Endoscopy 2020; 52(03): 220-226
DOI: 10.1055/a-1041-2945
Original article
© Georg Thieme Verlag KG Stuttgart · New York

How to identify patients who are less likely to have metachronous neoplasms after a colon cancer: a predictive model

Leonardo Frazzoni
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Liboria Laterza
 2  Endoscopy Service, AUSL Reggio Emilia, Reggio Emilia, Italy
,
Alessandro Mussetto
 3  Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy
,
Rocco Maurizio Zagari
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Cristina Trovato
 4  Division of Endoscopy, European Institute of Oncology, IRCCS, Milan, Italy
,
Mario De Bellis
 5  Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
,
Silvia Paggi
 6  Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
Stefania Piccirelli
 7  Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
,
Luigi Ricciardiello
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Paola Cesaro
 7  Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
,
Cristiano Spada
 7  Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
,
Giulia Dal Piaz
 3  Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy
,
Marina La Marca
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Fabio Fabbian
 2  Endoscopy Service, AUSL Reggio Emilia, Reggio Emilia, Italy
,
Laura Petrella
 8  Department of Statistics, University of Bologna, Bologna, Italy
,
Veronica Smania
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Pietro Marone
 5  Gastroenterology and Endoscopy Unit, Department of Abdominal Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
,
Fabiana Tatangelo
 9  Division of Pathology and Cytology, Istituto Nazionale Tumori – IRCSS – Fondazione Pascale, Naples, Italy
,
Franco Bazzoli
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Franco Radaelli
 6  Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
Alessandro Repici
10  Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy
,
Cesare Hassan
11  Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
Michele Scagliarini
 8  Department of Statistics, University of Bologna, Bologna, Italy
,
Lorenzo Fuccio
 1  Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
› Author Affiliations
Further Information

Publication History

submitted 23 May 2019

accepted after revision 08 October 2019

Publication Date:
13 December 2019 (online)

Abstract

Background Patients with prior colon cancer have increased risk of metachronous colorectal neoplasms; therefore, endoscopic surveillance is indicated. Current recommendations are not risk-stratified. We investigated predictive factors for colorectal neoplasms to build a model to spare colonoscopies for low-risk patients.

Methods This was a multicenter, retrospective study including patients who underwent surgery for colon cancer in 2001 – 2008 (derivation cohort) and 2009 – 2013 (validation cohort). A predictive model for neoplasm occurrence at second surveillance colonoscopy was developed and validated.

Results 421 and 203 patients were included in derivation and validation cohort, respectively. At second surveillance colonoscopy, 112 (26.6 %) and 55 (27.1 %) patients had metachronous neoplasms in derivation and validation groups; three cancers were detected in the latter. History of left-sided colon cancer (OR 1.64, 95 %CI 1.02 – 2.64), ≥ 1 advanced adenoma at index colonoscopy (OR 1.90, 95 %CI 1.05 – 3.43), and ≥ 1 adenoma at first surveillance colonoscopy (OR 2.06, 95 %CI 1.29 – 3.27) were independently predictive of metachronous colorectal neoplasms at second surveillance colonoscopy. For patients without such risk factors, diagnostic accuracy parameters were: 89.3 % (95 %CI 82.0 %-94.3 %) and 78.2 % (95 %CI 65.0 %-88.2 %) sensitivity, and 28.5 % (95 %CI 23.5 %-33.9 %) and 33.8 % (95 %CI 26.2 %-42.0 %) specificity in derivation and validation group, respectively. No cancer would be missed.

Conclusions Patients with prior left-sided colon cancer or ≥ 1 advanced adenoma at index colonoscopy or ≥ 1 adenoma at first surveillance colonoscopy had a significantly higher risk of neoplasms at second surveillance colonoscopy; patients without such factors had much lower risk and could safely skip the second surveillance colonoscopy. A prospective, multicenter validation study is needed.