Risk Of Advanced Colorectal Neoplasia Research Articles

Association Between Indefinite Dysplasia and Advanced Neoplasia in Patients With Inflammatory Bowel Diseases Undergoing Surveillance

Background and aimsLittle is known about the clinical significance of indefinite dysplasia (IND) in patients with inflammatory bowel diseases (IBD) undergoing colonoscopic surveillance for colorectal neoplasia.MethodsWe conducted a retrospective cohort analysis of 492 patients with colonic IBD for 8 or more years or concomitant primary sclerosing cholangitis, with no history of advanced colorectal neoplasia (high-grade dysplasia or colorectal cancer) or colectomy, undergoing colorectal neoplasia surveillance at tertiary IBD referral center from 2001 through 2017. Subjects received consistent histopathologic grading of dysplasia. We collected data on time to development of (advanced) colorectal neoplasia or colectomy using Kaplan Meier methods. We identified factors independently associated with (advanced) colorectal neoplasia with multivariable Cox regression analysis.ResultsAfter 2149 person-years of follow-up, 53 patients (10.8%) received a diagnosis of IND without prior or synchronous low-grade dysplasia (LGD). Compared to patients without dysplasia, patients with IND had a significantly higher risk of advanced colorectal neoplasia (adjusted hazard ratio, 6.85; 95% CI, 1.78–26.4) and colorectal neoplasia (adjusted hazard ratio, 3.25; 95% CI, 1.50–7.05), but not colectomy (P=.78). Compared to IND, LGD was associated with a significantly higher risk of advanced colorectal neoplasia (P=.05). Following a diagnosis of no dysplasia, IND only, or LGD, the incidence rates of advanced colorectal neoplasia were 0.4% per patient-year, 3.1% per patient-year, and 8.4% per patient-year, respectively.ConclusionsIn a retrospective analysis of patients with IBD undergoing colorectal neoplasia surveillance with consistent histopathologic grading of dysplasia, IND was independently associated with a significant increase in risk of advanced colorectal neoplasia. These findings require validation and if confirmed, a reappraisal of the colorectal neoplasia surveillance guidelines.

Association between waist circumference and risk of colorectal neoplasia in normal-weight adults.

Abdominal obesity, measured using waist circumference (WC), is associated with the colorectal neoplasia (CRN) risk. We examined whether WC is associated with the CRN risk even in normal-weight individuals. A cross-sectional study was performed on asymptomatic normal-weight (body mass index 18.5-23kg/m2 ) individuals who underwent colonoscopy as health checkups. Of 63057 examinees, 30498 were men (mean age, 41.1years) and 32559 were women (mean age, 41.7years). The prevalence of overall CRN in WC quartiles 1, 2, 3, and 4 was 14.2%, 15.5%, 15.5%, and 18.7%, respectively, in men and 7.4%, 8.9%, 9.4%, and 11.5%, respectively, in women. The prevalence of advanced CRN (ACRN) in WC quartiles 1, 2, 3, and 4 was 1.5%, 1.3%, 1.6%, and 2.1%, respectively, in men and 1.0%, 1.3%, 1.2%, and 1.3%, respectively, in women. Among men, the overall CRN risk in quartile 4 (>82cm) was higher than that in quartiles 1, 2, and 3 (adjusted odds ratio, OR [95% confidence interval, CI], 1.22 [1.11-1.34], 1.12 [1.05-1.23], and 1.18 [1.07-1.29], respectively); the ACRN risk in quartile 4 was also higher than that in quartiles 1, 2, and 3 (adjusted OR [95% CI], 1.41 [1.09-1.81], 1.56 [1.19-2.03], and 1.50 [1.16-1.94], respectively). Among women, the overall CRN risk in quartile 4 (>77cm) was higher than that in quartiles 1 and 3; the ACRN risk was not different among all groups. Even with a normal weight, a large WC was associated with the CRN risk, especially with the ACRN risk in men.

The relationship between diverticulosis and colorectal neoplasia: A meta-analysis.

