Wenli Song1,2, Zexian Chen3,4, Zheyu Zheng1,4, Zongjin Zhang1,4, Yongle Chen1,4, Xiaosheng He3,4, Ping Lan1,4, Jiancong Hu1,4, Xiaowen He1,4. 1. Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 2. Department of Gastrointestinal Surgery, the Eighth Affiliated hospital, Sun Yat-sen University, Shenzhen, China. 3. Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 4. Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Abstract
BACKGROUND: It is important to implement a preventive strategy for early detection and endoscopic removal of metachronous adenoma in patients with colorectal cancer (CRC). Here, we retrospectively explored the associated factors of metachronous adenoma in these patients. METHODS: This study recruited 551 patients with stage I and II CRC who underwent radical surgery between January 1, 2012 and July 1, 2017 with postoperative colonoscopic surveillance. Data on clinicopathological characteristics and surveillance colonoscopies were obtained from medical records. Univariate analysis by Kaplan-Meier method and multivariate analysis by Cox proportional hazards model were used to identify the factors associated with metachronous adenoma. RESULTS: Metachronous adenoma was detected in 110 (20.0%) patients. In these patients, 94.5% (104/110) had metachronous adenoma within 3 years postoperatively. Age, synchronous adenoma, hypertension, tumor stage, and surgical resection were correlated with metachronous adenoma in patients with stage I-II CRC after radical resection (log rank test, P<0.05). Multivariate analyses showed that synchronous adenoma (HR =2.515, 95% CI: 1.691-3.742, P<0.01); stage II (HR =2.066, 95% CI: 1.329-3.210, P<0.01); and left-side colorectal resection (HR =2.207, 95% CI: 1.292-3.772, P<0.01) were independent risk factors. CONCLUSIONS: Synchronous adenoma, left-side colorectal resection, and stage II cancer are independent risk factors of metachronous adenoma in patients with previous stage I and II CRC. In patients with risk factors, an enhanced colonoscopic strategy might be needed for early detection and timely endoscopic removal of metachronous adenoma. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
BACKGROUND: It is important to implement a preventive strategy for early detection and endoscopic removal of metachronous adenoma in patients with colorectal cancer (CRC). Here, we retrospectively explored the associated factors of metachronous adenoma in these patients. METHODS: This study recruited 551 patients with stage I and II CRC who underwent radical surgery between January 1, 2012 and July 1, 2017 with postoperative colonoscopic surveillance. Data on clinicopathological characteristics and surveillance colonoscopies were obtained from medical records. Univariate analysis by Kaplan-Meier method and multivariate analysis by Cox proportional hazards model were used to identify the factors associated with metachronous adenoma. RESULTS: Metachronous adenoma was detected in 110 (20.0%) patients. In these patients, 94.5% (104/110) had metachronous adenoma within 3 years postoperatively. Age, synchronous adenoma, hypertension, tumor stage, and surgical resection were correlated with metachronous adenoma in patients with stage I-II CRC after radical resection (log rank test, P<0.05). Multivariate analyses showed that synchronous adenoma (HR =2.515, 95% CI: 1.691-3.742, P<0.01); stage II (HR =2.066, 95% CI: 1.329-3.210, P<0.01); and left-side colorectal resection (HR =2.207, 95% CI: 1.292-3.772, P<0.01) were independent risk factors. CONCLUSIONS: Synchronous adenoma, left-side colorectal resection, and stage II cancer are independent risk factors of metachronous adenoma in patients with previous stage I and II CRC. In patients with risk factors, an enhanced colonoscopic strategy might be needed for early detection and timely endoscopic removal of metachronous adenoma. 2021 Journal of Gastrointestinal Oncology. All rights reserved.
Entities:
Keywords:
Colorectal cancer (CRC); early stage; metachronous adenoma; risk factors; surveillance colonoscopy
Authors: Su Jin Chung; Young Sun Kim; Sun Young Yang; Ji Hyun Song; Donghee Kim; Min Jung Park; Sang Gyun Kim; In Sung Song; Joo Sung Kim Journal: Gut Date: 2011-03-22 Impact factor: 23.059
Authors: Andrew M D Wolf; Elizabeth T H Fontham; Timothy R Church; Christopher R Flowers; Carmen E Guerra; Samuel J LaMonte; Ruth Etzioni; Matthew T McKenna; Kevin C Oeffinger; Ya-Chen Tina Shih; Louise C Walter; Kimberly S Andrews; Otis W Brawley; Durado Brooks; Stacey A Fedewa; Deana Manassaram-Baptiste; Rebecca L Siegel; Richard C Wender; Robert A Smith Journal: CA Cancer J Clin Date: 2018-05-30 Impact factor: 508.702
Authors: Jaroslaw Regula; Maciej Rupinski; Ewa Kraszewska; Marcin Polkowski; Jacek Pachlewski; Janina Orlowska; Marek P Nowacki; Eugeniusz Butruk Journal: N Engl J Med Date: 2006-11-02 Impact factor: 91.245
Authors: Fabio Levi; Lalao Randimbison; Rafael Blanc-Moya; Manuela Maspoli-Conconi; Valentina Rosato; Cristina Bosetti; Carlo La Vecchia Journal: Int J Cancer Date: 2012-09-07 Impact factor: 7.396
Authors: Driss Ait Ouakrim; Cécile Pizot; Magali Boniol; Matteo Malvezzi; Mathieu Boniol; Eva Negri; Maria Bota; Mark A Jenkins; Harry Bleiberg; Philippe Autier Journal: BMJ Date: 2015-10-06