Gut Liver.  2015 Nov;9(6):741-749. 10.5009/gnl14210.

The Risk of Metachronous Advanced Colorectal Neoplasia Rises in Parallel with an Increasing Number of High-Risk Findings at Baseline

• Lee SM
• Kim JH
• Sung IK
• Hong SN

• KMID: 2377931
• DOI: http://doi.org/10.5009/gnl14210

Abstract

BACKGROUND/AIMS
Colorectal adenomas that are > or =10 mm have villous histology or high-grade dysplasia, or that are associated with > or =3 adenomas are considered high-risk for metachronous advanced neoplasia. We evaluated the cumulative incidence of metachronous advanced neoplasia according to the total number of high-risk findings detected on baseline colonoscopy.
METHODS
This was a retrospective cohort study performed in 862 patients who underwent removal of colorectal adenomas between 2005 and 2009. At least one surveillance colonoscopy had been conducted at Konkuk University Medical Center, Seoul, Korea.
RESULTS
The cumulative incidence of metachronous advanced neoplasia in patients with 0, 1, 2, and 3-4 high-risk findings at 1 year were 0.7%, 1.3%, 2.8%, and 8.0%; at 3 years, those were 5.9%, 11.9%, 15.5%, and 24.7%; and at 5 years, those were 8.5%, 18.7%, 26.3%, and 37.2%, respectively. In a multivariate model, the risk of metachronous advanced neoplasia was significantly higher for the multiple high-risk findings group when compared with the 0 high-risk findings group (1 high-risk (+): hazard ratio, 1.86 [95% confidence interval, 1.00-3.44]; 2 high-risk (+): 1.84 [0.88-3.84]; and 3-4 high-risk (+): 3.29 [1.54-7.01]; ptrend=0.020).
CONCLUSIONS
The presence of overlapping multiple high-risk findings was associated with an increased risk of advanced neoplasia during surveillance.

Keyword

Colorectal neoplasia; Colonoscopy; Surveillance; Polypectomy

MeSH Terms

Adenoma/epidemiology/*etiology/pathology
Aged
Colonic Polyps/complications/surgery
*Colonoscopy
Colorectal Neoplasms/epidemiology/*etiology/pathology
Early Detection of Cancer/methods
Female
Humans
Incidence
Male
Middle Aged
Neoplasm Grading
Neoplasms, Second Primary/epidemiology/*etiology/pathology
Population Surveillance/methods
Proportional Hazards Models
Republic of Korea/epidemiology
Retrospective Studies
Risk Factors
Time Factors
Tumor Burden