Background/AimsDiverticulosis and colorectal neoplasia share epidemiological trends and risk factors which are common in Western countries and incidences increase with age. However, the data on an association between diverticulosis and colorectal neoplasia are conflicting. Thus, we performed a meta-analysis to evaluate whether diverticulosis is associated with colorectal neoplasia.MethodsA systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and SCOPUS was conducted to identify studies that investigated the association between diverticulosis and advanced colorectal neoplasia (advanced adenoma, colorectal cancer), adenomas, or polyps. The demographic characteristics of patients, including age, gender, indication for colonoscopy, confounding factors, and outcomes of colorectal neoplasia were assessed.ResultsWe identified 29 cross-sectional studies (N = 450,953) that investigated the association between diverticulosis and colorectal neoplasia. The meta-analysis found that diverticulosis was not associated with advanced colorectal neoplasia (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.63–1.50). Although there was a positive correlation between diverticulosis and adenomas (OR 1.47, 95% CI 1.18–1.84) and diverticulosis and polyps (OR 1.95, 95% CI 1.15–3.31), diverticulosis did not increase the risk of adenomas (OR 1.34, 95% CI 0.87–2.06) in patients who underwent screening colonoscopy. Moreover, all the increased risk of colorectal neoplasia in patients with diverticulosis was observed in published studies only, and not in unpublished ones.ConclusionsThis meta-analysis demonstrated that diverticulosis is not associated with an increased risk of advanced colorectal neoplasia. Although diverticulosis was associated with a higher risk of polyps and adenomas, the risk was not increased in screening populations. Moreover, the increased risk of colorectal neoplasia in patients with diverticulosis was observed only in published studies and not in unpublished ones.

Fecal Hemoglobin Concentration, a Good Predictor of Risk of Advanced Colorectal Neoplasia in Symptomatic and Asymptomatic Patients.

Background: Periodical fecal immunochemical testing (FIT) is a cost-effective strategy in colon cancer screening programmes. FIT is also used as a diagnostic test in symptomatic patients, but data, are scarce.Aim: To determine the association between FIT-Hb concentration and the risk of advanced neoplasia (AN) detected in colonoscopy in two different populations.Methods: The outcomes of colonoscopies performed after a positive FIT (>117 ng/ml) (Sentinel Gold test) result were analyzed in patients included within a population-based CRC screening programme (screening group) and, as diagnostic evaluation in symptomatic patients (symptomatic group). The study was performed between January 1st, 2014 and October 31, 2016. Data are reported as medians with interquartile ranges or frequencies and percentages. Positive predictive value (PPV) at arbitrary fecal hemoglobin concentrations were also reported calculated for AN.Results: We recruited 2742 patients who underwent a colonoscopy procedure, 1515 (53.5%) of them within the CRC screening programme. Patients in the screening group were younger (65.0 ± 3.3 vs. 66.2 ± 13.4 years, p < 0.001) and more frequently male (p < 0.001) vs. the symptomatic group. Colonoscopy found more frequently neoplastic lesions in the screening compared to the symptomatic group (61.9 vs. 44.8% p < 0.001). Hb concentration in FIT was significantly higher in patients with AN compared with patients without AN in both groups (p < 0.001). The age-adjusted risk of AN increased significantly in both groups according to FIT Hb concentration in the Quartile 3 [OR (95% CI): 2.94 (2.33–3.71)] and Quartile 4 [OR: 5.52 (4.36–6.99)]. Males, in both groups showed a higher probability of presenting AN. FIT values were higher for left- than for right-sided AN in the screening, but not in the symptomatic group. Positive predictive values for AN were higher in the screening group in positive FIT tests (range 43.9–70.5%; 117 to >1,000 ng/ml) compared to those in the symptomatic group (36.3–52.5%). Similar trends were observed for cancer diagnosis alone.Conclusions: Male gender, age, and FIT Hb concentration are predictors of risk of advanced adenoma and colorectal cancer and can be used to prioritize colonoscopy in patients with suspected advanced neoplasia, both in screening and in symptomatic patients.

Fecal Microbiota Differences According to the Risk of Advanced Colorectal Neoplasms

This study aimed to compare differences in the fecal microbiota according to the risk of advanced colorectal neoplasia (ACN) based on a risk-score model in a large Korean cohort. Stool samples were collected from 1122 health screening recipients: 404 enrolled in the average risk (AR) group, 514 in the moderate risk (MR) group, and 204 in the high risk (HR) group, in accordance with their risk of ACN. The fecal microbiota was characterized using pyrosequencing of the V3-V4 region of the 16S rRNA genes. The overall microbial diversity was significantly reduced with an increased risk of ACN [false discovery rate (FDR), P<0.001], and the composition was significantly different between the risk groups (Bonferroni corrected, P<0.05). On taxonomic comparison, 6 of 11 phyla and 39 of 88 genera were significantly different among the risk groups (all FDR P<0.05). These included under-representation of Bacteroides, Ruminococcus, and Bifidobacterium, and over-representation of Prevotella and Fusobacterium with an increased risk of ACN. In particular, we observed that the unknown genus of Ruminococcaceae were relatively abundant (16.2%) in the AR group and significantly depleted with an increased risk of ACN (13.5% in the HR group; FDR P<0.001). These findings support the hypothesis that the fecal microbiota is different according to the risk of ACN. An unknown genus of Ruminococcaceae, as novel potential butyrate producers, might have a possible role in colorectal tumorigenesis in the Korean population.

