Clinical and Genomic Characterization of Interval Colorectal Cancer in 3 Prospective Cohorts

Yang, Keming; Cao, Yin; Gurjao, Carino; Liu, Yang; Guo, Chuan‐Guo; Lo, Chun‐Han; Zong, Xiaoyu; Drew, David A.; Geraghty, Connor M.; Prezioso, Elizabeth; Moore, Matthew T.; Williams, Craig M.; Riley, Tom; Saul, Melissa; Ogino, Shuji; Giannakis, Marios; Bass, Adam J.; Schoen, Robert E.; Chan, Andrew T.

doi:10.1053/j.gastro.2022.08.020

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…Molecular analyses were beyond the scope of this work and may have yielded additional insights regarding inherent biological differences between PCCRC and DCRC. However, in the recent study by Yang et al, there were no significant mutational differences between screen-detected and interval CRCs, and the mortality differences between the 2 groups appear to be driven by higher proportions of stage IV disease among interval CRC cases. These observations, together with the relatively high overall rate of interval CRC reported in this study (approximately 15%), suggest that colonoscopy quality considerations are more pertinent with respect to the pathogenesis of PCCRC-3y, rather than inherent molecular differences.…”

Section: Discussionmentioning

confidence: 81%

“…Forsberg et al performed a population-based cohort study in Sweden; their PCCRC-3y rate was 7.2%, and patients with PCCRC had significantly shorter survival times than those with DCRC. Finally, a recent study by Yang et al assessed 4836 CRCs diagnosed in 3 large prospective cohorts and defined screen-detected and interval CRCs based on the timing of diagnosis with regard to the baseline screening procedure and the next recommended surveillance examination. They found that interval CRCs were associated with higher ACM and CSM than screen-detected CRC.…”

Section: Discussionmentioning

confidence: 99%

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Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

et al. 2023

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ImportancePostcolonoscopy colorectal cancer (PCCRC) refers to colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer was found and is reflective of colonoscopy quality at the individual and system levels. Colonoscopy is widely performed in the Veterans Affairs (VA) health care system, but the prevalence of PCCRC and its associated mortality are unknown.ObjectiveTo examine PCCRC prevalence and its all-cause mortality (ACM) and CRC-specific mortality (CSM) within the VA health care system.Design, Setting, and ParticipantsThis retrospective cohort study used VA-Medicare administrative data to identify 29 877 veterans aged 50 to 85 years with newly diagnosed CRC between January 1, 2003, and December 31, 2013. Patients whose colonoscopy occurred less than 6 months before CRC diagnosis with no other colonoscopy within the previous 36 months were categorized as having detected CRC (DCRC). Those who had a colonoscopy that did not detect CRC between 6 and 36 months before CRC diagnosis were categorized as having postcolonoscopy CRC (PCCRC-3y). A third group included patients with CRC and no colonoscopy within the prior 36 months. The final analysis of the data was performed in September 2022.ExposuresPrior receipt of colonoscopy.Main Outcomes and MeasuresCox proportional hazards regression (with censoring, last follow-up December 31, 2018) analyses were conducted to compare PCCRC-3y and DCRC for 5-year ACM and CSM after CRC diagnosis.ResultsOf 29 877 patients with CRC (median [IQR] age, 67 [60-75] years; 29 353 [98%] male; 5284 [18%] Black, 23 971 [80%] White, and 622 [2%] other), 1785 (6%) were classified as having PCCRC-3y and 21 811 (73%) as having DCRC. The 5-year ACM rates were 46% vs 42% for patients with PCCRC-3y vs patients with DCRC. The 5-year CSM rates were 26% vs 25% for patients with PCCRC-3y vs patients with DCRC. In multivariable Cox proportional hazards regression analysis, there was no significant difference in ACM and CSM between patients with PCCRC-3y (adjusted hazard ratio [aHR], 1.04; 95% CI, 0.98-1.11; P = .18) and patients with DCRC (aHR, 1.04; 95% CI, 0.95-1.13; P = .42). However, compared with patients with DCRC, patients with no prior colonoscopy had significantly higher ACM (aHR, 1.76; 95% CI, 1.70-1.82; P &lt; .001) and CSM (aHR, 2.22; 95% CI, 2.12-2.32; P &lt; .001). Compared with patients with DCRC, patients with PCCRC-3y had significantly lower odds of having undergone colonoscopy performed by a gastroenterologist (odds ratio, 0.48; 95% CI, 0.43-0.53; P &lt; .001).Conclusions and RelevanceThis study found that PCCRC-3y constituted 6% of CRCs in the VA system, which is similar to other settings. Compared with patients with CRC detected by colonoscopy, those with PCCRC-3y have comparable ACM and CSM.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

