Pathologic Features of Initial Adenomas as Predictors for Metachronous Adenomas of the Rectum
04 Nov 1998-Journal of the National Cancer Institute (Oxford University Press)-Vol. 90, Iss: 21, pp 1661-1665
TL;DR: The risk of metachronous adenomas is closely related to the pathology of initial adenomatous polyps, thus allowing identification of a high-risk group of adenoma patients for close surveillance after their initial polypectomy.
Abstract: Background Colorectal cancer is the third most common cancer in the world, arising mostly from pre-existing adenomatous polyps (adenomas) of the large bowel. Patients with colorectal adenomas are at increased risk of colorectal cancer because of a high recurrence rate for adenomas. We followed a cohort of 1490 patients with rectal adenomas to determine whether recurrence might be related to pathologic characteristics of the initial adenomas. Methods The patients were identified in Haining County, China, from 1977 through 1978 by means of examination with a 15-cm rigid sigmoidoscope. They were followed by endoscopic examination at years 2, 4, 6, 11, and 16 after their initial polypectomy. New adenomas in the rectum were identified in 280 patients in these follow-up examinations. Results Statistically significant twofold to threefold elevated risks of metachronous (recurrent) adenomas were observed for patients who had more than two initial adenomas or whose most advanced initial adenoma was more than 1.0 cm in size, was of villous/tubulovillous type, or showed moderate to severe dysplasia. Much stronger associations were observed for advanced metachronous neoplasms, which are defined as cancers or adenomas with severe dysplasia, with multivariate adjusted relative risks (95% confidence interval) of 4.2 (1.8-9.9) for a large initial adenoma (>1.0 cm), 8.1 (4.2-15.6) for villous/tubulovillous architecture, and 14.4 (5.0-41.3) for severe dysplasia. In particular, patients who had a large (>1.0 cm) adenoma with severe dysplasia at baseline had a relative risk of 37 (7.8-174.7) of developing advanced metachronous neoplasms compared with patients who had small adenoma(s) with mild dysplasia. Conclusions The risk of metachronous adenomas is closely related to the pathology of initial adenomas, thus allowing identification of a high-risk group of adenoma patients for close surveillance after their initial polypectomy.
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TL;DR: Observations based on epidemiologic studies and health services research will in the future provide the basis for reducing personal and social burdens caused by colorectal carcinoma.
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Cites background from "Pathologic Features of Initial Aden..."
...0 cm, villous or tubulovillous pathology, and moderate to severe dysplasia [16]....
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TL;DR: In this article, the immunohistochemical expression of p53 and Ki67 in colorectal adenomas was investigated to clarify their significance as indicators of malignancy and development of new polyps.
Abstract: The aim of this study was to investigate the immunohistochemical expression of p53 and Ki67 in colorectal adenomas in order to clarify their significance as indicators of malignancy and development of new polyps. Seventy-eight polyps were removed from 51 patients and examined. Twenty-nine patients (56.9%) had adenomas with low-grade atypia (13 of them developed new polyps at 3-year follow-up) and 22 (43.1%) had adenomas with high-grade atypia (6 of them developed new polyps at 3-year follow-up). We tested the association between p53 and Ki67 expression and various clinicopathological variables, and regression analysis was performed to identify the risk factors for malignancy and development of new adenomas. A significant correlation between the grade of atypia and p53 immunoreactivity was observed. Ki67 expression was not related to atypia and no correlation was found between p53 and Ki67 immunoreactivity. Regression analysis showed that size (p=0.0002) and p53 staining (p=0.0111) were the selected factors related to malignant transformation, whereas the number of synchronous primary polyps emerged as the only predictive factor of development of new adenomas, although without statistical significance. The expression of biological markers may be in future added to the currently examined features of polyps; however, further studies are needed to better define their predictive value.
9 citations
TL;DR: As NBI detected additional neoplastic lesions as well as demonstrated that lesions detected with white light were more extensive, adjunctive use of NBI for examining post-endoscopy resection sites should be studied in future, larger studies.
Abstract: Background
There is little data on the prevalence of residual neoplastic tissue or the rate of endoscopically detected recurrence in patients with prior surgical or endoscopic resection of advanced neoplasia.
8 citations
TL;DR: Wang et al. as mentioned in this paper collected and reported the current research status on epidemiology and risk factors of colorectal cancer in China, which can be achieved through strategies stimulating lifestyle changes, healthy diet habits, and early screening for high risk individuals.
Abstract: In China, colorectal cancer (CRC) ranked fourth and fifth in the highest incidence and mortality rates of all malignancies in 2018, respectively. Although these rates are below the world average, China placed first worldwide in the number of new CRC cases and CRC-related deaths because of its comparatively large population. This disease represents a threat to the health of population and incurs a heavy economic burden on the society and individuals. CRC has various risk factors, including age, sex, lifestyle, genetic factors, obesity, diabetes, gut microbiota status, and precancerous lesions. Furthermore, incidence and mortality rates of CRC are closely related to socioeconomic development levels, varying according to regional and population characteristics. Prevention is the main strategy to reduce incidence and mortality rates of CRC. This can be achieved through strategies stimulating lifestyle changes, healthy diet habits, and early screening for high-risk individuals. To reduce the burden of CRC, public health officials should promote prevention and management of modifiable risk factors through national policies. The rising incidence and mortality rates of CRC in China may be timely curbed by clarifying specific epidemiological characteristics, optimizing early screening strategies, and strictly implementing diagnosis and treatment guidelines. Thus, this study aimed to collect and report the current research status on epidemiology and risk factors of CRC in China.