Usefulness of risk stratification models for colorectal cancer based on fecal hemoglobin concentration and clinical risk factors

We aimed to develop risk stratification models for advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) based on fecal hemoglobin (f-Hb) concentration and clinical risk factors. We reviewed screenees aged≥50 years who underwent fecal immunochemical test (FIT) and colonoscopy and developed risk-scoring models for ACRN and CRC using logistic regression analysis. Participants were classified into low- (risk lower than that in FIT-negative individuals), intermediate- (risk higher than that in FIT-negative but lower than that in FIT-positive individuals), high- (risk similar to that in FIT-positive individuals), and very-high- (risk higher than that in FIT-positive individuals) risk groups. Of 3733 participants, 367 (9.8%) and 70 (1.9%) had ACRN and CRC, respectively. On multivariable analysis, age (ß= .043/y), former smoker (ß= .401), current smoker (ß= .841), diabetes (ß= .097), and square root of f-Hb concentration (ß= .071) were significantly associated with ACRN. In terms of CRC, age (ß= .035/y) and square root of f-Hb concentration (ß= .004) were associated factors. After point assignments based on the regression coefficient, we could classify screenees as low-, intermediate-, high-, and very-high-risk groups. ACRN was identified in 2.9%, 5.3%, 16.2%, and 35.7% of screenees in the low-, intermediate-, high-, and very-high-risk groups, respectively. CRC was identified in .1%, .5%, 3.9%, and 11.1% of screenees in the low-, intermediate-, high-, and very-high-risk groups, respectively. The proposed models can effectively stratify the risk for ACRN and CRC and provide accurate information on this risk in individuals who undergo FIT.

Association of time to colonoscopy after a positive fecal test result and fecal hemoglobin concentration with risk of advanced colorectal neoplasia

BackgroundWe evaluated the risk of advanced colorectal neoplasia (ACRN) and colorectal cancer (CRC) according to time to colonoscopy after positive fecal immunochemical test (FIT), fecal hemoglobin concentration, and combination of both. MethodsWe analyzed the records of 2362 patients aged ≥50 years who underwent colonoscopy because of a positive FIT result through the National Cancer Screening Program of Korea. ResultsACRN risk increased with increasing time to colonoscopy after a positive FIT (17.2%, 18.6%, 19.1%, 21.4%, and 27.2% in <30, 30–59, 60–149, 150–179, and ≥180 days; P = 0.034), and ACRN and CRC risk increased with increasing fecal hemoglobin concentration (ACRN, 13.2%, 16.9%, 18.5%, 23.2%, and 26.6%; CRC, 1.3%, 1.7%, 4.7%, 5.7%, and 12.8% with 100–200, 200–300, 300–500, 500–1000, and ≥1000 ng Hb/mL; both P < 0.001). Even after adjusting for confounders, follow-up after 180 days tended to be associated with a higher ACRN risk (adjusted odds ratio, 1.73; 95% confidence interval [CI], 0.91-3.27), compared with follow-up colonoscopy at <30 days, and fecal hemoglobin 500–1000, and ≥1000 ng Hb/mL were associated with a significantly higher ACRN and CRC risk, compared with 100–200 ng Hb/mL. Moreover, the group with ≥180 days and ≥1000 ng Hb/mL had a much higher CRC risk compared with the group with <180 days and <1000 ng Hb/mL (12.45-fold; 95% CI, 3.73–41.57). ConclusionsPatients with positive FIT results, especially those with higher fecal hemoglobin levels, should undergo timely follow-up colonoscopy.

Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program

IntroductionIncreased values in the fecal immunochemical test (FIT) are correlated with increasingly severe colorectal neoplasia, but little attention has been given to FIT values below the cut-off point (negative FIT, nFIT). We analysed the relationship between the concentrations of two consecutive nFIT and the risk of following screen-detected advanced neoplasia and interval cancer (IC) in a population-based colorectal cancer screening program. MethodsFIT results were categorised into non-detectable nFIT (0–3.8 μg haemoglobin/g feces), low nFIT (3.9–9.9) and high nFIT (10.0–19.9). Multivariable adjusted logistic regression was used to estimate the odds ratios (OR) of advanced neoplasia and IC with the nFIT results in the first two screens. ResultsMore than 90% of the 42,524 persons had non-detectable nFIT in the first and second screen; 4.5% and 5.8% had a low nFIT, respectively, and 2.2% and 2.9% had a high nFIT. The probability of testing positive and being diagnosed of advanced neoplasia or IC rose with increasing values of nFIT. Compared with those with two non-detectable nFIT results, the highest OR were found among those who had two high nFIT results (OR 21.75; 95% confidence interval: 12.44, 38.04) and those with one low nFIT and one high nFIT (ORs around 20). ConclusionsParticipants with nFIT results above the detection limit of the test had an increased risk of advanced neoplasia and IC in subsequent participations. This information could be used in the design of personalised screening strategies.

Risk Scores for Predicting Advanced Colorectal Neoplasia in the Average-risk Population: A Systematic Review and Meta-analysis.

OBJECTIVES:A systematic review and meta‐analysis was performed to summarize the available evidence on risk scores for predicting advanced colorectal neoplasia (advanced adenomas and cancer) in average‐risk and asymptomatic populations undergoing screening colonoscopy.METHODS:PubMed, EMBASE, and Web of Science databases were searched up to 28 March 2018. Studies that developed or validated a risk score to predict the risk of advanced colorectal neoplasia were included. Two reviewers independently extracted study characteristics including diagnostic performance indicators and assessed risk of bias and applicability in the included studies. Metaanalyses were conducted to determine the overall discrimination of risk scores evaluated by more than 1 study.RESULTS:A total of 22 studies including 17 original risk scores were identified. Risk scores included a median number of 5 risk factors. Factors most commonly included were age, sex, family history in first‐degree relatives, body mass index and smoking. The area under the receiver operating characteristic curve of risk scores ranged from 0.62 to 0.77 in the individual studies and from 0.61 to 0.70 in the meta‐analyses.CONCLUSIONS:Although the majority of available risk scores had relatively weak discriminatory power, they may be of some use for risk stratification in CRC screening. Rather than developing more risk scores based on environmental risk factors, future research should focus on exploring possibilities of enhancing predictive power by combining risk factor data with novel laboratory matters, such as polygenetic risk scores.

Influence of Obesity and Metabolic Abnormalities on the Risk of Developing Colorectal Neoplasia.

Obesity and metabolic syndrome are risk factors for colorectal neoplasia (CRN). However, the association between metabolically healthy obese (MHO) or metabolically unhealthy non-obese (MUNO) status and the risk of CRN remains unclear. We aimed to elucidate the association between MHO or MUNO status and the risk of CRN. A total of 139,023 asymptomatic subjects who underwent a primary screening colonoscopy were categorized into 4 groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO), MHO, MUNO, and metabolically unhealthy obese (MUO). Mean participant age was 41.0years, and the proportion of men was 65.3%. Among men, the risk of overall CRN increased in MHO (adjusted odds ratio [AOR] 1.22, 95% confidence intervals [CI] 1.12-1.33), MUNO (AOR 1.25, 95% CI 1.18-1.31), and MUO groups (AOR 1.47, 95% CI 1.40-1.54) compared with the MHNO group, whereas the risk of advanced CRN (ACRN) increased in MUNO (AOR 1.16, 95% CI 1.002-1.33) and MUO groups (AOR 1.49, 95% CI 1.31-1.70), but not in the MHO group (AOR 0.92, 95% CI 0.70-1.21). Moreover, among non-obese men, the risk of overall CRN and ACRN linearly increased with an increasing number of metabolic abnormalities. However, among women, only the MUO group had an increased risk of overall CRN (AOR 1.34, 95% CI 1.21-1.47) and no other significant associations were observed. Poor metabolic health, regardless of obesity, is an independent risk factor for CRN in men. Our results suggest that men with metabolic abnormalities should be considered as a high-risk group for colorectal cancer, even if they are not obese.

Impact of sarcopenia on the risk of advanced colorectal neoplasia.

