|
|
The first year follow-up after colorectal adenoma
polypectomy is important: A multiple-center study in symptomatic hospital-based
individuals in China |
Qin-Yan GAO1,Hui-Min CHEN1,Jing-Yuan FANG1,Jian-Qiu SHENG2,Ping ZHENG3,Cheng-Gong YU4,Bo JIANG5, |
1.Department of Gastroenterology,
Renji Hospital, Shanghai Jiao Tong University School of Medicine,
Shanghai Institute of Digestive Disease, Shanghai 200001, China; 2.Department of Gastroenterology,
PLA. The Military General Hospital of Beijing, Beijing 100700, China; 3.Shanghai 1st Hospital,
Shanghai Jiao Tong University, Shanghai 200001, China; 4.Department of Gastroenterology,
The Affiliated Drum Tower Hospital of Nanjing University Medical School,
Nanjing 210008, China; 5.Department of Gastroenterology,
Nanfang Hospital, Nanfang University, Guangzhou 510515, China; |
|
|
Abstract The recurrence of colorectal adenoma (CRA) is high. Although there are guidelines for colonoscopy surveillance after polypectomy in other countries, little is known about its recurrence rate and recurrence peak, especially in China. The aim of the present research is to investigate how long after polypectomy follow-up should take and to analyze risk factors of recurrence. 1208 patients who received polypectomies from five clinical research centers in four regions of China (Shanghai, Guangzhou, Nanjing and Beijing) were included. They were divided into 4 groups: group A (follow-up≤1 year after polypectomy), group B (follow-up 2–3 years after polypectomy), group C (follow-up 4–5 years after polypectomy), and group D (follow-up>5 years after polypectomy). The sex, age, adenoma location, size, number, and pathological characteristics were compared. On the whole, the recurrence rate was 59.46% in group A, 61.09% in group B, 78.07% in group C, and 87.12% in group D, which indicated an increased tendency with a prolonged follow-up duration. There was a significant difference between group A and C or D, and between group B and C or D (P<0.01), but there was no statistical difference between group A and B. Additionally, the recurrent patients in the first year had a recurrence rate of 97.33% in the first three years (59.46/61.09), which means that the peak of recurrence was almost entirely concentrated in the first year. The recurrence rate was higher in males and the elder. The risk factors included multiple numbers, villous feature, high-grade dysplasia of medium or smaller size and location in the distal colon. In conclusion, the peak of recurrence was almost totally concentrated in the first year; meanwhile, the first year follow-up is of critical importance in China. It may not be necessary to do the follow-up examination during the second and third years, but after three years, another colonoscopy should be undertaken.
|
Keywords
colorectal adenoma
polypectomy
follow-up
recurrence
risk factor
|
Issue Date: 05 December 2010
|
|
|
Lieberman D A, Weiss D G, Bond J H, Ahnen D J, Garewal H, Chejfec G. Use of colonoscopy to screen asymptomatic adults forcolorectal cancer. Veterans Affairs Cooperative Study Group 380. N Engl J Med, 2000, 343(3): 162–168 PMID: 10900274
|
|
Cotton S, Sharp L, Little J. The adenoma-carcinoma sequence and prospectsfor the prevention of colorectal neoplasia. Crit Rev Oncog, 1996, 7(5―6): 293–342 PMID: 9467664
|
|
Winawer S J, Zauber A G, Ho M N, O'Brien M J, Gottlieb L S, Sternberg S S, Waye J D, Schapiro M, Bond J H, Panish J F, Ackroyd F, Shike M, Kurtz R C, Hornsby-Lewis L, Gerdes H, Stewart E T. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med, 1993, 329(27): 1977–1981 PMID: 8247072
|
|
Strul H, Kariv R, Leshno M, Halak A, Jakubowicz M, Santo M, Umansky M, Shirin H, Degani Y, Revivo M, Halpern Z, Arber N. The prevalence rate and anatomic location of colorectal adenoma andcancer detected by colonoscopy in average-risk individuals aged 40―80years. Am J Gastroenterol, 2006, 101(2): 255–262 PMID: 16454827
|
|
Selby J V, Friedman G D, Quesenberry C P Jr, Weiss N S. A case-control study of screening sigmoidoscopyand mortality from colorectal cancer. N Engl J Med, 1992, 326(10): 653–657 PMID: 1736103
