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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.
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
URL: https://doi.org/10.1016/j.cgh.2022.12.005
DOI: 10.1016/j.cgh.2022.12.005
PubMed id: 36549471
