title: Risk stratification of individuals with low-risk colorectal adenomas using clinical characteristics: a pooled analysis.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Medicine, Section of Gastroenterology, Veteran Affairs San Diego Healthcare System, San Diego, California, USA.|Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California, USA.|Moores Cancer Center, University of California San Diego, La Jolla, California, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Epidemiology and Biostatistics, Arizona Cancer Center, Arizona College of Public Health, University of Arizona, Tucson, Arizona, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Baron
authors.affiliation: Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Cente and Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Gwen
authors.initials: G
authors.lastname: Murphy
authors.affiliation: Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Uri
authors.initials: U
authors.lastname: Ladabaum
authors.affiliation: Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria (ISABIAL), Alicante, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jover
authors.affiliation: Moores Cancer Center, University of California San Diego, La Jolla, California, USA.|Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Moores Cancer Center, University of California San Diego, La Jolla, California, USA.|Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Martinez
mesh_terms: D000236:Adenoma / Q000473:pathology*; D000367:Age Factors; D000368:Aged; D003111:Colonic Polyps / Q000473:pathology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000473:pathology*; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D047368:Tumor Burden
keywords: ADENOMA; COLORECTAL CANCER; EPIDEMIOLOGY; POLYP; SURVEILLANCE