Predictors of Metachronous Risk Polyps After Index Colonoscopy

Abstract

INTRODUCTION: Guidelines for surveillance after polypectomy are lacking in strong evidence. Our aim was to identify some precursors of colorectal cancer lesions at 3 years after polypectomy to improve stratification and surveillance programs. METHODS: We included patients with high-risk lesions (HRLs), defined as advanced adenoma (AA), large serrated polyps (SPs), and multiplicity (≥3 of any adenomas/SPs). Data on age, sex, cardiovascular risk factors, pharmacological treatment, and the histological characteristics in each individual, and mutations in genes involved in the most advanced index polyp, were collected. Parameters independently associated with a metachronous HRL diagnosis were evaluated through univariate and multivariate analyses. The results are reported as odds ratios and 95% confidence intervals along with P values. RESULTS: A total of 537 cases (median age: 60.7 years; 66% male) were included. Dyslipidemia and smoking correlated with metachronous HRLs. Multivariate logistic regression analysis showed that the presence of multiplicity with ≥3 polyps on the index colonoscopy was significantly associated with metachronous HRL, AA, proximal AA, and ≥3 polyps at 3 years. In addition, independent predictors of metachronous proximal AA were increasing age, female sex, and the loss of expression of the MLH1 protein. DISCUSSION: Multiplicity was a strong predictor of HRLs at 3 years, although the inclusion of other clinical variables (age, sex, smoking status, and dyslipidemia) improves surveillance recommendations. Without these risk factors, the surveillance could be extended to 5 years; we propose examining the somatic expression of MHL1 in all patients.

Total polyp number may be more important than size and histology of polyps for prediction of metachronous high-risk colorectal neoplasms

“…After adjusting for other factors, patients with multiple polyps (5 or more) had a higher risk of metachronous HR-CRN (OR 2.575). This result corresponds very well with that of a recent Spanish study, in which the presence of multiple polyps (3 or more adenomas and/or serrated polyps) was found to be a strong predictor of HR-CRN after index polypectomy [15]. The study also did not find any histological characteristics that increased the risk of metachronous HR-CRN.…”

New management of surveillance in patients with baseline serrated polyps: a large single-center retrospective cohort study in China

“…According to previous studies, the majority of guidelines put the age cutoff value at 50 years or older [19,20]. However, the incidence of early-onset colorectal cancer has been on the rise over the past four decades [21] and is expected to increase by >140% by 2030 [22].…”

Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital

“…27 Seventh, the retrospective design also precludes a detailed analysis of the extent to which differential exposure to risk factors for polyp recurrence other than age, sex, and socioeconomic status may have influenced our results. 28,29 Lastly, we relied on the subjective judgment of multiple endoscopists to provide data about polyp size, thereby raising the possibility of misclassification for ACN defined by size alone.…”