Large serrated polyps indicate a greater risk of advanced metachronous colorectal neoplasia than high-grade adenomas

Abstract

Background and study aims The risk of developing total metachronous advanced neoplasia (TMAN) in patients with index serrated lesions (SL) or adenoma with high-grade dysplasia (HGD) is unknown. We evaluated this risk in patients with either HGD, SL < 10 mm or SL ≥ 10 mm at index colonoscopy, who underwent surveillance colonoscopies.

Patients and methods This retrospective cohort study evaluated all consecutive patients (n = 2477) diagnosed between 2010 and 2019 with colorectal HGD, SLs < 10 mm or SLs ≥ 10 mm. We excluded patients aged < 45 or > 75 years or those who had inflammatory bowel disease, hereditary colorectal cancer (CRC) syndromes, previous or synchronous CRC, or no follow-up colonoscopy. Descriptive variables were compared using analysis of variance or Pearson chi-squared tests. Multivariate Cox regressions were used to compare the risk of TMAN between the HGD, SL < 10 mm and SL ≥ 10 mm groups.

Results Overall, 585 patients (mean age 63 years; 55% male; mean follow-up 3.67 years) were included (226 with SLs < 10 mm, 204 with SLs ≥ 10 mm, 155 with HGD). Compared with SLs < 10 mm, patients with HGD did not have a significantly different rate of TMAN (HR=0.75 [0.39–1.44]) and patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=2.08 [1.38–3.15]). Compared with HGD, patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=1.87 [1.04–3.36]).

Conclusions The risk for TMAN was higher for patients with SLs ≥ 10 mm than with HGD or SLs < 10 mm. This risk should be considered when planning surveillance intervals for patients diagnosed with large SLs.

Keywords

CRC screening - Colorectal cancer - Endoscopy Lower GI Tract - Polyps / adenomas / ... - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Tissue diagnosis

Publication History

Received: 23 December 2022

Accepted after revision: 04 July 2023

Accepted Manuscript online:
06 July 2023

Article published online:
15 September 2023

• References

• 1 Fitzmaurice C, Allen C, Barber RM. et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 2017; 3: 524-548
• 2 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
• 3 Zauber AG, Winawer SJ, OʼBrien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
• 4 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1131-1153.e5
• 5 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 2020; 52: 687-700
• 6 Atkin W, Wooldrage K, Brenner A. et al. Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study. Lancet Oncol 2017; 18: 823-834
• 7 van Heijningen EM, Lansdorp-Vogelaar I, Kuipers EJ. et al. Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology 2013; 144: 1410-1418
• 8 Wieszczy P, Kaminski MF, Franczyk R. et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies. Gastroenterology 2020; 158: 875-883.e5
• 9 Fairley KJ, Li J, Komar M. et al. Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clin Transl Gastroenterol 2014; 5: e64
• 10 Anderson JC, Butterly LF, Robinson CM. et al. Risk of metachronous high-risk adenomas and large serrated polyps in individuals with serrated polyps on index colonoscopy: data from the New Hampshire Colonoscopy Registry. Gastroenterology 2018; 154: 117-27.e2
• 11 Macaron C, Vu HT, Lopez R. et al. Risk of metachronous polyps in individuals with serrated polyps. Dis Colon Rectum 2015; 58: 762-768
• 12 Melson J, Ma K, Arshad S. et al. Presence of small sessile serrated polyps increases rate of advanced neoplasia upon surveillance compared with isolated low-risk tubular adenomas. Gastrointest Endosc 2016; 84: 307-314
• 13 Pereyra L, Zamora R, Gómez EJ. et al. Risk of metachronous advanced neoplastic lesions in patients with sporadic sessile serrated adenomas undergoing colonoscopic surveillance. Am J Gastroenterol 2016; 111: 871-878
• 14 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-1457
• 15 Djinbachian R, Lafontaine ML, Anderson JC. et al. Risk of total metachronous advanced neoplasia at surveillance colonoscopy after detection of serrated lesions: a matched case-cohort study [published online ahead of print, 2023 Mar 9]. Endoscopy 2023;
• 16 He X, Hang D, Wu K. et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2020; 158: 852-861.e4
• 17 Leddin D, Enns R, Hilsden R. et al. Colorectal cancer surveillance after index colonoscopy: guidance from the Canadian Association of Gastroenterology. Can J Gastroenterol 2013; 27: 224-228
• 18 Lieberman DA, Rex DK, Winawer SJ. et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012; 143: 844-857
• 19 Holme Ø, Bretthauer M, Eide TJ. et al. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut 2015; 64: 929-936
• 20 Lee JY, Park HW, Kim MJ. et al. Prediction of the risk of a metachronous advanced colorectal neoplasm using a novel scoring system. Dig Dis Sci 2016; 61: 3016-3025
• 21 Martínez ME, Baron JA, Lieberman DA. et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology 2009; 136: 832-841
• 22 Jung YS, Park JH, Park CH. Serrated polyps and the risk of metachronous colorectal advanced neoplasia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2022; 20: 31-43.e1
• 23 Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 1975; 36: 2251-2270
• 24 O'Brien MJ, Winawer SJ, Zauber AG. et al. The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas. Gastroenterology 1990; 98: 371-379
• 25 Good NM, Macrae FA, Young GP. et al. Ideal colonoscopic surveillance intervals to reduce incidence of advanced adenoma and colorectal cancer. J Gastroenterol Hepatol 2015; 30: 1147-1154
• 26 Lorentzen JA, Grzyb K, De Angelis PM. et al. Oncogene mutations in colorectal polyps identified in the Norwegian Colorectal Cancer Prevention (NORCCAP) Screening Study. Clin Med Insights Pathol 2016; 9: 19-28
• 27 Maltzman T, Knoll K, Martinez ME. et al. Ki-ras proto-oncogene mutations in sporadic colorectal adenomas: relationship to histologic and clinical characteristics. Gastroenterology 2001; 121: 302-309
• 28 Park JH, Kang SH, Joo JS. et al. Effect of diminutive adenoma with high-grade dysplasia on surveillance colonoscopy interval. Dig Dis 2022; 40: 545-552
• 29 Djinbachian R, Dubé AJ, Durand M. et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2019; 51: 673-683