POLYP SIZE BUT NOT HISTOLOGIC TYPE IS ASSOCIATED WITH RISK FOR COLORECTAL CANCER MORTALITY IN A LARGE SCREENING COHORT

Aims Histologic workup and determination of size of colorectal polyps is needed for the assignment to surveillance colonoscopy, however recent guidelines excluded villous components in adenomas as a high-risk feature. We aimed to assess long-term colorectal cancer mortality in a screening cohort of the Austrian colorectal cancer screening program, in patients with removed polyps≤10mm and>10mm as well as histologic types (tubulous, any villous component and serrated).

Methods Mortality outcomes in patients with either negative colonoscopy, polyps≤10mm,>10mm and histologic type were calculated using cumulative incidence competing risks method with death from CRC and death from other causes as competing risks. Association of polyp size or histologic features with the risk of CRC death was assessed using Cox proportional hazards model.

Results 259,815 patients were included in the analysis. 3.9% had polyps>10mm removed at colonoscopy, 17.2% had tubular adenomas, 3.9% had adenomas with any villous component (villous or tubulovillous) and 16.1% had serrated polyps. Patients with polyps>10mm removed at screening had a 10-year cumulative rate of CRC death of 0.58% (CI 0.580-0.581%), for those with polyps≤10mm mortality was 0.14% (CI 0.140-0.141%), and for those with a negative colonoscopy 0.097% (CI 0.096-0.097%). Only polyp size>10mm, but no histologic type was associated with CRC mortality (HR 3.41, CI 1.73- 6.74).

Conclusions We support current guidelines not using villous histology as a high-risk feature and propose to keep the current polyp size cutoff of 10mm for surveillance colonoscopy.

Publication History

Article published online:
14 April 2022