Metachronous colon tumors: risk factors and rationale for the surveillance colonoscopy after initial polypectomy

Fukutomi, Yasushi; Moriwaki, Hisataka; Nagase, Seisuke; Tajika, Masahiro; Naito, Tomoo; Miwa, Yoshiyuki; Yamada, Yasuhiro; Araki, Hiroshi; Okuno, Masataka; Nagura, Kazuo; Kato, Tomohiro; Ninomiya, Mitsuo

doi:10.1007/s00432-002-0375-9

Cited by 28 publications

(30 citation statements)

References 19 publications

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“…Following also our own successful experience in preventing human second primary liver cancer (22,23), we decided to start the present study with the clean colon after polypectomy because such colonic mucosa provides a high-risk field for metachronous (i.e., second primary colorectal adenoma; ref. 19), which we targeted as the end-point biomarker. The rate of metachronous tumorigenesis in the present control group was similar to that in our preceding study (19), but seems to be higher than those in other previous studies (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…The present study was conducted as a randomized trial to investigate whether GTE supplementation inhibits the metachronous adenomas after total endoscopic resection of preceding colorectal adenomas because such mucosa provides a field with a higher risk for the development of second primary adenomas (19). We evaluated the antitumor efficacy and safety of 1.5 g GTE (3 tablets) per day.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

“…Initially, the required sample size was calculated as 60 patients in each group, based on the incidence of metachronous adenomas (19) and estimated risk reduction by GTE as 0.5 (11). We actually recruited 136 participants who underwent endoscopic resection of one or more colorectal adenomas.…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

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Green Tea Extracts for the Prevention of Metachronous Colorectal Adenomas: A Pilot Study

Shimizu

Fukutomi²,

Ninomiya³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Experimental studies indicate the chemopreventive properties of green tea extract (GTE) on colorectal cancer. Epidemiologically, green tea consumption of >10 cups daily reduced colorectal cancer risk in Japanese. Because colorectal adenomas are the precursors to most sporadic colorectal cancers, we conducted a randomized trial to determine the preventive effect of GTE supplements on metachronous colorectal adenomas by raising green tea consumption in the target population from an average of 6 cups (1.5 g GTE) daily to z10 cups equivalent (2.5 g GTE) by supplemental GTE tablets. Methods: We recruited 136 patients, removed their colorectal adenomas by endoscopic polypectomy, and 1 year later confirmed the clean colon (i.e., no polyp) at the second colonoscopy. The patients were then randomized into two groups while maintaining their

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Section: Discussionmentioning

confidence: 99%

Section: Patients Materials and Methodsmentioning

confidence: 99%

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Green Tea Extracts for the Prevention of Metachronous Colorectal Adenomas: A Pilot Study

Shimizu

Fukutomi²,

Ninomiya³

et al. 2008

Cancer Epidemiology, Biomarkers &Amp; Prevention

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185

130

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“…Furthermore, their analysis included a limited number of variables and drawn discordant conclusions. On the other hand, some authors suggest CRC history as a possible risk factor favoring metachronous lesion development (17,18). Consequently, CRC patients could represent, from the beginning, a high risk population for having Nowadays, there is no agreement about which evolutive control might be better, after CRC is resected and different Clinical Guidelines have been proposed for this purpose (19)(20)(21).…”

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Drawing up an individual risk index for development of metachronous neoplastic lesions in resected colorectal cancer

Borda

Martínez-Peñuela²,

Borda

et al. 2012

Rev. esp. enferm. dig.

