title: Development and validation of a risk score for advanced colorectal adenoma recurrence after endoscopic resection.
abstract: OBJECTIVE
  To develop and validate a risk score for advanced colorectal adenoma (ACA) recurrence after endoscopic polypectomy.
  
  
  METHODS
  Out of 3360 patients who underwent colon polypectomy at University of Foggia between 2004 and 2008, data of 843 patients with 1155 ACAs was retrospectively reviewed. Surveillance intervals were scheduled by guidelines at 3 years and primary endpoint was considered 3-year ACA recurrence. Baseline clinical parameters and the main features of ACAs were entered into a Cox regression analysis and variables with P < 0.05 in the univariate analysis were then tested as candidate variables into a stepwise Cox regression model (conditional backward selection). The regression coefficients of the Cox regression model were multiplied by 2 and rounded in order to obtain easy to use point numbers facilitating the calculation of the score. To avoid overoptimistic results due to model fitting and evaluation in the same dataset, we performed an internal 10-fold cross-validation by means of bootstrap sampling.
  
  
  RESULTS
  Median lesion size was 16 mm (12-23) while median number of adenomas was 2.5 (1-3), whereof the number of ACAs was 1.5 (1-2). At 3 years after polypectomy, recurrence was observed in 229 ACAs (19.8%), of which 157 (13.5%) were metachronous neoplasms and 72 (6.2%) local recurrences. Multivariate analysis, after exclusion of the variable "type of resection" due to its collinearity with other predictive factors, confirmed lesion size, number of ACAs and grade of dysplasia as significantly associated to the primary outcome. The score was then built by multiplying the regression coefficients times 2 and the cut-off point 5 was selected by means of a Receiver Operating Characteristic curve analysis. In particular, 248 patients with 365 ACAs fell in the higher-risk group (score ≥ 5) where 3-year recurrence was detected in 174 ACAs (47.6%) whereas the remaining 595 patients with 690 ACAs were included in the low-risk group (score < 5) where 3-year recurrence rate was 7.9% (55/690 ACAs). Area under the curve of the model was 0.81 (0.72-0.86) with an overall classification error rate of 0.09. The model was finally validated by means of 10-fold cross validation.
  
  
  CONCLUSIONS
  Our study provides support for the use of a novel risk score as a clinical predictor of ACA recurrence after colon polypectomy.
authors.affiliation: Antonio Facciorusso, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Unit, University of Foggia, 71100 Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Facciorusso
authors.affiliation: Antonio Facciorusso, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Unit, University of Foggia, 71100 Foggia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Di Maso
authors.affiliation: Antonio Facciorusso, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Unit, University of Foggia, 71100 Foggia, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Serviddio
authors.affiliation: Antonio Facciorusso, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Unit, University of Foggia, 71100 Foggia, Italy.
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Vendemiale
authors.affiliation: Antonio Facciorusso, Marianna Di Maso, Nicola Muscatiello, Gastroenterology Unit, University of Foggia, 71100 Foggia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Muscatiello
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D003111:Colonic Polyps / Q000473:pathology / Q000601:surgery*; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D047368:Tumor Burden
keywords: Advanced colorectal adenoma; Colonoscopy; Colorectal cancer; Polypectomy; Survival