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IDDF2019-ABS-0110 A predictive model identifies patients less likely to have adenomas after a colon cancer
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  1. Leonardo Frazzoni1,
  2. Michele Scagliarini1,
  3. Liboria Laterza1,
  4. Cristina Trovato2,
  5. Alessandro Mussetto3,
  6. Mario De Bellis4,
  7. Silvia Paggi5,
  8. Cristiano Spada6,
  9. Laura Petrella1,
  10. Veronica Smania1,
  11. Franco Bazzoli1,
  12. Luigi Ricciardiello1,
  13. Franco Radaelli5,
  14. Cesare Hassan7,
  15. Lorenzo Fuccio1
  1. 1University of Bologna, Italy
  2. 2European Institute of Oncology, Milan, Italy
  3. 3S. Maria delle Croci Hospital, Ravenna, Italy
  4. 4University of Verona, Italy
  5. 5Valduce Hospital, Como, Italy
  6. 6Fondazione Poliambulanza, Brescia, Italy
  7. 7Nuovo Regina Margherita Hospital, Rome, Italy

Abstract

Background Patients with prior colorectal cancer (CRC) are at slightly increased risk of metachronous colorectal neoplasms, therefore endoscopic surveillance is indicated. Current recommendations of repeating examinations at 1, 3 and 5 years after surgery, are not tailored according to risk stratification. Our aim was to find predictive factors of colorectal neoplasms to build a predictive model, to spare colonoscopies for low-risk patients.

Methods Multicenter retrospective study including patients with colon carcinoma surgically resected from 2001 to 2008 (training cohort) and from 2009 to 2013 (validation cohort). A predictive model for neoplasms occurrence at second surveillance colonoscopy was developed and externally validated.

Results 396 and 131 patients were included in training and validation cohort respectively. Patients with ≥1 adenoma at the 2nd surveillance colonoscopy were 113/396 (28.5%) and 21/131 (16.5%) in the two groups. In the validation cohort, 3 cancers were found.

Four variables were associated with higher risk of metachronous colorectal adenomas at 2nd surveillance colonoscopy on multivariate analysis: age >65 years old, left colectomy, ≥1 advanced adenoma at basal colonoscopy and ≥1 adenoma at first surveillance colonoscopy (table 1). The predictive model showed fair discrimination, with an area under the ROC curve of 0.69 and 0.64, in training and validation cohort respectively.

In validation group, If patients with a low-risk profile (i.e. none of the risk factors) skip the 2nd surveillance colonoscopy, 25/131 (19.1%) exams would be saved while missing 2/21 (9.5%) patients with ≥1 adenoma; no cancer would be missed.

Abstract IDDF2019-ABS-0110 Table 1

Variables included in the predictive model for developing ≥1 adenoma or advanced adenoma at the 2nd surveillance colonoscopy

Conclusions We provided a risk-stratification tool for adenoma occurrence after colon surgery, which could prove cost-effective to select patients who could skip the second surveillance colonoscopy.

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