8 citations
01 Jan 2005
TL;DR: Não houve diferença estatística quando comparados os achados positivos na colonoscopia entre os grupos de pólipos retais adenomatosos e hiperplásicos (p = 0,052); o tamanho do pó Lipo retal não foi estatisticamente significante para achado de neoplasia proximal.
Abstract: RESUMO: O câncer colorretal é a terceira causa de morte nas regiões sul e sudeste do Brasil. Os tumores crescem lentamente seguindo a seqüência adenoma-carcinoma. A colonoscopia permite o diagnóstico e a ressecção dos pólipos. Atualmente discute-se a colonoscopia para pacientes portadores de pólipos retais não-neoplásicos e pólipos pequenos, além dos adenomas. Objetivo: Verificar a prevalência dos pólipos colônicos nos pacientes portadores de pólipos retais, correlacionar o tipo histológico e o tamanho do pólipo retal com o achado de neoplasia proximal. Pacientes e Método: Estudo transversal, entre 2000 e 2003, com pacientes portadores de pólipos retais submetidos a colonoscopia. Dividiram-se os pacientes por faixa etária, tipo e tamanho do pólipo retal. Pólipos e câncer foram considerados achados positivos na colonoscopia. Foram excluídas síndromes polipóides genéticas e câncer retal. Resultados: Examinaram-se 1.715 pacientes dos quais 74 (4,31%) tinham pólipos retais. O estudo histopatológico mostrou que 54,1% eram adenomatosos, 23% hiperplásicos, 12,2% inflamatórios e 10,8%, excrescências de mucosa. A maioria dos pólipos foi encontrada em pacientes acima de 40 anos, havendo significância estatística no grupo dos neoplásicos (p < 0,0001). Não houve diferença estatística quando comparados os achados positivos na colonoscopia entre os grupos de pólipos retais adenomatosos e hiperplásicos (p = 0,052). O tamanho do pólipo retal não foi estatisticamente significante para achados positivos na colonoscopia. Conclusões: Prevalência de pólipos proximais em portadores de pólipos retais foi 49,1%. Prevalência de neoplasia proximal foi de 42,5% e 11,7% nos portadores de pólipos retais neoplásicos e não-neoplásicos, respectivamente. O tamanho do pólipo retal não foi preditivo para achado de neoplasia proximal.
8 citations
References
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TL;DR: A model for the genetic basis of colorectal neoplasia that includes the following salient features is presented, which may be applicable to other common epithelial neoplasms, in which tumors of varying stage are more difficult to study.
11,576 citations
TL;DR: The results of the National Polyp Study support the view that colorectal adenomas progress to adenocarcinomas, as well as the current practice of searching for and removing adenomatous polyps to prevent coloreCTal cancer.
Abstract: Background The current practice of removing adenomatous polyps of the colon and rectum is based on the belief that this will prevent colorectal cancer. To address the hypothesis that colonoscopic polypectomy reduces the incidence of colorectal cancer, we analyzed the results of the National Polyp Study with reference to other published results. Methods The study cohort consisted of 1418 patients who had a complete colonoscopy during which one or more adenomas of the colon or rectum were removed. The patients subsequently underwent periodic colonoscopy during an average follow-up of 5.9 years, and the incidence of colorectal cancer was ascertained. The incidence rate of colorectal cancer was compared with that in three reference groups, including two cohorts in which colonic polyps were not removed and one general-population registry, after adjustment for sex, age, and polyp size. Results Ninety-seven percent of the patients were followed clinically for a total of 8401 person-years, and 80 percent returned...
4,310 citations
TL;DR: Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp‐cancer sequence although the majority of adenomas do not become cancerous during a normal adult life span.
Abstract: The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.
1,944 citations
TL;DR: The long-term risk of colorectal cancer after rigid-instrument sigmoidoscopy and polypectomy in 1618 patients with rectosigmoid adenomas who did not undergo surveillance was assessed, finding that surveillance may not be of value because the risk of cancer is so low.
Abstract: Background and Methods Surveillance by repeated colonoscopy is currently recommended for patients with colorectal adenomas. We assessed the long-term risk of colorectal cancer after rigid-instrument sigmoidoscopy and polypectomy in 1618 patients with rectosigmoid adenomas (tumors of the rectum or distal sigmoid colon) who did not undergo surveillance. A total of 22,462 person-years of observation were accrued (mean, 14 years per patient). Results The incidence of subsequent rectal cancer in these patients was similar to that in the general population (standardized incidence ratio, 1.2; 95 percent confidence interval, 0.7 to 2.1). Most rectal cancers developed in patients whose adenomas had been inadequately removed; the risk was very low after complete removal. The risk of subsequent colon cancer depended on the histologic type, size, and number of adenomas in the rectosigmoid. Among 842 patients with a rectosigmoid adenoma that was tubulovillous, villous, or large (≥1 cm), colon cancer developed...
1,018 citations
TL;DR: Colonoscopy performed three years after colonoscopic removal of adenomatous polyps detects important colonic lesions as effectively as follow-up colonoscopy after both one and three years.
Abstract: Background The identification and removal of adenomatous polyps and post-polypectomy surveillance are considered to be important for the control of colorectal cancer. In current practice, the intervals between colonoscopies after polypectomy are variable, often a year long, and not based on data from randomized clinical trials. We sought to determine whether follow-up colonoscopy at three years would detect important colonic lesions as well as follow-up colonoscopy at both one and three years. Methods Patients were eligible if they had one or more adenomas, no previous polypectomy, and a complete colonoscopy and if all their polyps had been removed. They were randomly assigned to have follow-up colonoscopy at one and three years or at three years only. The two study end points were the detection of any adenoma, and the detection of adenomas with advanced pathological features (defined as those >1 cm in diameter and those with high-grade dysplasia or invasive cancer). Results Of 2632 eligible patients, 141...
933 citations