Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study

Abstract

Background Long-term colorectal cancer incidence and mortality after colorectal polyp removal remains unclear. We aimed to assess colorectal cancer incidence and mortality in individuals with removal of different histological subtypes of polyps relative to the general population. MethodsWe did a matched cohort study through prospective record linkage in Sweden in patients aged at least 18 years with a first diagnosis of colorectal polyps in the nationwide gastrointestinal ESPRESSO histopathology cohort . For each polyp case, we identified up to five matched reference individuals from the Total Population Register on the basis of birth year, age, sex, calendar year of biopsy, and county of residence. We excluded patients and reference individuals with a diagnosis of colorectal cancer either before or within the first 6 months after diagnosis of the index polyp. Polyps were classified by morphology codes into hyperplastic polyps, sessile serrated polyps, tubular adenomas, tubulovillous adenomas, and villous adenomas. Colorectal cancer cases were identified from the Swedish Cancer Registry, and cause-of-death data were retrieved from the Cause of Death Register. We collected information about the use of endoscopic examination before and after the index biopsy from the Swedish National Patient Registry, and counted the number of endoscopies done before and after the index biopsies. We calculated cumulative risk of colorectal cancer incidence and mortality at 3, 5, 10, and 15 years, and computed hazard ratios (HRs) and 95% CIs for colorectal cancer incidence and mortality using a stratified Cox proportional hazards model within each of the matched pairs. Findings 178 377 patients with colorectal polyps and 864 831 matched reference individuals from the general population were included in our study. The mean age of patients at polyp diagnosis was 58•6 (SD 13•9) years for hyperplastic polyps, 59•7 (14•2) years for sessile serrated polyps, 63•9 (12•9) years for tubular adenomas, 67•1 (12•1) years for tubulovillous adenomas, and 68•9 (11•8) years for villous adenomas. During a median of 6•6 years (IQR 3•0-11•6) of follow-up, we documented 4278 incident colorectal cancers and 1269 colorectal cancer-related deaths in patients with a polyp, and 14 350 incident colorectal cancers and 5242 colorectal cancer deaths in general reference individuals. The 10-year cumulative incidence of colorectal cancer was 1•6% (95% CI 1•5-1•7) for hyperplastic polyps, 2•5% (1•9-3•3) for sessile serrated polyps, 2•7% (2•5-2•9) for tubular adenomas, 5•1% (4•8-5•4) for tubulovillous adenomas, and 8•6% (7•4-10•1) for villous adenomas compared with 2•1% (2•0-2•1) in reference individuals. Compared with reference individuals, patients with any polyps had an increased risk of colorectal cancer, withmultivariable HR of 1•11 (95% CI 1•02-1•22) for hyperplastic polyps, 1•77 (1•34-2•34) for sessile serrated polyps, 1•41 (1•30-1•52) for tubular adenomas, 2•56 (2•36-2•78) for tubulovillous adenomas, and 3•82 (3•07-4•76) for villous adenomas (p<0•05 for all ...

Predictors of Metachronous Risk Polyps After Index Colonoscopy

“…Endoscopic polypectomy reduces the incidence and mortality of CRC and remains the key to successful population screening programs ( 2 , 5 , 6 ). Recent evidence confirms that individuals with AA and/or large SPs have a 3–4 times higher risk of mortality due to CRC than individuals without polyps ( 7 , 8 ). The risk of developing new lesions over time is associated with different factors ( 9 , 10 ).…”

Significant and Conflicting Correlation of IL-9 With Prevotella and Bacteroides in Human Colorectal Cancer

“…Colorectal cancer (CRC) is a complex and widespread disease and is the second cause of cancer-related deaths in the world ( 1 ). Usually, it begins as benign polyps that can become (especially the adenomatous type) cancerous if not removed: in humans, a variable percentage of polyps, ranging from 1% to 10%, evolve into malignancies ( 2 ) because multistep colorectal tumorigenesis does not involve exclusively genetic factors, but also host factors, such as inflammatory and immune responses ( 3 , 4 ). Indeed, chronic inflammation increases cancer risk through a deregulated activation of the immune system, which causes a loss of tissue architecture and genotoxic cellular DNA damage ( 5 ).…”

Antibiotic Use Associated With Risk of Colorectal Polyps in a Nationwide Study

“…We used topography codes of T67 (for colon) and T68 (for rectum) in combination with SnoMed codes to identify colorectal polyps. 16 For conventional adenomas, we used the SnoMed codes of M82100 (tubular adenoma), M82630 (tubulovillous adenoma), and M82611 (villous adenoma). Serrated polyps included hyperplastic polyps and sessile serrated polyps.…”

“…The accuracy of polyp identification has been described in our previous studies. [16][17][18] Information on antibiotic use was derived from the Swedish Prescribed Drug Register, which has collected information on all medications prescribed to the entire Swedish population since July 1, 2005. 19 To ensure that we had at least 1-year information on antibiotic use, we identified participants with the first diagnosis of colorectal polyps aged at least 18 years in ESPRESSO since July 1, 2006.…”