Simple Clinical Risk Score Identifies Patients with Serrated Polyps in Routine Practice

Abstract

Large, proximal, or dysplastic (LPD) serrated polyps (SP) need accurate endoscopic recognition and removal as these might progress to colorectal cancer. Herewith, we examined the risk factors for having 1 LPD SP. We developed and validated a simple SP risk score as a potential tool for improving their detection. We reviewed clinical, endoscopic, and histologic features of serrated polyps in a study of patients undergoing elective colonoscopy (derivation cohort). A self-administered questionnaire was obtained. We conducted logistic regression analyses to identify independent risk factors for having 1 LPD SP and incorporated significant variables into a clinical score. We subsequently tested the performance of the SP score in a validation cohort. We examined 2,244 patients in the derivation and 2,402 patients in the validation cohort; 6.3% and 8.2% had 1 LPD SP, respectively. Independent risk factors for LPD SPs were age of more than 50 years [OR 2.2; 95% confidence interval (CI), 1.3-3.8; P ¼ 0.004], personal history of serrated polyps (OR 2.6; 95% CI, 1.3-4.9; P ¼ 0.005), current smoking (OR 2.2; 95% CI, 1.4-3.6; P ¼ 0.001), and nondaily/no aspirin use (OR 1.8; 95% CI, 1.1-3.0; P ¼ 0.016). In the validation cohort, a SP score 5 points was associated with a 3.0-fold increased odds for LPD SPs, compared with patients with a score <5 points. In the present study, age of more than 50 years, a personal history of serrated polyps, current smoking, and nondaily/no aspirin use were independent risk factors for having LPD SPs. The SP score might aid the endoscopist in the detection of such lesions. Cancer Prev Res; 6(8); 855-63. Ó2013 AACR.

Risk Factors for Serrated Polyps of the Colorectum

“…A German study reported an increased risk of HPs in those older than 55 years of age (age >55 vs. ≤55 years: OR 1.72, 95% CI 1.00, 2.96) [42] while a Japanese study reported similar results (age 55-64 vs. ≤44 years: OR 2.06, 95% CI 1.13, 3.78; age ≥65 vs. ≤44 years: OR 2.90, 95% CI 1.60, 5.30) [46] (Table 1). Two studies reported increased risk of SPs among individuals older than 50 years of age: Bouwens et al (Age >50 vs. ≤50 years: OR 2.2, 95% CI 1.3, 3.8) and Burnett-Hartman et al (age 50-59 vs. <50 years: OR 1.87, 95% CI 1.20, 2.91) [48, 51]. …”

“…Men were found to have an increased risk of SPs by Erhardt et al (OR 1.83, 95% CI 1.05, 3.18), just as women were found to have decreased risk of SPs by Morimoto et al (OR 0.6, 95% CI 0.5, 0.9) [42, 45] (Table 2). However, other studies have not shown any significant association between sex and SPs, including Omata et al (male OR 1.54, 95% CI 0.97, 2.44), Min et al (male OR 1.82, 95% CI 0.99, 3.32), Bouwens (male OR 0.9, 95% CI 0.6, 1.2), Burnett-Hartman (female OR 1.06, 95% CI 0.8, 1.4), and Wallace (female proximal OR 1.07 95% CI 0.82, 1.39) [48, 51, 52, 56]. …”

“…Burnett-Hartman found no correlation with tobacco use of 199 proximal SPs (current vs. never smokers OR 0.88 95% CI 0.32, 2.39) [48]. In contrast, Bouwens et al did find an increased risk of large (>6 mm), proximal or dysplastic SPs associated with smoking (current vs. never smokers OR 2.2, 95% CI 1.4, 3.6) [51]. …”

“…With respect to more advanced SPs, 3 studies reported no association between alcohol and risk of proximal or large SPs [48, 51, 52] (Supplementary Table 2). Burnett-Hartman et al reported that alcohol use was not associated with SSAs specifically (≥14 vs. <1 drinks/week: OR 1.09 95% CI 0.54, 2.20).…”

Pathogenesis and Management of Serrated Polyps: Current Status and Future Directions

“…Recently, investigators in The Netherlands developed a risk score to predict the detection of large, proximal, or dysplastic serrated polyps in patients undergoing colonoscopy 25. The derivation cohort consisted of 2,244 patients and 2,402 patients in the validation cohort.…”