Association between serrated polyps and the risk of synchronous advanced colorectal neoplasia in average-risk individuals

ObjectiveKnowing risk for advanced colorectal neoplasia (AN) could help patients and providers choose among screening tests, improving screening efficiency and uptake. We created a risk prediction model for AN to help decide which test might be preferred, a use not considered for existing models.DesignAverage-risk 50-to-80-year olds undergoing first-time screening colonoscopy were recruited from endoscopy units in Indiana. We measured sociodemographic and physical features, medical and family history and lifestyle factors and linked these to the most advanced finding. We derived a risk equation on two-thirds of the sample and assigned points to each variable to create a risk score. Scores with comparable risks were collapsed into risk categories. The model and score were tested on the remaining sample.ResultsAmong 3025 subjects in the derivation set (mean age 57.3 (6.5) years; 52% women), AN prevalence was 9.4%. The 13-variable model (c-statistic=0.77) produced three risk groups with AN risks of 1.5% (95% CI 0.72% to 2.74%), 7.06% (CI 5.89% to 8.38%) and 27.26% (CI 23.47% to 31.30%) in low-risk, intermediate-risk and high-risk groups (p value <0.001), containing 23%, 59% and 18% of subjects, respectively. In the validation set of 1475 subjects (AN prevalence of 8.4%), model performance was comparable (c-statistic=0.78), with AN risks of 2.73% (CI 1.25% to 5.11%), 5.57% (CI 4.12% to 7.34%) and 25.79% (CI 20.51% to 31.66%) in low-risk, intermediate-risk and high-risk subgroups, respectively (p<0.001), containing proportions of 23%, 59% and 18%.ConclusionAmong average-risk persons, this model estimates AN risk with high discrimination, identifying a lower risk subgroup that may be screened non-invasively and a higher risk subgroup for which colonoscopy may be preferred. The model could help guide patient–provider discussions of screening options, may increase screening adherence and conserve colonoscopy resources.

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Prevalence of advanced colorectal neoplasia according to risk categories at screening colonoscopy in a tertiary referral center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.578 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 578-578

Author(s):

Eduardo Negrete Carballo ◽

Fidel David Huitzil Melendez

Keyword(s):

Colorectal Cancer ◽

High Risk ◽

Risk Stratification ◽

Colorectal Neoplasia ◽

Screening Colonoscopy ◽

Average Risk ◽

Moderate Risk ◽

Advanced Colorectal Neoplasia ◽

Advanced Neoplasm ◽

Colorectal Screening

578 Background: Colorectal cancer (CRC) is the third most common cancer in the world. There is strong evidence that screening for colorectal cancer improves survival in conutries with high incidence. Although Mexico is considered a country with a low incidence of CRC, 4694 potentially preventable deaths occur every year. There is no established CRC screening program in our country, risk stratification of the target populations to be screened may bring potential advantages, making the strategy more cost-effective. The Asia-Pacific Colorectal Screening (APCS) score, is a validated risk-stratification tool that helps identify individuals at risk for advanced colorectal neoplasm amongst the asymptomatic population. Methods: We performed a retrospective, cross-sectional analysis of database records from 1172 patients who underwent screening colonoscopy betwen january 2013 and november 2014. Results: The prevalence of advanced colorectal neoplasia was 2.9%. Applying the APCS stratification, 91 subjects (7.8%) were in the average risk tier, 849 subjects (72.4%) in the moderate risk tier and 232 (19.8%) subjects in the high risk tier. The prevalence of advanced neoplasia in the average risk, moderate risk and high risk groups was 0%, 2.6% and 5.1%, respectively. The subjects in the high risk tier had 2.21-fold (p = 0.021) increased prevalence of advanced neoplasia than those in the average-moderate tier. Conclusions: The APCS score is a simple risk stratification index for colorectal advanced neoplasm that uses elementary clinical information on age, gender, family history and smoking to stratify the risk of colorectal advanced neoplasm in asymptomatic subjects for priority of colorectal screening.

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Serrated polyps and their association with synchronous advanced colorectal neoplasia

Gastroenterología y Hepatología (English Edition) ◽

10.1016/j.gastre.2015.12.008 ◽

2016 ◽

Vol 39 (9) ◽

pp. 574-583

Author(s):

Jesús Urman ◽

Marta Gomez ◽

Marta Basterra ◽

María del Rosario Mercado ◽

Marta Montes ◽

...

Keyword(s):

Colorectal Neoplasia ◽

Serrated Polyps ◽

Advanced Colorectal Neoplasia

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Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia

Endoscopy International Open ◽

10.1055/a-1019-2976 ◽

2019 ◽

Vol 07 (12) ◽

pp. E1748-E1754 ◽

Cited By ~ 3

Author(s):

Soo-Kyung Park ◽

Hak-Soo Kim ◽

Hyo-Joon Yang ◽

Yoon Suk Jung ◽

Jung Ho Park ◽

...

Keyword(s):

Cumulative Incidence ◽

Colorectal Neoplasia ◽

Advanced Adenoma ◽

Serrated Adenoma ◽

Serrated Polyps ◽

Advanced Colorectal Neoplasia ◽

Significant Difference ◽

The Family ◽

Risk Patients

Abstract Background and aims The family of serrated polyps (SP) includes hyperplastic polyps (HP), sessile serrated adenomas/polyps, and traditional serrated adenoma. We investigated whether SP synchronous with adenoma at index colonoscopy is associated with metachronous advanced colorectal neoplasia (CRN). Methods Patients with ≥ 1 adenoma on index colonoscopy and who had undergone a follow-up colonoscopy were included. The patients were divided into four groups according to the presence of SP and advanced adenoma (AA) on index colonoscopy (non-AA, non-AA + SP, AA, AA + SP). The cumulative incidence of metachronous advanced CRN at surveillance colonoscopy was compared between groups. Results Among a total of 2209 patients, the numbers of patients in the non-AA, non-AA + SP, AA, and AA + SP groups were 922, 441, 625, and 221, respectively. The cumulative incidence of metachronous advanced CRN was higher in patients in the AA + SP group than that in the AA group (P<0.001), and there was no significant difference between the non-AA + SP group and the non-AA group (P = 0.06). The cumulative incidence of metachronous advanced CRN at 3 years was 17.9 % [95 % confidence interval (CI) 8.0–27.6], 10.7 % [95 %CI 7.7–3.6], 3.5 % [95 %CI 1.3–5.6], and 3.4 % [95 %CI 2.0–4.7] in the AA + SP, AA, non-AA + SP, and non-AA group, respectively. In a multivariate analysis, overall SP [hazard ratio (HR) 2.24; 95 %CI 1.38–3.64, P = 0.001], proximal SP (HR 2.31; 95 %CI 1.32–4.08), and HP (HR 2.19; 95 %CI 1.35–3.57) were risk factors for metachronous advanced CRN in patients with AA on index colonoscopy. Conclusions Coexistent AA and SP on index colonoscopy significantly increased the risk of metachronous advanced CRN compared with AA alone. Further large prospective studies are needed to confirm whether more intensive follow-up improves outcomes in these high risk patients.

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