Risk of colorectal cancer following colonoscopic polypectomy

Lucio Bertario, Antonio Russo, Paola Sala, Paolo Pizzetti, Giovanni Ballardini, Salvatore Andreola, Pasquale Spinelli

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)157-162
Number of pages6
JournalTumori
Volume85
Issue number3
Publication statusPublished - May 1999

Fingerprint

Adenoma
Colorectal Neoplasms
Villous Adenoma
Colonoscopy
Adenomatous Polyps
National Cancer Institute (U.S.)
Large Intestine
Proportional Hazards Models
Colonic Neoplasms
Adenocarcinoma
Confidence Intervals
Carcinoma

Keywords

  • Colorectal neoplasms
  • Endoscopic polypectomy
  • Large bowel adenomas

ASJC Scopus subject areas

  • Cancer Research

Cite this

Bertario, L., Russo, A., Sala, P., Pizzetti, P., Ballardini, G., Andreola, S., & Spinelli, P. (1999). Risk of colorectal cancer following colonoscopic polypectomy. Tumori, 85(3), 157-162.

Risk of colorectal cancer following colonoscopic polypectomy. / Bertario, Lucio; Russo, Antonio; Sala, Paola; Pizzetti, Paolo; Ballardini, Giovanni; Andreola, Salvatore; Spinelli, Pasquale.

In: Tumori, Vol. 85, No. 3, 05.1999, p. 157-162.

Research output: Contribution to journalArticle

Bertario, L, Russo, A, Sala, P, Pizzetti, P, Ballardini, G, Andreola, S & Spinelli, P 1999, 'Risk of colorectal cancer following colonoscopic polypectomy', Tumori, vol. 85, no. 3, pp. 157-162.
Bertario L, Russo A, Sala P, Pizzetti P, Ballardini G, Andreola S et al. Risk of colorectal cancer following colonoscopic polypectomy. Tumori. 1999 May;85(3):157-162.
Bertario, Lucio ; Russo, Antonio ; Sala, Paola ; Pizzetti, Paolo ; Ballardini, Giovanni ; Andreola, Salvatore ; Spinelli, Pasquale. / Risk of colorectal cancer following colonoscopic polypectomy. In: Tumori. 1999 ; Vol. 85, No. 3. pp. 157-162.
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AU - Russo, Antonio

AU - Sala, Paola

AU - Pizzetti, Paolo

AU - Ballardini, Giovanni

AU - Andreola, Salvatore

AU - Spinelli, Pasquale

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N2 - 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.

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