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

Autor:	Zorzi M; Veneto Tumor Registry, Azienda Zero, Padova, Italy., Battagello J; Veneto Tumor Registry, Azienda Zero, Padova, Italy., Amidei CB; Veneto Tumor Registry, Azienda Zero, Padova, Italy., Antonelli G; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Italy. Electronic address: giulio.antonelli@gmail.com., Germanà B; Gastroenterology and Digestive Endoscopy Unit, San Martino Hospital, ULSS 1 Dolomiti, Belluno, Italy., Valiante F; Gastroenterology and Digestive Endoscopy Unit, Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Feltre, Italy., Benvenuti S; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy., Tringali A; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 2 Marca Trevigiana, Conegliano, Italy., Bortoluzzi F; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Venice, Italy., Cervellin E; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 3 Serenissima, Dolo, Italy., Giacomin D; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 4 Veneto Orientale, San Donà di Piave, Italy., Meggiato T; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 5 Rovigo, Rovigo, Italy., Rizzotto ER; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Padua, Italy., Fregonese D; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Camposampiero, Italy., Dinca M; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 6 Euganea, Monselice, Italy., Baldassarre G; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Santorso, Italy., Scalon P; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 7 Pedemontana, Bassano del Grappa, Italy., Pantalena M; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Arzignano, Italy., Milan L; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 8 Berica, Vicenza, Italy., Bulighin G; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, San Bonifacio, Italy., Di Piramo D; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Villafranca, Italy., Azzurro M; Gastroenterology and Digestive Endoscopy Unit, Azienda ULSS 9 Scaligera, Legnago, Italy., Gabbrielli A; Gastroenterology and Digestive Endoscopy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy., Repici A; Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy., Rugge M; Veneto Tumor Registry, Azienda Zero, Padova, Italy; Pathology and Cytopathology Unit, Department of Medicine, University of Padova, Padova, Italy., Hassan C; Gastroenterology and Digestive Endoscopy Unit, Humanitas Research Hospital, Rozzano, Italy; Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Italy.
Jazyk:	angličtina
Zdroj:	Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association [Clin Gastroenterol Hepatol] 2024 Jul; Vol. 22 (7), pp. 1518-1527.e7. Date of Electronic Publication: 2024 Feb 05.
DOI:	10.1016/j.cgh.2024.01.027
Abstrakt:	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. (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu