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Multicenter Study
. 2020 Mar;158(4):884-894.e5.
doi: 10.1053/j.gastro.2019.09.039. Epub 2019 Oct 4.

Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population

Jeffrey K Lee  1 , Christopher D Jensen  2 , Theodore R Levin  3 , Chyke A Doubeni  4 , Ann G Zauber  5 , Jessica Chubak  6 , Aruna S Kamineni  7 , Joanne E Schottinger  8 , Nirupa R Ghai  9 , Natalia Udaltsova  2 , Wei K Zhao  2 , Bruce H Fireman  2 , Charles P Quesenberry  2 , E John Orav  10 , Celette S Skinner  11 , Ethan A Halm  12 , Douglas A Corley  13
Affiliations
Multicenter Study

Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population

Jeffrey K Lee et al. Gastroenterology. 2020 Mar.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Gastroenterology. 2021 Mar;160(4):1433. doi: 10.1053/j.gastro.2020.10.012. Epub 2020 Oct 12. Gastroenterology. 2021. PMID: 33058781 No abstract available.

Abstract

Background & aims: The long-term risks of colorectal cancer (CRC) and CRC-related death following adenoma removal are uncertain. Data are needed to inform evidence-based surveillance guidelines, which vary in follow-up recommendations for some polyp types. Using data from a large, community-based integrated health care setting, we examined the risks of CRC and related death by baseline colonoscopy adenoma findings.

Methods: Participants at 21 medical centers underwent baseline colonoscopies from 2004 through 2010; findings were categorized as no-adenoma, low-risk adenoma, or high-risk adenoma. Participants were followed until the earliest of CRC diagnosis, death, health plan disenrollment, or December 31, 2017. Risks of CRC and related deaths among the high- and low-risk adenoma groups were compared with the no-adenoma group using Cox regression adjusting for confounders.

Results: Among 186,046 patients, 64,422 met eligibility criteria (54.3% female; mean age, 61.6 ± 7.1 years; median follow-up time, 8.1 years from the baseline colonoscopy). Compared with the no-adenoma group (45,881 patients), the high-risk adenoma group (7563 patients) had a higher risk of CRC (hazard ratio [HR] 2.61; 95% confidence interval [CI] 1.87-3.63) and related death (HR 3.94; 95% CI 1.90-6.56), whereas the low-risk adenoma group (10,978 patients) did not have a significant increase in risk of CRC (HR 1.29; 95% CI 0.89-1.88) or related death (HR 0.65; 95% CI 0.19-2.18).

Conclusions: With up to 14 years of follow-up, high-risk adenomas were associated with an increased risk of CRC and related death, supporting early colonoscopy surveillance. Low-risk adenomas were not associated with a significantly increased risk of CRC or related deaths. These results can inform current surveillance guidelines for high- and low-risk adenomas.

Keywords: Adenoma; Colonoscopy; Colorectal Cancer; Polyp.

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Conflict of interest statement

Disclosures: No conflicts of interest exist for any of the authors.

Figures

Figure 1.
Figure 1.
Flow diagram of adenoma study cohort
Figure 2.
Figure 2.
Age-adjusted colorectal cancer incidence rates per 100,000 person-years by year since baseline colonoscopy
Figure 3.
Figure 3.
Cumulative colorectal cancer incidence by adenoma findings at the baseline colonoscopy
Figure 4.
Figure 4.
Covariate-adjusted* hazard ratios for colorectal cancer(A) and related deaths(B) * Cox proportional hazards models adjusted for participant’s age, sex, race/ethnicity, Charlson comorbidity score at baseline, body mass index at baseline, baseline colonoscopy indication, physician adenoma detection rate, and year of baseline coionoscopy. Cl, confidence interval
See this image and copyright information in PMC

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