TY - JOUR
T1 - A population-based analysis on the incidence of metachronous colon cancer after endoscopic resection of advanced adenomas with high-grade dysplasia
T2 - does location matter?
AU - Boatman, Sonja
AU - Kohn, Julia
AU - Mott, Sarah L.
AU - Gaertner, Wolfgang B.
AU - Madoff, Robert D.
AU - Melton, Genevieve B.
AU - Shaukat, Aasma
AU - Hassan, Imran
AU - Goffredo, Paolo
N1 - Publisher Copyright:
© 2024 Society for Surgery of the Alimentary Tract
PY - 2024
Y1 - 2024
N2 - Background: Advanced adenomas (AAs) with high-grade dysplasia (HGD) represent a risk factor for metachronous neoplasia, with guidelines recommending short-interval surveillance. Although the worse prognosis of proximal (vs distal) colon cancers (CCs) is established, there is paucity of evidence on the impact of laterality on the risk of subsequent neoplasia for these AAs. Methods: Adults with HGD adenomas undergoing polypectomy were identified in the Surveillance, Epidemiology, and End Results database (2000-2019). Cumulative incidence of malignancy was estimated using the Kaplan-Meier method. Fine-Gray models assessed the effect of patient and disease characteristics on CC incidence. Results: Of 3199 patients, 26% had proximal AAs. A total of 65 cases of metachronous adenocarcinoma were identified after polypectomy of 35 proximal and 30 distal adenomas with HGD. The 10-year cumulative incidence of CC was 2.3%; when stratified by location, it was 4.8% for proximal vs 1.4% for distal adenomas. Proximal location was significantly associated with increased incidence of metachronous cancer (adjusted hazard ratio, 3.32; 95% CI, 2.05-5.38). Conclusion: Proximal location of AAs with HGD was associated with >3-fold increased incidence of metachronous CC and shorter time to diagnosis. These data suggest laterality should be considered in the treatment and follow-up of these patients.
AB - Background: Advanced adenomas (AAs) with high-grade dysplasia (HGD) represent a risk factor for metachronous neoplasia, with guidelines recommending short-interval surveillance. Although the worse prognosis of proximal (vs distal) colon cancers (CCs) is established, there is paucity of evidence on the impact of laterality on the risk of subsequent neoplasia for these AAs. Methods: Adults with HGD adenomas undergoing polypectomy were identified in the Surveillance, Epidemiology, and End Results database (2000-2019). Cumulative incidence of malignancy was estimated using the Kaplan-Meier method. Fine-Gray models assessed the effect of patient and disease characteristics on CC incidence. Results: Of 3199 patients, 26% had proximal AAs. A total of 65 cases of metachronous adenocarcinoma were identified after polypectomy of 35 proximal and 30 distal adenomas with HGD. The 10-year cumulative incidence of CC was 2.3%; when stratified by location, it was 4.8% for proximal vs 1.4% for distal adenomas. Proximal location was significantly associated with increased incidence of metachronous cancer (adjusted hazard ratio, 3.32; 95% CI, 2.05-5.38). Conclusion: Proximal location of AAs with HGD was associated with >3-fold increased incidence of metachronous CC and shorter time to diagnosis. These data suggest laterality should be considered in the treatment and follow-up of these patients.
KW - Adenoma laterality
KW - Advanced adenoma
KW - Colon cancer
KW - Endoscopic polypectomy
UR - http://www.scopus.com/inward/record.url?scp=85187982716&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85187982716&partnerID=8YFLogxK
U2 - 10.1016/j.gassur.2024.02.024
DO - 10.1016/j.gassur.2024.02.024
M3 - Article
C2 - 38485589
AN - SCOPUS:85187982716
SN - 1091-255X
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
ER -