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
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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Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society.
Sidney J. Winawer,Ann G. Zauber,Robert H. Fletcher,Jonathon S. Stillman,Michael J. O'Brien,Bernard Levin,Robert A. Smith,David Lieberman,Randall W. Burt,Theodore R. Levin,John H. Bond,Durado Brooks,Tim Byers,Neil Hyman,Lynne M. Kirk,Alan G. Thorson,Clifford Simmang,David W. Johnson,Douglas K. Rex +18 more
TL;DR: In this article, a careful analytic approach was designed to address all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be stratified more definitely at their baseline colonoscopy into those at lower risk or increased risk for a subsequent advanced neoplasia.
Journal ArticleDOI
Guidelines for colonoscopy surveillance after polypectomy: A consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society
Sidney J. Winawer,Ann G. Zauber,Robert H. Fletcher,Jonathon S. Stillman,Michael J. O'Brien,Bernard Levin,Robert A. Smith,David Lieberman,Randall W. Burt,Theodore R. Levin,John H. Bond,Durado Brooks,Tim Byers,Neil Hyman,Lynne M. Kirk,Alan G. Thorson,Clifford Simmang,David W. Johnson,Douglas K. Rex +18 more
TL;DR: A careful analytic approach was designed addressing all evidence available in the literature to delineate predictors of advanced pathology, both cancer and advanced adenomas, so that patients can be more definitely stratified at their baseline colonoscopy into those at lower or increased risk for a subsequent advanced neoplasia.
Journal ArticleDOI
A Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses After Colonoscopic Polypectomy
Maria Elena Martinez,John A. Baron,David A. Lieberman,Arthur Schatzkin,Elaine Lanza,Sidney J. Winawer,Ann G. Zauber,Ruiyun Jiang,Dennis J. Ahnen,John H. Bond,Timothy R. Church,Douglas J. Robertson,Stephanie A. Smith-Warner,Elizabeth T. Jacobs,David S. Alberts,E. Robert Greenberg,E. Robert Greenberg +16 more
TL;DR: Factors that are associated most strongly with risk of advanced neoplasia are patient age and the number and size of prior adenomas.
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Five-year colon surveillance after screening colonoscopy.
David A. Lieberman,David G. Weiss,William V. Harford,Dennis J. Ahnen,Dawn Provenzale,Stephen J. Sontag,Thomas G. Schnell,Gregorio Chejfec,Donald R. Campbell,Jayashri Kidao,John H. Bond,Douglas B. Nelson,George Triadafilopoulos,Francisco C. Ramirez,Judith Collins,Tiina K. Johnston,Kenneth R. McQuaid,Harinder S. Garewal,Richard E. Sampliner,Romeo Esquivel,Douglas J. Robertson +20 more
TL;DR: There is a strong association between results of baseline screening colonoscopy and rate of serious incident lesions during 5.5 years of surveillance and patients with 1 or 2 tubular adenomas less than 10 mm represent a low-risk group compared with other patients with colon neoplasia.
Journal ArticleDOI
Adenoma characteristics as risk factors for recurrence of advanced adenomas.
Maria Elena Martinez,Richard E. Sampliner,James R. Marshall,Achyut K. Bhattacharyya,Mary E. Reid,David S. Alberts +5 more
TL;DR: Large or proximally located adenomas are important indicators of recurrence of advanced lesions and careful surveillance of this area is warranted.
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