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Aim: to identify possible risk factors for the development of metachronous lesions in colorectal cancer (CRC) which would allow to establish a post-surgical individual prognostic index.Patients and methods: three hundred eighty-two surgically treated CRC were reviewed. We compared the incidence of metachronous lesions in 40 variables concerning patient clinical data and initial neoplastic findings. An individual risk index for metachronicity was drawn up including those variables which presented significant differences in multivariate logistic regression, dividing patients into three groups.Results: variables with prognostic value for metachronicity were distal cancer location: OR= 2.30 (1.03-5.13), alcohol intake: OR = 2.20 (1.08-4.48), presence of synchronous adenomas: isolated: OR = 2.47 (1.03-4.48), multiple: OR = 4.26 (1.78-10.17), and presence of synchronous advanced adenoma: OR= 2.91 (1.52-12.60). Tumor MUC-5 expression proved to have a protective role: ). An individual risk score was established considering these variables and patients could be classified into three groups, with a discrimination power for metachronicity of p< 0.0000001. Classification in high and low risk groups had a sensitivity = 75.32%, specificity = 84.21%, positive predictive value = 75.34%, negative predictive value = 92.31% and global diagnostic accuracy = 80.75%.Conclusions: the identification of risk factors for the development of metachronous lesions allow to calculate, at the time of surgical treatment, an individual prognostic index and to classify patients into three different risk groups. In high and low risk groups, both specificity and accuracy were acceptable for the prognosis of metachronous lesions, being remarkable the negative predictive power of our classification, which could become relevant when planning a different endoscopic follow up of these patients.Key words: Colorectal cancer. Follow-up. Metachronous lesions. INTRODUCTIONThe majority of colorectal cancers (CRC) are sporadic cases (1,2) and little is known about metachronous or synchronous neoplasms development (3,4). These multicentric lesions could be due to mutations in genes related to apoptosis, cellular proliferation or DNA repairing (5), or forms of hereditary non polyposis colorectal cancer syndrome with low penetrance (6). Finally, this tumor multicentricity could be caused by multiple interacting factors, such as personal or familial predisposition, environmental mechanisms, morphological or immunophenotypical tumor features which would favoured an increased risk of neoplasm development along different colonic sites (7). Once the tumor and all the possible synchronic lesions are endoscopically or surgically resected, the tumor multicentricity might promote the development of new neoplastic lesions (8,9). Similar to synchronous lesions, metachronic neoplasms will be adenomas in most cases and less frequently CRC. There are several publications related to development of metachronous lesions after the resection of the initial polyps in patient...

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Carotenoids, vitamin A and risk of adenomatous polyp recurrence in the polyp prevention trial

Steck-Scott

Forman

Sowell

et al. 2004

Intl Journal of Cancer

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Key words: carotenoids; vitamin A; adenomatous polyps; epidemiologyCarotenoids are fat-soluble pigments found primarily in fruits and vegetables. Besides the well-known provitamin A activity of hydrocarbon carotenoids, numerous mechanisms have been postulated for carotenoid effects on carcinogenesis including inhibition of growth and induction of differentiation of cancer cells by modulating the expression of cell cycle regulatory proteins, modulation of the IGF-1/IGFPB-3 system, enhancement of immune function, increased gap junction intracellular communication, modulation of redox signaling and prevention of oxidative DNA damage and modulation of carcinogen metabolizing enzymes. 1 Consumption of carotenoid-rich fruits and vegetables has been associated with a reduction in risk of colorectal, lung, ovarian and other cancers. 2-5 However, few epidemiologic studies have examined individual carotenoid or vitamin A intake or serum concentrations and risk of colorectal cancer or adenomatous polyps, which are precursors to colorectal cancer. In a large beta-carotene supplementation trial of adenoma recurrence, similar in design to the Polyp Prevention Trial (PPT), participants in the beta-carotene supplemented group (20 mg/day) and placebo group experienced a similar rate of adenoma recurrence by intent to treat analysis. 6 In a subsequent analysis, stratified by smoking and drinking status, a significant protective effect from beta-carotene supplementation was observed in nonsmoking and nondrinking individuals. 7 Colorectal cancer is the third leading cancer in men and women in the U.S., resulting in an estimated 56,600 deaths in the year 2002. 8 While not all adenomas develop into cancer, it is believed that at least 95% of all colorectal cancers are derived from adenomatous polyps. The prevalence of colorectal adenomas in the U.S. ranges from 35-60%, 9 and recurrence of adenomas has been estimated at 10% or more annually. 10 Factors associated with recurrence of these lesions, including adenoma and patient characteristics, are not fully understood; however, a number of studies have demonstrated an increased recurrence of adenomas in individuals with a history of multiple adenomas. 11,12 Thus, reducing the incidence or recurrence of any or multiple adenoma formation is a plausible means for preventing colorectal cancer. Since genetic and epidemiology data suggest differences in colorectal cancer 13Abbreviations: BMI, body mass index; CI, confidence interval; FFQ, food frequency questionnaire; GAM, generalized additive model; LRT, log likelihood ratio test; NSAIDS, nonsteroidal anti-inflammatory drugs; OR, odds ratio; PPT, Polyp Prevention Trial.

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Metachronous colon tumors: risk factors and rationale for the surveillance colonoscopy after initial polypectomy

Abstract: These results may help optimizing surveillance strategies for metachronous colon tumors and raising the economic benefit of colonoscopy.

Cited by 28 publications

References 19 publications

Green Tea Extracts for the Prevention of Metachronous Colorectal Adenomas: A Pilot Study

Green Tea Extracts for the Prevention of Metachronous Colorectal Adenomas: A Pilot Study

Drawing up an individual risk index for development of metachronous neoplastic lesions in resected colorectal cancer

Carotenoids, vitamin A and risk of adenomatous polyp recurrence in the polyp prevention trial

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