Sarcopenia is a pathological condition characterized by the progressive loss of muscle mass and increased amount of visceral fat. Recent evidence has revealed that sarcopenia is associated with certain diseases. However, the impact of sarcopenia on colorectal neoplasia has not been documented clearly. We studied the association between sarcopenia and advanced colorectal neoplasia in a large screening population. This cross-sectional study included 14024 asymptomatic adults who underwent first-time screening colonoscopy. Sarcopenia (class II) was defined as an appendicular skeletal muscle mass (ASM)/bodyweight (%) value more than two standard deviations below the mean for healthy young adults. ASM was estimated using bioelectrical impedance analysis. In a multivariable model adjusted for age, sex, obesity (body mass index≥25), smoking status, alcohol intake, regular exercise, and family history of colorectal cancer, the odds ratio (OR) for advanced colorectal neoplasia on comparing participants with sarcopenia (class II) to those without sarcopenia (class I+II) was 1.52 (95% confidence interval [CI], 1.23-1.86). Further adjustment for metabolic parameters attenuated this association, but the association was still significant (OR, 1.34; 95% CI, 1.07-1.68). Furthermore, the multivariable (traditional risk factors)-adjusted OR associated with a 1% decrease on the introduction of ASM/weight% as a continuous variable in regression models was 1.04 (95% CI, 1.01-1.07) for advanced colorectal neoplasia. Our findings indicate that sarcopenia is significantly and progressively associated with the risk of advanced colorectal neoplasia. This association might be explained by metabolic factors that could be potential mediators of the effect of sarcopenia.

The association between Helicobacter pylori infection and the risk of advanced colorectal neoplasia may differ according to age and cigarette smoking.

The association between Helicobacter pylori infection and advanced colorectal neoplasia (ACN) remains controversial. This study aimed to clarify the association between H.pylori infection and ACN according to age groups. We retrospectively analyzed the association between H.pylori infection and ACN in patients aged <50 and ≥50years receiving a health checkup that included colonoscopy. Helicobacter pylori positivity was determined by the results of serum anti-H.pylori immunoglobulin G or rapid urease test, if the anti-H.pylori immunoglobulin G was in the borderline range. Among the 19337 patients who were included, 56.2% and 3.4% were positive for H.pylori and ACN, respectively. Helicobacter pylori infection independently increased the risk of ACN in patients aged <50years (odds ratio [OR], 1.602; 95% confidence intervals [CI], 1.194-2.150) but not in patients aged ≥50years (OR, 1.046; 95% CI, 0.863-1.268). The positive association between H.pylori infection and ACN was affected by smoking history. When stratified by age and smoking history, H.pylori infection conferred an increased risk of ACN in patients aged <50years with a history of smoking (OR, 1.926; 95% CI, 1.336-2.775) but not in the other 3 groups (3-way interaction test P=.023). Among patients aged <50years with ACN, ACN in the left colon was found more frequently in patients with H.pylori infection and a history of smoking than in those without (69.3% vs 54.4%, respectively; P=.031). Helicobacter pylori infection confers an increased risk of ACN, but the association may differ according to age and smoking history.

High Risk of Advanced Colorectal Neoplasia in Patients With Primary Sclerosing Cholangitis Associated With Inflammatory Bowel Disease

Patients with inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC, termed PSC-IBD) are at increased risk for colorectal cancer, but their risk following a diagnosis of low-grade dysplasia (LGD) is not well described. We aimed to determine the rate of advanced colorectal neoplasia (aCRN), defined as high-grade dysplasia and/or colorectal cancer, following a diagnosis of indefinite dysplasia or LGD in this population. We performed a retrospective, longitudinal study of 1911 patients with colonic IBD (293 with PSC and 1618 without PSC) who underwent more than 2 surveillance colonoscopies from 2000 through 2015 in The Netherlands or the United States (9265 patient-years of follow-up evaluation). We collected data on clinical and demographic features of patients, as well as data from each surveillance colonoscopy and histologic report. For each surveillance colonoscopy, the severity of active inflammation was documented. The primary outcome was a diagnosis of aCRN during follow-up evaluation. We also investigated factors associated with aCRN in patients with or without a prior diagnosis of indefinite dysplasia or LGD. Patients with PSC-IBD had a 2-fold higher risk of developing aCRN than patients with non-PSC IBD. Mean inflammation scores did not differ significantly between patients with PSC-IBD (0.55)vs patients with non-PSC IBD (0.56) (P= .89), nor did proportions of patients with LGD (21% of patients with PSC-IBD vs 18% of patients with non-PSC IBD) differ significantly (P= .37). However, the rate of aCRN following a diagnosis of LGD was significantly higher in patients with PSC-IBD (8.4 per 100 patient-years) than patients with non-PSC IBD (3.0 per 100 patient-years; P= .01). PSC (adjusted hazard ratio [aHR], 2.01; 95% CI, 1.09-3.71), increasing age (aHR 1.03; 95% CI, 1.01-1.05), and active inflammation (aHR, 2.39; 95% CI, 1.63-3.49) were independent risk factors for aCRN. Dysplasia was more often endoscopically invisible in patients with PSC-IBD than in patients with non-PSC IBD. In a longitudinal study of almost 2000 patients with colonic IBD, PSC remained a strong independent risk factor for aCRN. Once LGD is detected, aCRN develops at a higher rate in patients with PSC and is more often endoscopically invisible than in patients with only IBD. Our findings support recommendations for careful annual colonoscopic surveillance for patients with IBD and PSC, and consideration of colectomy once LGD is detected.

