Low Colorectal Cancer Risk After Resection of High-Risk Pedunculated Polyps

医学 结肠镜检查 结直肠癌 大肠息肉 胃肠病学 切除术 内科学 普通外科 癌症 外科
作者
Manuel Zorzi,Jessica Battagello,Claudio Barbiellini Amidei,Giulio Antonelli,Bastianello Germanà,Flavio Valiante,Stefano Benvenuti,A. Tringali,Francesco Bortoluzzi,Erica Cervellin,D. Giacomin,T. Meggiato,E. Rosa Rizzotto,Diego Fregonese,Manuela Dinca,Gianluca Baldassarre,P Scalon,Maurizio Pantalena,Luisa Milan,G. Bulighin,Daniele Di Piramo,Maurizio Azzurro,Armando Gabbrielli,Alessandro Repici,Massimo Rugge,Cesare Hassan
出处
期刊:Clinical Gastroenterology and Hepatology [Elsevier BV]
卷期号:22 (7): 1518-1527.e7 被引量:1
标识
DOI:10.1016/j.cgh.2024.01.027
摘要

Background

Post–fecal immunochemical test (FIT) colonoscopy represents a setting with an enriched prevalence of advanced adenomas. Due to an expected higher risk of colorectal cancer (CRC), postpolypectomy surveillance is recommended, generating a substantially increased load on endoscopy services. The aim of our study was to investigate postpolypectomy CRC risk in a screening population of FIT+ subjects after resection of low-risk adenomas (LRAs) or high-risk adenomas (HRAs).

Methods

We retrieved data from a cohort of patients undergoing postpolypectomy surveillance within a FIT-based CRC screening program in Italy between 2002 and 2017 and followed-up to December 2021. Main outcomes were postpolypectomy CRC incidence and mortality risks according to type of adenoma (LRA/HRA) removed at colonoscopy as well as morphology, size, dysplasia, and location of the index lesion. We adopted as comparators FIT+/colonoscopy-negative and FIT– patients. The absolute risk was calculated as the number of incident CRCs per 100,000 person-years of follow-up. We used Cox multivariable regression models to identify associations between CRC risks and patient- and polyp-related variables.

Results

Overall, we included 87,248 post-FIT+ colonoscopies (133 endoscopists). Of these, 42,899 (49.2%) were negative, 21,650 (24.8%) had an LRA, and 22,709 (26.0%) an HRA. After a median follow-up of 7.25 years, a total of 635 CRCs were observed. For patients with LRAs, CRC incidence (hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.92–1.53) was not increased compared with the FIT+/colonoscopy-negative group, while for HRAs a significant increase in CRC incidence (HR, 1.53; 95% CI, 1.14–2.04) was found. The presence of 1 or more risk factors among proximal location, nonpedunculated morphology, and high-grade dysplasia explained most of this excess CRC risk in the HRA group (HR, 1.85; 95% CI, 1.36–2.52). Patients with only distal pedunculated polyps without high-grade dysplasia, representing 39.2% of HRA, did not have increased risk compared with the FIT– group (HR, 0.87; 95% CI, 0.59–1.28).

Conclusions

CRC incidence is significantly higher in patients with HRAs diagnosed at colonoscopy. However, such excess risk does not appear to apply to patients with only distal pedunculated polyps without high-grade dysplasia, an observation that could potentially reduce the burden of surveillance in FIT programs.
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