Risk Of Metachronous Advanced Colorectal Neoplasia Research Articles

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.

Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia.

Background and aims The family of serrated polyps (SP) includes hyperplastic polyps (HP), sessile serrated adenomas/polyps, and traditional serrated adenoma. We investigated whether SP synchronous with adenoma at index colonoscopy is associated with metachronous advanced colorectal neoplasia (CRN). Methods Patients with ≥ 1 adenoma on index colonoscopy and who had undergone a follow-up colonoscopy were included. The patients were divided into four groups according to the presence of SP and advanced adenoma (AA) on index colonoscopy (non-AA, non-AA + SP, AA, AA + SP). The cumulative incidence of metachronous advanced CRN at surveillance colonoscopy was compared between groups. Results Among a total of 2209 patients, the numbers of patients in the non-AA, non-AA + SP, AA, and AA + SP groups were 922, 441, 625, and 221, respectively. The cumulative incidence of metachronous advanced CRN was higher in patients in the AA + SP group than that in the AA group ( P <0.001), and there was no significant difference between the non-AA + SP group and the non-AA group ( P = 0.06). The cumulative incidence of metachronous advanced CRN at 3 years was 17.9 % [95 % confidence interval (CI) 8.0–27.6], 10.7 % [95 %CI 7.7–3.6], 3.5 % [95 %CI 1.3–5.6], and 3.4 % [95 %CI 2.0–4.7] in the AA + SP, AA, non-AA + SP, and non-AA group, respectively. In a multivariate analysis, overall SP [hazard ratio (HR) 2.24; 95 %CI 1.38–3.64, P = 0.001], proximal SP (HR 2.31; 95 %CI 1.32–4.08), and HP (HR 2.19; 95 %CI 1.35–3.57) were risk factors for metachronous advanced CRN in patients with AA on index colonoscopy. Conclusions Coexistent AA and SP on index colonoscopy significantly increased the risk of metachronous advanced CRN compared with AA alone. Further large prospective studies are needed to confirm whether more intensive follow-up improves outcomes in these high risk patients.

Effect of Cotinine-Verified Change in Smoking Status on Risk of Metachronous Colorectal Neoplasia After Polypectomy

Previous assessments of colorectal neoplasia (CRN) recurrence after polypectomy used self-report to determine smoking status. We evaluated the association between change in smoking status and metachronous CRN risk after polypectomy using cotinine level in urine to determine tobacco exposure. We performed a retrospective study of participants in the Kangbuk Samsung Health Study in Korea who underwent a screening colonoscopy examination and measurement of cotinine in urine samples. Our analysis included 4762 patients who had 1 or more adenomas detected in an index colonoscopy performed between January 2010 and December 2014, and underwent a surveillance colonoscopy, 6 or more months later, until December2017. Patients were classified into 4 groups based on the change in cotinine-verified smoking status from index to follow-up colonoscopy (mean interval, 3.2 ± 1.3 y), as follows: remained nonsmokers (n= 2962; group 1), smokers changed to nonsmokers (n= 600; group 2), nonsmokers changed to smokers (n= 138; group 3), and remained smokers (n= 1062; group 4). After adjustment for confounding factors, group 4 had a significantly higher risk of metachronous CRN than group 1 (hazard ratio [HR], 1.54; 95% CI, 1.36-1.73) and group 2 (HR, 1.63; 95% CI, 1.39-1.99). Group 4 also had a higher risk of metachronous advanced CRN than group 1 (HR, 2.84; 95% CI, 1.79-4.53) and group 2 (HR, 2.10; 95% CI, 1.13-3.89). Group 3 had a higher risk of metachronous CRN than group 1 (HR, 1.50; 95% CI, 1.14-1.97) and group 2 (HR, 1.62; 95% CI, 1.20-2.20). In a retrospective study of individuals with at least 1 adenoma, we found that cotinine-verified changes in smoking status between index and follow-up colonoscopy are associated with a risk of metachronous CRN. Helping patients quit smoking is important for effective prevention of colorectal cancer.

Association between family history of colorectal cancer and the risk of metachronous colorectal neoplasia following polypectomy in patients aged

The relationship between a family history of colorectal cancer (CRC) and the risk of metachronous colorectal neoplasia (CRN) following polypectomy remains unknown. We aimed to compare the risk of metachronous CRN according to CRC family history in groups of patients aged <50 and ≥50years. We studied patients who underwent ≥1 adenoma removal between 2010 and 2014 and follow-up surveillance colonoscopic examinations until 2017. Among the 9866 patients studied, 544 (5.5%) had ≥1 first-degree relatives (FDRs) affected by CRC. In patients aged <50years (n=7787), as compared with having no family history of CRC, a positive family history in any FDR (hazard ratio [HR] 1.37, 95% confidence interval [CI] 1.16-1.62), a father (HR 1.35, 95% CI 1.09-1.68), or a mother (HR 1.32, 95% CI 1.005-1.74) was associated with an increased risk of metachronous CRN after adjusting for confounding factors. However, in patients aged ≥50years (n=2079), there was no significant association between having an FDR with CRC and the risk of metachronous CRN. For metachronous advanced CRN, the association between its risk and family history of CRC was not observed in either the <50years or ≥50years of age group. Having an FDR with CRC at a young age (<50years) appears to be closely related to the risk of metachronous CRN. However, considering that the risk of metachronous advanced CRN did not depend on CRC family history, the interval of post-polypectomy surveillance colonoscopy may not need to be adjusted depending on CRC family history.

Appropriate Surveillance Interval after Colonoscopic Polypectomy in Patients Younger than 50 Years.

