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Risk Factors for Metachronous Colorectal Cancer or Advanced Adenomas After Endoscopic Resection of High-risk Adenomas

Lookup NU author(s): Dr Matthew Rutter


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© 2022 AGA InstituteBackground & Aims: Among the characteristics of high-risk adenomas (HRAs), some may predict a higher risk of metachronous advanced lesions. Our aim was to assess which HRA characteristics are associated with high risk of metachronous colorectal cancer (CRC) or advanced adenomas (AAs). Methods: We systematically searched Pubmed, EMBASE, and Cochrane for cohort studies and clinical trials of CRC or AA incidence at surveillance stratified by baseline lesion size, histology, and multiplicity. We calculated pooled relative risks (RRs) using a random-effects model. Heterogeneity was assessed with the I2 statistic. Results: Fifty-five studies were included, with 936,540 patients with mean follow-up 5.4 ± 2.9 years. CRC incidence per 1000 person-years was 2.6 (2.1–3.0) for adenomas ≥20 mm, 2.7 (2.2–3.2) for high-grade dysplasia (HGD), 2.0 (1.8–2.3) for villous component, 0.8 (0.1-1.4) for ≥5 adenomas, 1.0 (0.7–1.2) for ≥3 adenomas. Metachronous CRC risk was higher in adenomas ≥20 mm vs 10 to 19 mm (RR, 2.08; 95% confidence interval [CI], 1.20–3.61), HGD vs low-grade dysplasia (RR, 2.89; 95% CI, 1.88–4.44), villous vs tubular (RR, 1.75; 95% CI, 1.33–2.31). No significant differences in CRC risk were found in ≥3 adenomas vs 1 to 2 (RR, 1.24; 95% CI, 0.84–1.83), nor in ≥5 adenomas vs 3 to 4 (RR, 0.79; 95% CI, 0.30–2.11). Compared with normal colonoscopy, RR for CRC risk was 2.61 (95% CI, 2.06–3.32) for ≥10mm, 6.62 (95% CI, 4.60–9.52) for HGD, 3.58 (95% CI, 2.24–5.73) for villous component, and 2.03 (95% CI, 1.40–2.94) for ≥3 adenomas. Similar trends were seen for metachronous AAs. Conclusion: Metachronous CRC risk is highest in patients with baseline adenomas with ≥20 mm or HGD. Multiplicity does not seem to be associated with substantially higher CRC risk in the near term.

Publication metadata

Author(s): Baile-Maxia S, Mangas-Sanjuan C, Ladabaum U, Hassan C, Rutter MD, Bretthauer M, Medina-Prado L, Sala-Miquel N, Pomares OM, Zapater P, Jover R

Publication type: Review

Publication status: Published

Journal: Clinical Gastroenterology and Hepatology

Year: 2023

Volume: 21

Issue: 3

Pages: 630-643

Print publication date: 01/03/2023

Online publication date: 20/12/2022

Acceptance date: 02/04/2022

ISSN (print): 1542-3565

ISSN (electronic): 1542-7714

Publisher: W.B. Saunders


DOI: 10.1016/j.cgh.2022.12.005

PubMed id: 36549471