The impact of passive smoking on the risk of colorectal neoplasia in never, former, and current smokers.

Active smoking is well known to be a risk factor for colorectal neoplasia (CRN). However, it remains unclear whether passive smoking is also related to the risk of CRN. This study investigated the effect of passive smoking on the risk of CRN in never, former, and current smokers. A cross-sectional study was performed on asymptomatic examinees who underwent colonoscopy as part of a health check-up. Of 136707 participants, 33052 (24.2%) were never passive smokers, and 103655 (75.8%) were ever passive smokers. The mean age of the study population was 41.0years. The proportion of never, former, and current smokers was 56.9%, 21.4%, and 24.8%, respectively, and the proportion of overall CRN and advanced CRN (ACRN) was 15.4% and 1.7%, respectively. Ever passive smoke exposure was associated with an increased risk of overall CRN in never smokers (adjusted odds ratio [AOR] 1.08; 95% confidence interval [CI] 1.02-1.13) and former smokers (AOR 1.08; 95% CI 1.00-1.17) but not in current smokers (AOR 1.02; 95% CI 0.94-1.11). Additionally, it significantly increased the risk of ACRN among never smokers (AOR 1.17; 95% CI 1.01-1.35) and tended to increase the risk of ACRN among former smokers (AOR 1.26; 95% CI 0.99-1.61). Moreover, the risk of CRN increased with increasing frequency and duration of passive smoking in never and former smokers. Passive smoking was an independent risk factor for CRN in never and former smokers. Never and former smokers who are highly exposed to passive smoke as well as current smokers should be given priority for colonoscopy.

Clinical risk stratification model for advanced colorectal neoplasia in persons with negative fecal immunochemical test results.

ObjectivesThe fecal immunochemical test (FIT) has low sensitivity for detecting advanced colorectal neoplasia (ACRN); thus, a considerable portion of FIT-negative persons may have ACRN. We aimed to develop a risk-scoring model for predicting ACRN in FIT-negative persons.Materials and methodsWe reviewed the records of participants aged ≥40 years who underwent a colonoscopy and FIT during a health check-up. We developed a risk-scoring model for predicting ACRN in FIT-negative persons.ResultsOf 11,873 FIT-negative participants, 255 (2.1%) had ACRN. On the basis of the multivariable logistic regression model, point scores were assigned as follows among FIT-negative persons: age (per year from 40 years old), 1 point; current smoker, 10 points; overweight, 5 points; obese, 7 points; hypertension, 6 points; old cerebrovascular attack (CVA), 15 points. Although the proportion of ACRN in FIT-negative persons increased as risk scores increased (from 0.6% in the group with 0–4 points to 8.1% in the group with 35–39 points), it was significantly lower than that in FIT-positive persons (14.9%). However, there was no statistical difference between the proportion of ACRN in FIT-negative persons with ≥40 points and in FIT-positive persons (10.5% vs. 14.9%, P = 0.321).ConclusionsFIT-negative persons may need to undergo screening colonoscopy if they clinically have a high risk of ACRN. The scoring model based on age, smoking habits, overweight or obesity, hypertension, and old CVA may be useful in selecting and prioritizing FIT-negative persons for screening colonoscopy.

