{"id":6674,"date":"2019-10-14T19:00:50","date_gmt":"2019-10-14T17:00:50","guid":{"rendered":"https:\/\/www.endoscopy-campus.com\/?post_type=ec-news&p=6674"},"modified":"2019-10-14T19:00:51","modified_gmt":"2019-10-14T17:00:51","slug":"polish-study-stratifies-postpolypectomy-surveillance-groups-based-on-cancer-incidence-and-mortality-not-advanced-adenomas","status":"publish","type":"ec-news","link":"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/polish-study-stratifies-postpolypectomy-surveillance-groups-based-on-cancer-incidence-and-mortality-not-advanced-adenomas\/","title":{"rendered":"Polish Study Stratifies Postpolypectomy Surveillance Groups Based on Cancer Incidence and Mortality, Not Advanced Adenomas"},"content":{"rendered":"\n
Current postpolypectomy surveillance colonoscopy interval recommendations are based on studies using advanced neoplasia as an endpoint, typically defined as cancer or advanced adenomas (adenomas \u22651 cm, high-grade dysplasia [HGD], villous elements, or \u22653 adenomas). A large, Polish screening colonoscopy study has created risk categories using only colorectal cancer incidence and mortality as endpoints.<\/p>\n\n\n\n
Between 2000 and 2011, 132 screening centers in Poland performed screening colonoscopy on 265,688 persons (mean age, 56 years; 38% male). The median follow-up was 7.1 years, and the maximum follow-up was 14.4 years. There were 439 cases of colorectal cancer (CRC) and 132 CRC deaths during follow-up.<\/p>\n\n\n\n
Recursive partitioning was used to develop the following novel classification system: high risk was adenomas \u226520 mm in size; intermediate risk, adenomas <20 mm with HGD; and low risk, adenomas <20 mm without HGD. In the current stratification system (high risk: adenomas \u22651 cm, HGD, villous elements, or \u22653 adenomas), 63.5% of persons with adenomas are low risk compared to 90% in the novel system.<\/p>\n\n\n\n
Compared to the general population, those with no adenomas had a 73% risk reduction in cancer incidence compared to 65% with the current low-risk group, 35% with the current high-risk group, 65% with the novel low-risk group, and no reduction with the novel intermediate-risk group; the group with \u226520-mm adenomas had twice the risk of the general population. Thus, compared to the general population, the current and novel low-risk groups had the same cancer incidence rates. The absolute risk increase in CRC in individuals moved from the current to the new low-risk group was only 6 per 100,000 patients.<\/p>\n\n\n\n
Compared to screened individuals with no adenomas, the current and novel low-risk groups had an approximate 50% increase in cancer incidence. The hazard ratio in the novel intermediate- risk group was 3.58, and in the group with \u226520-mm adenomas, the risk increased 9.25-fold. Risk increases for cancer death had comparable magnitude.<\/p>\n\n\n\n
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Comment: These are important data because they stratify based on cancer incidence and mortality during follow-up, not advanced adenomas. In the U.S., where adenoma detection rates are often much higher, there might be additional risk stratification possible within the low-risk group, and it\u2019s not clear that U.S. practice and the U.S. medical-legal system would tolerate the absolute risks of postcolonoscopy cancer observed in this study. Nevertheless, these data strongly suggest that expansion of the low-risk adenoma-bearing cohort in the U.S. should be feasible and safe.. <\/p><\/blockquote><\/figure>\n\n\n\n
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\n\nNote to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.\n\n<\/p>\n\n\n\n
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\n\nDouglas K. Rex, MD, FASGE\n\n<\/p>\n<\/div><\/div>\n\n\n\n
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