title: Postpolypectomy colonoscopy surveillance guidelines: predictive accuracy for advanced adenoma at 4 years.
abstract: BACKGROUND
  Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers.
  
  
  OBJECTIVE
  To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined as > or =3 adenomas or any advanced adenomas) and 5- to 10-year follow-up for patients with 2 or fewer nonadvanced adenomas, who are considered to be at low risk.
  
  
  METHODS
  Analysis of prospective data from the Polyp Prevention Trial.
  
  
  METHODS
  United States.
  
  
  METHODS
  1905 patients who had colorectal adenomas removed at baseline screening or diagnostic colonoscopy and completed the trial.
  
  
  METHODS
  Baseline adenoma characteristics, risk-stratified according to definitions used in the guidelines, were examined as predictors for advanced adenoma recurrence.
  
  
  RESULTS
  125 patients (6.6%) had advanced and 629 (33.0%) had nonadvanced adenoma recurrence; 1151 (60.4%) had no recurrence within 4 years of follow-up. The probability of advanced adenoma recurrence was 0.09 (95% CI, 0.07 to 0.11) among patients with high-risk adenomas at baseline and 0.05 (CI, 0.04 to 0.06) among those with low-risk adenomas at baseline. The relative risk for advanced adenoma recurrence for patients with high-risk adenomas versus those with low-risk adenomas at baseline was 1.68 (CI, 1.19 to 2.38) when advanced adenoma recurrence was compared with no advanced adenoma recurrence and 1.76 (CI, 1.26 to 2.46) when advanced adenoma recurrence was compared with no adenoma recurrence. The c-statistics for these 2 comparisons were 0.68 and 0.72, respectively.
  
  
  CONCLUSIONS
  Participants were self-selected and had restrictions on the degree of obesity.
  
  
  CONCLUSIONS
  Although the risk for recurrence of advanced adenoma within 4 years is greater for patients with high-risk adenomas at baseline than for those with low-risk adenomas, the discrimination of this risk stratification scheme is relatively low.
authors.affiliation: Cancer Prevention Fellowship Program, Biometry Research Group, Divisionof Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. laiyemoa@mail.nih.gov
authors.forename: Adeyinka O
authors.initials: AO
authors.lastname: Laiyemo
authors.forename: Gwen
authors.initials: G
authors.lastname: Murphy
authors.forename: Paul S
authors.initials: PS
authors.lastname: Albert
authors.forename: Leah B
authors.initials: LB
authors.lastname: Sansbury
authors.forename: Zhuoqiao
authors.initials: Z
authors.lastname: Wang
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Marcus
authors.forename: Bette
authors.initials: B
authors.lastname: Caan
authors.forename: James R
authors.initials: JR
authors.lastname: Marshall
authors.forename: Peter
authors.initials: P
authors.lastname: Lance
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: Joel
authors.initials: J
authors.lastname: Weissfeld
authors.forename: Martha L
authors.initials: ML
authors.lastname: Slattery
authors.forename: Randall
authors.initials: R
authors.lastname: Burt
authors.forename: Frank
authors.initials: F
authors.lastname: Iber
authors.forename: Moshe
authors.initials: M
authors.lastname: Shike
authors.forename: J Walter
authors.initials: JW
authors.lastname: Kikendall
authors.forename: Elaine
authors.initials: E
authors.lastname: Lanza
authors.forename: Arthur
authors.initials: A
authors.lastname: Schatzkin
mesh_terms: D000236:Adenoma / Q000175:diagnosis* / Q000517:prevention & control; D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control; D017410:Practice Guidelines as Topic / Q000592:standards*; D018570:Risk Assessment; D013997:Time Factors