et al. 2023

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“…Because of the risk of developing colorectal cancer, colonoscopic removal of precancerous polyps is recommended[8]. However, incompletely resected polyps have been an important issue clinically and have been implicated in the development of interval colorectal cancer [9,10], which has a signi cantly increased risk of death [11] .Meanwhile, fragmentation of polyps is common during specimen retrieval.…”

Section: Discussionmentioning

confidence: 99%

A Novel Polyp Retrieval Bag Reduces the Polyp Fragmentation Rate in Colon Polypectomy : A Single-Blind Randomized Controlled Study

Chu,

Ma,

Min

et al. 2024

Preprint

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Purpose The fragmentation of polyps affects complete resection confirmation. The primary aim of this study was to assess the feasibility of a novel polyp retrieval bag for reducing the fragmentation rate of colon polyps. Methods Patients with a 5–15 mm colon polyp were recruited and randomized to two groups at a 1:1 ratio. After polyp resection, polyps obtained from patients in the treatment group were extracted using a novel polyp retrieval bag without traversing the instrument channel, while polyps obtained from patients in the control group were collected by traversing the instrument channel, attaching the polyp trap to the instrument channel port and applying suction. Results From January to July, 2022, a total of 225 patients were assessed for study eligibility. A total of 204 patients were enrolled in the study, and seven patients with specimen retrieval failure were excluded from the analysis. The polyp fragmentation rate in the treatment group was significantly lower than that in the control group (3.0% [3/100] vs. 17.5% [17/97], P = 0.001). There was no significant difference in the retrieval failure rates between the treatment group and control group (2.0% [2/102] vs. 4.9% [5/102], P = 0.442). There were fewer colonoscope insertions in the treatment group than in the control group (102 vs. 110), but a significant difference was not present (P = 0.065). No significant adverse events were observed in the follow-up. Conclusions This study demonstrated that the polyp retrieval bag was safe and feasible for reducing the fragmentation rate of retrieved polyps. Trial registration: The study was registered at ClinicalTrials.gov ( NCT05189912, 1/12/2021).

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“…An I-CRC is defined by the World Endoscopy Organization as a “colorectal cancer diagnosed after a screening or surveillance exam in which no cancer is detected, and before the date of the next recommended exam” [ 9 ]. Compared to CRCs in general, studies on I-CRC outcomes are across the spectrum, ranging from better to worse outcomes [ 10 ]. Studies into the causes behind I-CRCs are limited and discordant, but they essentially fall into two broad categories.…”

Section: Introductionmentioning

confidence: 99%

“…The first is procedural where lesions were inadvertently missed or inadequately resected, accounting for about 85% of I-CRCs by some estimates [ 11 , 12 ]. The second reason is biological, in that up to 20% of these cancers might have unpredictable behavior and arise within a time interval that precludes an effective interval screening [ 10 ]. Studies on the molecular features of these cancers are just beginning to emerge, but they have not demonstrated significant differences to control cancers with respect to microsatellite instability or differences on whole exome sequencing [ 8 , 10 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador

et al. 2022

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Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3–60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001–2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency.

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Clinical and Genomic Characterization of Interval Colorectal Cancer in 3 Prospective Cohorts

Cited by 6 publications

References 41 publications

Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

Mortality After Postcolonoscopy Colorectal Cancer in the Veterans Affairs Health Care System

A Novel Polyp Retrieval Bag Reduces the Polyp Fragmentation Rate in Colon Polypectomy : A Single-Blind Randomized Controlled Study

Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador

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