colorectal cancer in symptomatic patients and provides a data-based approach to prioritization of colonoscopy resources.

Performance of artificial intelligence for detection of subtle and advanced colorectal neoplasia.

There is uncertainty regarding the efficacy of artificial intelligence (AI) software to detect advanced subtle neoplasia, particularly flat lesions and sessile serrated lesions (SSLs), due to low prevalence in testing datasets and prospective trials. This has been highlighted as a top research priority for the field. An AI algorithm was evaluated on four video test datasets containing 173 polyps (35,114 polyp-positive frames and 634,988 polyp-negative frames) specifically enriched with flat lesions and SSLs, including a challenging dataset containing subtle advanced neoplasia. The challenging dataset was also evaluated by eight endoscopists (four independent, four trainees, according to the Joint Advisory Group on gastrointestinal endoscopy [JAG] standards in the UK). In the first two video datasets, the algorithm achieved per-polyp sensitivities of 100% and 98.9%. Per-frame sensitivities were 84.1% and 85.2%. In the subtle dataset, the algorithm detected a significantly higher number of polyps (P < 0.0001), compared to JAG-independent and trainee endoscopists, achieving per-polyp sensitivities of 79.5%, 37.2% and 11.5%, respectively. Furthermore, when considering subtle polyps detected by both the algorithm and at least one endoscopist, the AI detected polyps significantly faster on average. The AI based algorithm achieved high per-polyp sensitivities for advanced colorectal neoplasia, including flat lesions and SSLs, outperforming both JAG independent and trainees on a very challenging dataset containing subtle lesions that could have been overlooked easily and contribute to interval colorectal cancer. Further prospective trials should evaluate AI to detect subtle advanced neoplasia in higher risk populations for colorectal cancer.