BackgroundCurrent postpolypectomy surveillance guidelines are based on studies in patients aged ≥50 years. Equal application of the guidelines in patients aged < 50 years may be unreasonable. We aimed to determine an appropriate surveillance interval after adenoma removal in patients aged < 50 years.MethodsWe studied 10,013 patients who underwent ≥ 1 adenoma removal and follow-up colonoscopy. The cumulative risk of metachronous advanced colorectal neoplasia (ACRN) was compared among the eight groups based on age (30–39, 40–44, 45–49 and ≥ 50 years) and baseline adenoma characteristics (low- [LRA] and high-risk adenoma [HRA]).ResultsThe risk of metachronous ACRN in patients aged 30–39 and 40–44 years with HRA was comparable to that in those aged ≥ 50 years with LRA (P = 0.839 and P = 0.381, respectively). However, the risk in those aged 45–49 years with HRA was higher than in those aged ≥ 50 years with LRA (P = 0.003), and the risk was not significantly different from that in those aged ≥ 50 years with HRA (P = 0.092). Additionally, the 5-year cumulative risk in those aged 45–49 years with LRA was not significantly different from that in those aged ≥ 50 years with LRA.ConclusionThe postpolypectomy surveillance interval can be extended up to 5 years in patients aged 30–44 years with HRA, similar to those aged ≥ 50 years with LRA. However, the interval in patients aged 45–49 years with HRA and LRA should be 3 and 5 years, respectively, similar to those aged ≥ 50 years.

Risk of developing metachronous advanced colorectal neoplasia after colonoscopic polypectomy in patients aged 30 to 39 and 40 to 49 years

Current guidelines define postpolypectomy surveillance intervals in patients aged≥50 years. The risk of metachronous colorectal neoplasia (CRN) and the optimal postpolypectomy surveillance interval in patients aged<50 years remain unclear. We compared the risk of metachronous CRN in patients aged 30 to 39, 40 to 49, and≥50 years. We studied patients who underwent≥1 adenoma removal between 2010 and 2014 and follow-up colonoscopic surveillance until2017. Among 10,014 patients studied, 3242, 4606, and 2166 were 30 to 39, 40 to 49, and≥50 years old, respectively. After high-risk adenoma removal, the 3-year risk of metachronous advanced CRN (ACRN) in patients aged 30 to 39 and 40 to 49 years was lower than in patients≥50 years old (1.9% and 3.6% vs 8.1%, respectively; P< .001 and .008). After low-risk adenoma removal, the 5-year risk of metachronous ACRN in patients aged 30 to 39 and 40 to 49 years was lower than in patients≥50 years old (2.8% and 3.3% vs 5.9%, respectively; P= .010 and .031). The risk of metachronous ACRN or≥3 adenomas in patients aged 30 to 39 years was significantly lower than in patients aged 40 to 49 years. Age remained significantly associated with the risk of metachronous ACRN despite adjustments for potential confounders. The risk of metachronous ACRN was lower in patients aged<50 years than in those aged≥50 years; thus, the postpolypectomy surveillance interval may be extendable to >3 and 5 years in high-risk and low-risk adenoma groups, respectively, in patients aged<50 years.

Number of advanced adenomas on index colonoscopy: Important risk factor for metachronous advanced colorectal neoplasia

Background/AimsAlthough the patients with multiple advanced adenomas (AA) in index colonoscopy may have an increased risk for subsequent advanced colorectal neoplasia (CRN), the current guidelines do not consider this factor. We aimed to compare the risk of metachronous advanced CRN according to the number of AAs. MethodsA total of 2250 patients with ≥1 adenoma at index colonoscopy were included. The patients were divided according to the number of AAs (1, 2 and ≥3 AAs). The relative and 3-year absolute risk of metachronous advanced CRN was compared between the AA groups. ResultsThe relative risk of metachronous advanced CRN was higher in the patients with ≥3 AAs than in the patients with one AA (16.7% vs. 6.8%, p = 0.004). The 3-year absolute risk of metachronous advanced CRN was higher in the patients with ≥3 AAs than in the patients with 1–2 AA (19.4% vs. 6.9%, p = 0.04). Having ≥3 AAs (odds ratio, 5.42; 95% confidence interval 1.75–16.83) was a significant risk factor for developing advanced CRN. ConclusionsThe risk of metachronous advanced CRN in the patients with ≥3 AAs was higher than that in the patients with one or two AAs. More intensive surveillances might be needed for these patient groups.

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.

Metabolic unhealthiness is an important predictor for the development of advanced colorectal neoplasia

Obesity is a well-known risk factor for colorectal neoplasia. Yet, the associations of both metabolic and obesity status with metachronous colorectal neoplasia remain unclear. We conducted a cohort study of 9,331 adults who underwent screening colonoscopy and surveillance colonoscopy. Participants were classified as metabolically healthy if they had no metabolic syndrome component. Participants were categorized into four groups according to body mass index and metabolic status: metabolically healthy non-obese (MHNO; n = 2,745), metabolically abnormal non-obese (MANO; n = 3,267), metabolically healthy obese (MHO; n = 707), and metabolically abnormal obese (MAO; n = 2,612). MAO individuals [n = 159 advanced colorectal neoplasia (AN) cases, 6.1%] and MANO individuals (n = 167 AN cases, 5.1%) had a higher incidence of AN compared with MHNO individuals (n = 79 AN cases, 2.9%). In a multivariable model, the risk of metachronous AN was higher in MANO (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.12–1.84) and MAO (HR 1.52, 95% CI 1.18–1.96) than in MHNO. In contrast, the risk of metachronous AN was not significantly elevated in MHO. In subgroup analyses, with or without adenoma at baseline, MAO was a risk group for metachronous AN, and MHO was not. Our findings suggest that metabolic unhealthiness is a significant predictor for metachronous AN.