A combination of clinical risk stratification and fecal immunochemical test is useful for identifying persons with high priority of early colonoscopy

BackgroundWe aimed to develop a combination screening strategy for advanced colorectal neoplasia based on the Asia-Pacific Colorectal Screening score and fecal immunochemical test results. MethodsWe reviewed the records of participants who had undergone a colonoscopy and fecal immunochemical test as part of a comprehensive health screening program. The prevalence of advanced colorectal neoplasia in participants 40–49 years old was analyzed according to Asia-Pacific Colorectal Screening scores and fecal immunochemical test results. ResultsWe analyzed the data of 9205 participants 40–49 years old and 3215 participants ≥50 years old. The prevalence of advanced colorectal neoplasia in participants 40–49 years old was 1.0%, 2.1%, 7.1%, and 13.4% in the “fecal immunochemical test (−) & Asia-Pacific Colorectal Screening<2,” “fecal immunochemical test (−) & Asia-Pacific Colorectal Screening≥2,” “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening<2,” and “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening≥2” subgroups, respectively. The prevalence of advanced colorectal neoplasia in “fecal immunochemical test (+) & Asia-Pacific Colorectal Screening≥2” subgroup was higher than in participants ≥50 years old with Asia-Pacific Colorectal Screening≥4 (13.4% vs. 5.8%, P<0.001). ConclusionsFecal immunochemical test-positive individuals 40–49 years old with an Asia-Pacific Colorectal Screening≥2 have a higher risk of advanced colorectal neoplasia than individuals ≥50 years old with an Asia-Pacific Colorectal Screening≥4.

Changes in Adult BMI and Waist Circumference Are Associated with Increased Risk of Advanced Colorectal Neoplasia.

Waist circumference (WC) is a stronger predictor of colon cancer (CRC) risk than body mass index (BMI). However, how well change in either WC or BMI predicts risk of advanced colorectal neoplasia (AN) is unclear. To determine the relationship between change in BMI and WC from early adulthood to later age and the risk of AN and which change measure is a stronger predictor. In 4500 adults, ages 50-80, with no previous neoplasia and undergoing screening colonoscopy, BMI and WC at age 21 and at time of screening were reported. Changes in BMI and WC were defined using universal risk cutoffs. Known CRC risk factors were controlled in the logistic models. Overall, model statistics showed WC change (omnibus test χ 2=10.15, 2 DF, p value=0.006) was a statistically stronger predictor of AN than BMI change (omnibus test χ 2=5.66, 5 DF, p value=0.34). Independent of BMI change, participants who increased WC (OR 1.44; 95% CI 1.05-1.96) or maintained a high-risk WC (OR 2.50; 95% CI 1.38-4.53) at age 21 and at screening had an increased risk of AN compared to those with a low-risk WC. Study participants who were obese at age 21 and at screening had an increased risk of AN (OR 1.87; 95% CI 1.08-3.23) compared to those who maintained a healthy BMI. Maintaining an overweight BMI or increasing BMI was not associated with AN. Maintaining an unhealthy BMI and WC throughout adult life may increase risk of AN. WC change may be a better predictor of AN than BMI change.

Adenoma detection rate influences the risk of metachronous advanced colorectal neoplasia in low-risk patients

In individuals with either no or 1 to 2 nonadvanced adenomas, future risks of advanced colorectal neoplasia (AN) vary according to clinical risk factors. However, little is known about the association between the adenoma detection rate (ADR) and the risk for metachronous AN in patients with low-risk adenomas. We identified 7171 participants with no or 1 to 2 nonadvanced adenomas at first-time screening colonoscopy. The risk of metachronous AN was investigated at surveillance colonoscopy, according to clinical characteristics and the ADR. In multivariate analysis the risk for metachronous AN was strongly associated with increasing age, male sex, increasing number of adenomas, and the ADR of the endoscopist. With the ADR modeled as a continuous variable, each 1.0% increase in the rate of ADR predicted a 3.0% decrease in the risk of metachronous AN (adjusted odds ratio [OR], .97; 95% confidence interval [CI], .95-.99). With the ADR modeled using a binary cut-off (32%), the risk of metachronous AN was reduced in patients of endoscopists with an ADR≥32% (adjusted OR, .53; 95% CI, .35-.83). Moreover, the risk of metachronous AN was reduced (adjusted OR, .66; 95% CI, .46-.95) in patients of endoscopists with an ADR in the highest tertile, compared with patients of endoscopists with ADRs in the lowest tertile. The impact of ADR on metachronous AN was significant for patients with low-risk adenomas rather than patients with no adenoma. In patients with low-risk adenomas, the ADR of the endoscopist was inversely associated with the risk of metachronous AN.

Impact of Age on the Risk of Advanced Colorectal Neoplasia in a Young Population: An Analysis Using the Predicted Probability Model.

