title: The Risk of Metachronous Advanced Colorectal Neoplasia Rises in Parallel with an Increasing Number of High-Risk Findings at Baseline.
abstract: OBJECTIVE
  Colorectal adenomas that are ≥10 mm have villous histology or high-grade dysplasia, or that are associated with ≥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.
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Sung
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sung Noh
authors.initials: SN
authors.lastname: Hong
mesh_terms: D000236:Adenoma / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D000368:Aged; D003111:Colonic Polyps / Q000150:complications / Q000601:surgery; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016609:Neoplasms, Second Primary / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011159:Population Surveillance / Q000379:methods; D016016:Proportional Hazards Models; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D047368:Tumor Burden
keywords: Colonoscopy; Colorectal neoplasia; Polypectomy; Surveillance