Pathologic Features of Initial Adenomas as Predictors for Metachronous Adenomas of the Rectum
Gong Yang,Wei Zheng,Qi Rong Sun,Xiao-Ou Shu,Wei Dong Li,Hai Yu,Gao Fei Shen,Yong Zhou Shen,John D. Potter,Shu Zheng +9 more
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TLDR
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.read more
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References
More filters
Journal ArticleDOI
A genetic model for colorectal tumorigenesis
Eric R. Fearon,Bert Vogelstein +1 more
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.
Journal ArticleDOI
Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup.
Sidney J. Winawer,A G Zauber,M N Ho,Michael J. O'Brien,Leonard S. Gottlieb,S S Sternberg,Jerome D. Waye,Melvin Schapiro,John H. Bond,Joel F. Panish +9 more
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.
Journal ArticleDOI
The evolution of cancer of the colon and rectum.
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.
Journal ArticleDOI
Long-term risk of colorectal cancer after excision of rectosigmoid adenomas
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.
Journal ArticleDOI
Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps
Sidney J. Winawer,A G Zauber,Michael J. O'Brien,M N Ho,Lawrence J. Gottlieb,S S Sternberg,Jerome D. Waye,John H. Bond,Melvin Schapiro,Stewart Et +9 more
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.
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