A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
OBJECTIVE
Limited data exist regarding the actual risk of developing advanced adenomas and cancer after polypectomy or the factors that determine risk.


METHODS
We pooled individual data from 8 prospective studies comprising 9167 men and women aged 22 to 80 with previously resected colorectal adenomas to quantify their risk of developing subsequent advanced adenoma or cancer as well as identify factors associated with the development of advanced colorectal neoplasms during surveillance.


RESULTS
During a median follow-up period of 47.2 months, advanced colorectal neoplasia was diagnosed in 1082 (11.8%) of the patients, 58 of whom (0.6%) had invasive cancer. Risk of a metachronous advanced adenoma was higher among patients with 5 or more baseline adenomas (24.1%; standard error, 2.2) and those with an adenoma 20 mm in size or greater (19.3%; standard error, 1.5). Risk factor patterns were similar for advanced adenomas and invasive cancer. In multivariate analyses, older age (P < .0001 for trend) and male sex (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.19-1.65) were associated significantly with an increased risk for metachronous advanced neoplasia, as were the number and size of prior adenomas (P < .0001 for trend), the presence of villous features (OR, 1.28; 95% CI, 1.07-1.52), and proximal location (OR, 1.68; 95% CI, 1.43-1.98). High-grade dysplasia was not associated independently with metachronous advanced neoplasia after adjustment for other adenoma characteristics.


CONCLUSIONS
Occurrence of advanced colorectal neoplasia is common after polypectomy. Factors that are associated most strongly with risk of advanced neoplasia are patient age and the number and size of prior adenomas.
Martínez
María Elena
ME
Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA.
Baron
John A
JA
Lieberman
David A
DA
Schatzkin
Arthur
A
Lanza
Elaine
E
Winawer
Sidney J
SJ
Zauber
Ann G
AG
Jiang
Ruiyun
R
Ahnen
Dennis J
DJ
Bond
John H
JH
Church
Timothy R
TR
Robertson
Douglas J
DJ
Smith-Warner
Stephanie A
SA
Jacobs
Elizabeth T
ET
Alberts
David S
DS
Greenberg
E Robert
ER
D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D055815:Young Adult