The incidence of colorectal cancer is decreasing in adults aged ≥50years and increasing in those aged <50years. We aimed to establish risk stratification model for advanced colorectal neoplasia (ACRN) in persons aged <50years. We reviewed the records of participants who had undergone a colonoscopy as part of a health examination at two large medical examination centers in Korea. By using logistic regression analysis, we developed predicted probability models for ACRN in a population aged 30-49years. Of 96,235 participants, 57,635 and 38,600 were included in the derivation and validation cohorts, respectively. The predicted probability model considered age, sex, body mass index, family history of colorectal cancer, and smoking habits, as follows: Y ACRN=-8.755+0.080·X age-0.055·X male+0.041·X BMI+0.200·X family_history_of_CRC+0.218·X former_smoker+0.644·X current_smoker. The optimal cutoff value for the predicted probability of ACRN by Youden index was 1.14%. The area under the receiver-operating characteristic curve (AUROC) values of our model for ACRN were higher than those of the previously established Asia-Pacific Colorectal Screening (APCS), Korean Colorectal Screening (KCS), and Kaminski's scoring models [AUROC (95% confidence interval): model in the current study, 0.673 (0.648-0.697); vs. APCS, 0.588 (0.564-0.611), P<0.001; vs. KCS, 0.602 (0.576-0.627), P<0.001; and vs. Kaminski's model, 0.586 (0.560-0.612), P<0.001]. In a young population, a predicted probability model can assess the risk of ACRN more accurately than existing models, including the APCS, KCS, and Kaminski's scoring models.

Abstract 5319: Comparison of changes in waist circumference and body mass index (BMI) through adulthood and their relationship with advanced colorectal neoplasia

Abstract Background: Waist circumference (WC) is a stronger predictor of colon cancer risk than body mass index (BMI); however, how well change in either WC or BMI over time predicts the risk of AN remains unclear. Purpose: To investigate 1) the relationship between change in adiposity measures (BMI and WC) from early adulthood to older age and the risk of advanced colorectal neoplasia (AN) and 2) whether WC change or BMI change is a stronger predictor of risk of AN. Methods: The sample included 4,500 adults, 50-80 years with no previous colorectal cancer or adenomatous polyps and undergoing first-time screening colonoscopy. Participants reported adiposity measures (height, weight and WC) at early adulthood (age 21) and at time of screening (mean age 57). Changes in BMI were categorized as 1) increase from healthy BMI to overweight or obese, 2) increase from overweight to obese, and 3) stable BMI level at age 21 and time of screening. WC was defined as high-risk for females with a WC ≥35 and males ≥40 inches. Changes for WC were categorized as 1) increase from a low-risk WC to a high-risk WC, and 2) stable-risk WC at age 21 and time of screening. Gender, age, family history, exercise, aspirin use, alcohol, smoking and intake of red meat and vegetables were included in the logistic models. Results: Being obese both at age 21 and at screening resulted in a significant increased risk of AN (OR=1.87; 95% CI 1.08-3.23) compared to those with a stable-healthy BMI at both time points. Stable overweight BMI at age 21 and at screening (OR=1.54; 95% CI 0.97-2.45) and increased BMI from healthy to overweight or obese and overweight to obese were not associated with AN, as compared to those who had a healthy BMI at both time points. Compared to those with a low-risk WC at both time points, those who had a high-risk WC at age 21 and at time of screening had a two-fold increased risk of AN (OR=2.15; 95% CI 1.35-3.45). Increasing WC from age 21 to time of screening compared to those with low-risk WC was not associated with risk of AN (OR=1.23; 95% CI 0.97-1.57). When both WC and BMI change were included, WC change (=10.15, 2 DF, p-value=0.0062) but not BMI change (=5.66, 2 DF, p-value=0.34) predicted risk of AN. Conclusions: Maintaining a high-risk WC or obese BMI is associated with increased risk for AN; however, when BMI is controlled, maintaining a high-risk WC may independently increase the risk for AN. Practitioners should caution adults with high-risk WC and obese BMI values to better control their adiposity. Citation Format: Wambui G. Gathirua-Mwangi, Patrick Monahan, Yiqing Song, Terrell Zollinger, Timothy Stump, Victoria Champion, Thomas Imperiale. Comparison of changes in waist circumference and body mass index (BMI) through adulthood and their relationship with advanced colorectal neoplasia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5319. doi:10.1158/1538-7445.AM2017-5319