Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines

Abstract

The European guidelines for quality assurance in colorectal cancer (CRC) screening have established high-risk (≥ 5 adenomas or an adenoma ≥ 20 mm) and intermediate-risk (3 - 4 adenomas or at least one adenoma 10 - 19 mm in size, or villous histology, or high grade dysplasia) groups with different endoscopic surveillance intervals. The aim of this study was to evaluate the difference in the incidence of advanced neoplasia (advanced adenoma or CRC) between the two risk groups. This retrospective group study included patients meeting high- or intermediate-risk criteria for adenomas detected in CRC screening programs and the COLONPREV study before European guidelines were adopted in Spain (June 2011) with a 3-year surveillance recommendation according to Spanish guidelines. The primary outcome measure was the incidence of advanced neoplasia in patients undergoing surveillance. The secondary outcome measure was the CRC incidence. We used an adjusted proportional hazards regression model to control confounding variables. The study included 5401 patients (3379 intermediate risk, 2022 high risk). Endoscopic surveillance was performed in 65.5 % of the patients (2.8 ± 1 years). The incidence of advanced neoplasia in the high- and intermediate-risk groups was 16.0 % (59.0 cases/1000 patient-years) and 12.3 % (41.2 cases/1000 patient-years), respectively. The CRC incidence was 0.5 % (1.4 cases/1000 patient-years) and 0.4 % (1 case/1000 patient-years), respectively. The advanced neoplasia and CRC attributable risk to the high risk group was of 3.7 % and 0.1 %, respectively. In the proportional hazards analysis, the risk of advanced neoplasia was greater in the high-risk group (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2 - 1.8), with no significant differences in the CRC incidence (HR 1.6, 95 %CI 0.6 - 3.8). Patients meeting high-risk criteria have a higher incidence of advanced neoplasia during endoscopic surveillance. No differences were found in the CRC incidence at a 3-year surveillance recommendation.

British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines

“…Five studies12 98–101 only reported statistical analyses on AN, with four reporting no significant association between HGD at index and risk of AN at first surveillance, and the fifth study (Cubiella et al 100) reporting an OR of 0.7 (95% CI 0.5 to 0.98), consistent with reduced risk associated with HGD. Again, risk of bias was generally rated as moderate to low.…”

Adherencia al seguimiento de las personas con adenoma de alto riesgo diagnosticadas y excluidas del Programa de detección precoz de cáncer de colon y recto de Barcelona

“…Los autores consideran que la adherencia al seguimiento observada en este estudio es aceptable al compararla con los resultados publicados en otros estudios realizados. El único estudio que se ha encontrado de ámbito español que contempla la adherencia a la colonoscopia es un ensayo clínico y obtuvo una adherencia del 65,5% 9 . Estudios observacionales realizados en un contexto clínico en Holanda 10 y Estados Unidos 12 obtuvieron adherencias inferiores, del 66% y 21,4%, respectivamente.…”

“…En el presente estudio se obtuvo una media de seguimiento de 2,8 ± 0,8 años, datos muy similares a los de Cubiella J et al en España 9 . El 57,7% de las colonoscopias efectuadas se realizaron dentro del intervalo recomendado por las guías clínicas vigentes en esos momentos (3 años ± 6meses).…”

“…Son pocos los estudios que han evaluado la adherencia al seguimiento de este grupo de personas en el contexto de los programas de cribado, la mayoría se enmarcan en un contexto clínico y muestran una amplia variabilidad en la adherencia endoscópica. En un reciente estudio realizado en España 9 , en el marco de un ensayo clínico, se ha observado una adherencia a la realización de la colonoscopia de seguimiento del 65,5% en personas con adenomas de alto riesgo, que fueron diagnosticadas a través de un Programa de cribado; con un intervalo de tiempo medio de 2,8 años ± 1 año. En Holanda, Van Heijningen E-MB et al 10 observaron un seguimiento endoscópico del 66,0% en las personas diagnosticadas de adenoma (de bajo y alto riesgo), mientras que Jonkers et al 11 describieron un 85,3% de adherencia en el seguimiento en personas con adenomas colorrectales, con intervalos superiores a los recomendados en un 32,5% e inferiores en un 27,3%…”

The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

“…In part this is due to the lower frequency of gastric lesions in Western populations, which due to their relative technical simplicity act as good training cases. In the West colorectal lesions are the most frequent indication for ESD [4,5].Although classically considered to be lesions at high risk for colorectal cancer (CRC), evidence suggests that complex polyps are generally benign.…”