|
|
Newcomb P A, Norfleet R G, Storer B E. Surawicz T S, Marcus P M. Screening sigmoidscopy and colorectal cancer mortality. J Natl Cancer Inst, 1992, 84: 1572–1575 PMID: 1404450
|
|
Martínez M E, Baron J A, Lieberman D A, Schatzkin A, Lanza E, Winawer S J, Zauber A G, Jiang R, Ahnen D J, Bond J H, Church T R, Robertson D J, Smith-Warner S A, Jacobs E T, Alberts D S, Greenberg E R. A pooled analysis of advancedcolorectal neoplasia diagnoses after colonoscopic polypectomy. Gastroenterology, 2009, 136(3): 832–841 PMID: 19171141
|
|
Winawer S J, Zauber A G, O'Brien M J, Ho M N, Gottlieb L S, Sternberg S S, Waye J D, Bond J H, Schapiro M, Stewart E T, Panish J F, Ackroyd F, Kurtz R C, Shike M. Randomized comparison of surveillanceintervals after colonoscopic removal of newly diagnosed adenomatouspolyps. N Engl J Med, 1993, 328(13): 901–906 PMID: 8446136
|
|
J?rgensen O D, Kronborg O, Fenger C. A randomized surveillancestudy of patients with pedunculated and small sessile tubular andtubulovillous adenomas. The Funen Adenoma Follow-up Study. Scand J Gastroenterol, 1995, 30(7): 686–692 PMID: 7481533
|
|
Winawer S J, Zauber A G, Fletcher R H, Stillman J S, O'Brien M J, Levin B, Smith R A, Lieberman D A, Burt R W, Levin T R, Bond J H, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex D K. Guidelines for colonoscopy surveillance after polypectomy: a consensus updateby the US Multi-Society Task Force on Colorectal Cancer and the AmericanCancer Society. Gastroenterology, 2006, 130(6): 1872–1885 PMID: 16697750
|
|
Sung J J, Lau J Y, Young G P, Sano Y, Chiu H M, Byeon J S, Yeoh K G, Goh K L, Sollano J, Rerknimitr R, Matsuda T, Wu K C, Ng S, Leung S Y, Makharia G, Chong V H, Ho K Y, Brooks D, Lieberman D A, Chan F K. Asia Pacific consensusrecommendations for colorectal cancer screening. Gut, 2008, 57(8): 1166–1176 PMID: 18628378
|
|
Rundle A G, Lebwohl B, Vogel R, Levine S, Neugut A I. Colonoscopic screening in average-risk individuals ages 40 to 49 vs 50 to 59 years. Gastroenterology, 2008, 134(5): 1311–1315 PMID: 18471508
|
|
Phillips K A, Liang S Y, Ladabaum U, Haas J, Kerlikowske K, Lieberman D, Hiatt R, Nagamine M, Van Bebber S L. Trends in colonoscopy for colorectal cancer screening. Med Care, 2007, 45(2): 160–167 PMID: 17224779
|
|
The Lancet Oncology. Prevention at a cost. Lancet Oncol, 2004, 5(10): 581 PMID: 15465457
|
|
Winawer S J, Zauber A G, Fletcher R H, Stillman J S, O'Brien M J, Levin B, Smith R A, Lieberman D A, Burt R W, Levin T R, Bond J H, Brooks D, Byers T, Hyman N, Kirk L, Thorson A, Simmang C, Johnson D, Rex D K. Guidelines for colonoscopy surveillance after polypectomy: a consensus updateby the US Multi-Society Task Force on Colorectal Cancer and the AmericanCancer Society. Gastroenterology, 2006, 130(6): 1872–1885 PMID: 16697750
|
|
Noshirwani K C, van Stolk R U, Rybicki L A, Beck G J. Adenoma size and number are predictive of adenoma recurrence:implications for surveillance colonoscopy. Gastrointest Endosc, 2000, 51(4 Pt 1): 433–437 PMID: 10744815
|
|
Nusko G, Mansmann U, Kirchner T, Hahn E G. Risk related surveillance following colorectal polypectomy. Gut, 2002, 51(3): 424–428 PMID: 12171968
|
|
van Stolk R U, Beck G J, Baron J A, Haile R, Summers R. Adenoma characteristics atfirst colonoscopy as predictors of adenoma recurrence and characteristicsat follow-up. Gastroenterology, 1998, 115(1): 13–18 PMID: 9649453
|
|
Martínez M E, Sampliner R, Marshall J R, Bhattacharyya A K, Reid M E, Alberts D S. Adenoma characteristics asrisk factors for recurrence of advanced adenomas. Gastroenterology, 2001, 120(5): 1077–1083 PMID: 11266371
|
|
Lieberman D A, Weiss D G, Harford W V, Ahnen D J, Provenzale D, Sontag S J, Schnell T G, Chejfec G, Campbell D R, Kidao J, Bond J H, Nelson D B, Triadafilopoulos G, Ramirez F C, Collins J F, Johnston T K, McQuaid K R, Garewal H, Sampliner R E, Esquivel R, Robertson D. Five-year colon surveillance after screening colonoscopy. Gastroenterology, 2007, 133(4): 1077–1085 PMID: 17698067
|
|
Viewed |
|
|
|
Full text
|
|
|
|
|
Abstract
|
|
|
|
|
Cited |
|
|
|
|
|
Shared |
|
|
|
|
|
Discussed |
|
|
|
|