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A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.

A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.

Authors :
Martínez ME
Baron JA
Lieberman DA
Schatzkin A
Lanza E
Winawer SJ
Zauber AG
Jiang R
Ahnen DJ
Bond JH
Church TR
Robertson DJ
Smith-Warner SA
Jacobs ET
Alberts DS
Greenberg ER
Source :
Gastroenterology [Gastroenterology] 2009 Mar; Vol. 136 (3), pp. 832-41. Date of Electronic Publication: 2008 Dec 09.
Publication Year :
2009

Abstract

Background & Aims: Limited data exist regarding the actual risk of developing advanced adenomas and cancer after polypectomy or the factors that determine risk.<br />Methods: We pooled individual data from 8 prospective studies comprising 9167 men and women aged 22 to 80 with previously resected colorectal adenomas to quantify their risk of developing subsequent advanced adenoma or cancer as well as identify factors associated with the development of advanced colorectal neoplasms during surveillance.<br />Results: During a median follow-up period of 47.2 months, advanced colorectal neoplasia was diagnosed in 1082 (11.8%) of the patients, 58 of whom (0.6%) had invasive cancer. Risk of a metachronous advanced adenoma was higher among patients with 5 or more baseline adenomas (24.1%; standard error, 2.2) and those with an adenoma 20 mm in size or greater (19.3%; standard error, 1.5). Risk factor patterns were similar for advanced adenomas and invasive cancer. In multivariate analyses, older age (P < .0001 for trend) and male sex (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.19-1.65) were associated significantly with an increased risk for metachronous advanced neoplasia, as were the number and size of prior adenomas (P < .0001 for trend), the presence of villous features (OR, 1.28; 95% CI, 1.07-1.52), and proximal location (OR, 1.68; 95% CI, 1.43-1.98). High-grade dysplasia was not associated independently with metachronous advanced neoplasia after adjustment for other adenoma characteristics.<br />Conclusions: Occurrence of advanced colorectal neoplasia is common after polypectomy. Factors that are associated most strongly with risk of advanced neoplasia are patient age and the number and size of prior adenomas.

Details

Language :
English
ISSN :
1528-0012
Volume :
136
Issue :
3
Database :
MEDLINE
Journal :
Gastroenterology
Publication Type :
Academic Journal
Accession number :
19171141
Full Text :
https://doi.org/10.1053/j.gastro.2008.12.007