Colorectal cancer risk after removal of polyps in fecal immunochemical test based screening.

Autor:	van Toledo DEFWM; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands., IJspeert JEG; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands., Spaander MCW; Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands., Nagtegaal ID; Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands., van Leerdam ME; Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, the Netherlands.; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands., Lansdorp-Vogelaar I; Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands., Dekker E; Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.; Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	EClinicalMedicine [EClinicalMedicine] 2023 Jul 05; Vol. 61, pp. 102066. Date of Electronic Publication: 2023 Jul 05 (Print Publication: 2023).
DOI:	10.1016/j.eclinm.2023.102066
Abstrakt:	Background: Colonoscopy surveillance intervals are based on the predicted risk of metachronous colorectal cancer (CRC) after polyp removal. However, risk estimation per polyp subtype is difficult due to the fact that many patients have multiple polyps. To enable risk estimation per polyp subtypes we examined the metachronous CRC risk of subgroups based on presence or absence of co-occurring findings. Methods: Using high-quality screening colonoscopies performed after a positive fecal immunochemical test between 2014 and 2020 within the Dutch CRC screening program, we applied Cox regression analysis to evaluate the association between findings at baseline colonoscopy and metachronous CRCs. For our primary outcome, we appointed each patient to unique subgroups based on removed polyp subtypes that were present or absent at baseline colonoscopy and used the groups without polyps as reference. High-risk subgroups were individuals with high-risk serrated polyps, defined as serrated polyp ≥10 mm, sessile serrated lesions with dysplasia, or traditional serrated adenomas, as well as high-risk adenomas, defined as adenoma ≥10 mm or containing high-grade dysplasia. Findings: In total 253,833 colonoscopies were included. Over a median follow-up of 36 months (IQR, 21-57), we identified 504 metachronous CRCs. Hazard ratios for metachronous CRC was 1.70 (95% CI, 1.07-2.69) for individuals with high-risk serrated polyps without high-risk adenomas, 1.22 (0.96-1.55) for individuals with high-risk adenomas without high-risk serrated polyps, and 2.00 (1.19-3.39) for individuals with high-risk serrated polyps and high-risk adenomas, compared to patients without polyps. Interpretation: Accounting for co-occurring findings, we observed an increased metachronous CRC risk for individuals that had high-risk serrated polyps with the presence of high-risk adenomas, or individuals with high-risk serrated polyps without high-risk adenomas. These findings could provide more evidence to support post-polypectomy surveillance guidelines. Funding: None. Competing Interests: ED: Received endoscopic equipment on loan of Olympus and FujiFilm and research grant from FujiFilm; received honorarium for consultancy from FujiFilm, Tillots, Olympus, GI Supply, Cancer Prevention Pharmaceuticals, PAION and Ambu; and a speakers' fee from Olympus, Roche, GI Supply, PAION and IPSEN. MS: received research support from Sentinel, Sysmex, Boston Scientific, Norgine and Medtronic. All other authors have nothing to disclose. (© 2023 The Author(s).)
Databáze:	MEDLINE
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