Document Detail


Risk of colorectal cancer following colonoscopic polypectomy.
MedLine Citation:
PMID:  10426124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS AND BACKGROUND: To follow a cohort of patients who had undergone polypectomies in order to assess the overall risk of subsequent colorectal cancer in relation with various adenomas characteristics. METHODS: A total of 1,063 patients with adenomatous polyps of the large intestine were treated between 1979 and 1996 at the National Cancer Institute of Milan, during a screening program for colorectal carcinoma. Data on patients who had undergone colonoscopies were collected prospectively. The relation between colorectal cancer and adenomas characteristics was assessed by computing the hazard ratio (HR) values and corresponding confidence intervals (95% CI), according to Cox. RESULTS: Of the 1,063 patients who met the eligibility requirements, 672 had single adenomas (63.2%) and 391 had multiple adenomas (36.8%). Histological examination revealed 743 cases of tubular adenoma, 196 cases of tubulo-villous adenoma, and 96 cases of villous adenoma. High-grade dysplasia was found in 3.1% of the cases. During the 8,906 persons/year of follow-up, adenocarcinomas of the large bowel developed in 11 patients. Several adenomas' characteristics at index polypectomy were significant predictors of colorectal cancer occurrence. In univariate analysis the risk of colon cancer was significantly related with multiple adenomas (HR 4.2, 95% CI 1.1-6.5), high-grade dysplasia adenomas (HR 10.0, 95% CI 2.6-38.1) and with adenomas larger than 2 cm (HR 5.0, 95% CI 1.2-20.4). A multivariate stepwise procedure confirmed that the presence of multiple adenomas and presence of high-grade dysplasia are the most important predictors of carcinomas. Hazard ratios for colorectal cancer occurrence, from multivariate Cox's model, were 5.1 (95% CI 1.2-19.9) for multiple compared to single adenomas, and 13.0 (95% CI 3.6-50.7) for adenomas with high-grade dysplasia compared to those with low-grade dysplasia. CONCLUSIONS: High-grade dysplasia, number and size of adenomas were confirmed as the major cancer predictors. Based on this conclusion, a subgroup of patients, who may benefit from intensive surveillance colonoscopy, can be identifiable.
Authors:
L Bertario; A Russo; P Sala; P Pizzetti; G Ballardini; S Andreola; P Spinelli
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Tumori     Volume:  85     ISSN:  0300-8916     ISO Abbreviation:  Tumori     Publication Date:    1999 May-Jun
Date Detail:
Created Date:  1999-08-05     Completed Date:  1999-08-05     Revised Date:  2008-12-12    
Medline Journal Info:
Nlm Unique ID:  0111356     Medline TA:  Tumori     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  157-62     Citation Subset:  IM    
Affiliation:
Digestive Surgical Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. bertario@istitutotumori.mi.it
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MeSH Terms
Descriptor/Qualifier:
Adenoma / etiology*,  pathology
Adult
Aged
Aged, 80 and over
Colonic Polyps / complications*,  surgery*
Colonoscopy*
Colorectal Neoplasms / etiology*,  pathology
Endoscopy*
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Risk

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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