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Risk stratification of individuals with low-risk colorectal adenomas using clinical characteristics: a pooled analysis
  1. Samir Gupta1,2,3*,
  2. Elizabeth T Jacobs4*,
  3. John A Baron5,
  4. David A Lieberman6,
  5. Gwen Murphy7,
  6. Uri Ladabaum8,
  7. Amanda J Cross9,
  8. Rodrigo Jover10,
  9. Lin Liu3,11,
  10. Maria Elena Martinez3,11
  1. 1Department of Medicine, Section of Gastroenterology, Veteran Affairs San Diego Healthcare System, San Diego, California, USA
  2. 2Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California, USA
  3. 3Moores Cancer Center, University of California San Diego, La Jolla, California, USA
  4. 4Department of Epidemiology and Biostatistics, Arizona Cancer Center, Arizona College of Public Health, University of Arizona, Tucson, Arizona, USA
  5. 5Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  6. 6Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Cente and Oregon Health and Science University, Portland, Oregon, USA
  7. 7Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  8. 8Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
  9. 9Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
  10. 10Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria (ISABIAL), Alicante, Spain
  11. 11Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Maria Elena Martinez, Department of Family Medicine & Public Health, Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, #0901, La Jolla CA 92093-0901, USA; e8martinez{at}ucsd.edu

Abstract

Objective For individuals with 1–2 small (<1 cm) low-risk colorectal adenomas, international guidelines range from no surveillance to offering surveillance colonoscopy in 5–10 years. We hypothesised that the risks for metachronous advanced neoplasia (AN) among patients with low-risk adenomas differ based on clinical factors distinct from those currently used.

Design We pooled data from seven prospective studies to assess the risk of metachronous AN. Two groups with 1–2 small adenomas were defined based on guidelines from the UK (n=4516) or the European Union (EU)/US (n=2477).

Results Absolute risk of metachronous AN ranged from a low of 2.9% to a high of 12.2%, depending on specific risk factor and guideline used. For the UK group, the highest absolute risks for metachronous AN were found among individuals with a history of prior polyp (12.2%), villous histology (12.2%), age ≥70 years (10.9%), high-grade dysplasia (10.9%), any proximal adenoma (10.2%), distal and proximal adenoma (10.8%) or two adenomas (10.1%). For the EU/US group, the highest absolute risks for metachronous AN were among individuals with a history of prior polyp (11.5%) or the presence of both proximal and distal adenomas (11.0%). In multivariate analyses, strong associations for increasing age and history of prior polyps and odds of metachronous AN were observed, whereas more modest associations were shown for baseline proximal adenomas and those with villous features.

Conclusions Risks of metachronous AN among individuals with 1–2 small adenomas vary according to readily available clinical characteristics. These characteristics may be considered for recommending colonoscopy surveillance and require further investigation.

  • ADENOMA
  • SURVEILLANCE
  • EPIDEMIOLOGY
  • COLORECTAL CANCER
  • POLYP

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