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Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans.
Gut. 2011 Nov; 60(11):1537-43.Gut

Abstract

OBJECTIVE

Postpolypectomy surveillance guidelines for colorectal cancer introduced the concept of 'risk stratification'; however, few studies have been conducted for validation of its usefulness. The aim of this study was to assess the 5-year incidence of advanced neoplasia recurrence based on the risk stratification scheme of the guidelines and to identify its risk factors.

METHODS

A prospective study of surveillance colonoscopy after screening colonoscopy was carried out at the Seoul National University Hospital Healthcare System Gangnam Center. 3803 asymptomatic Koreans aged 50-69 were enrolled prospectively and 5-year cumulative adenoma rates were analysed according to three risk groups: normal (no baseline adenoma), low-risk (1-2 adenomas <10 mm) and high-risk (an advanced adenoma or ≥ 3 adenomas) groups. The RR was computed by HR using Cox proportional regression after multivariate adjustments. The primary outcome was the 5-year cumulative rate of recurrent advanced adenoma in each risk category and the secondary outcome was its predictive factors.

RESULTS

Among 3803 subjects enrolled between 2003 and 2005, 2452 were followed-up within 5 years: 1242, 671 and 539 in the normal, low-risk and high-risk groups, respectively. Compared with the normal group, the low-risk group had a sufficiently low 5-year incidence and did not show an increased risk for subsequent advanced adenoma (2.4% vs 2.0%, HR=1.14, 95% CI 0.61 to 2.17). Conversely, a significantly higher 5-year rate (12.2%) and early recurrence (4.6, 7.4 and 9.6% at 1, 2 and 3 years) of advanced adenoma were revealed in the high-risk group. Among various patients and adenoma characteristics, only high-risk adenoma (HR=5.95, 95% CI 3.66 to 9.68) along with a number of ≥ 3 (HR=3.06, 95% CI 1.51 to 6.57) and size ≥ 10 mm (HR=3.02, 95% CI 1.80 to 5.06) were independent predictors.

CONCLUSIONS

The surveillance interval for low-risk patients could be extended beyond 5 years. Colonoscopic surveillance should be targeted to high-risk patients, and 3-year follow-up after initial polypectomy may be appropriate.

Authors+Show Affiliations

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21427200

Citation

Chung, Su Jin, et al. "Five-year Risk for Advanced Colorectal Neoplasia After Initial Colonoscopy According to the Baseline Risk Stratification: a Prospective Study in 2452 Asymptomatic Koreans." Gut, vol. 60, no. 11, 2011, pp. 1537-43.
Chung SJ, Kim YS, Yang SY, et al. Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. Gut. 2011;60(11):1537-43.
Chung, S. J., Kim, Y. S., Yang, S. Y., Song, J. H., Kim, D., Park, M. J., Kim, S. G., Song, I. S., & Kim, J. S. (2011). Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. Gut, 60(11), 1537-43. https://doi.org/10.1136/gut.2010.232876
Chung SJ, et al. Five-year Risk for Advanced Colorectal Neoplasia After Initial Colonoscopy According to the Baseline Risk Stratification: a Prospective Study in 2452 Asymptomatic Koreans. Gut. 2011;60(11):1537-43. PubMed PMID: 21427200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Five-year risk for advanced colorectal neoplasia after initial colonoscopy according to the baseline risk stratification: a prospective study in 2452 asymptomatic Koreans. AU - Chung,Su Jin, AU - Kim,Young Sun, AU - Yang,Sun Young, AU - Song,Ji Hyun, AU - Kim,Donghee, AU - Park,Min Jung, AU - Kim,Sang Gyun, AU - Song,In Sung, AU - Kim,Joo Sung, Y1 - 2011/03/22/ PY - 2011/3/24/entrez PY - 2011/3/24/pubmed PY - 2012/1/19/medline SP - 1537 EP - 43 JF - Gut JO - Gut VL - 60 IS - 11 N2 - OBJECTIVE: Postpolypectomy surveillance guidelines for colorectal cancer introduced the concept of 'risk stratification'; however, few studies have been conducted for validation of its usefulness. The aim of this study was to assess the 5-year incidence of advanced neoplasia recurrence based on the risk stratification scheme of the guidelines and to identify its risk factors. METHODS: A prospective study of surveillance colonoscopy after screening colonoscopy was carried out at the Seoul National University Hospital Healthcare System Gangnam Center. 3803 asymptomatic Koreans aged 50-69 were enrolled prospectively and 5-year cumulative adenoma rates were analysed according to three risk groups: normal (no baseline adenoma), low-risk (1-2 adenomas <10 mm) and high-risk (an advanced adenoma or ≥ 3 adenomas) groups. The RR was computed by HR using Cox proportional regression after multivariate adjustments. The primary outcome was the 5-year cumulative rate of recurrent advanced adenoma in each risk category and the secondary outcome was its predictive factors. RESULTS: Among 3803 subjects enrolled between 2003 and 2005, 2452 were followed-up within 5 years: 1242, 671 and 539 in the normal, low-risk and high-risk groups, respectively. Compared with the normal group, the low-risk group had a sufficiently low 5-year incidence and did not show an increased risk for subsequent advanced adenoma (2.4% vs 2.0%, HR=1.14, 95% CI 0.61 to 2.17). Conversely, a significantly higher 5-year rate (12.2%) and early recurrence (4.6, 7.4 and 9.6% at 1, 2 and 3 years) of advanced adenoma were revealed in the high-risk group. Among various patients and adenoma characteristics, only high-risk adenoma (HR=5.95, 95% CI 3.66 to 9.68) along with a number of ≥ 3 (HR=3.06, 95% CI 1.51 to 6.57) and size ≥ 10 mm (HR=3.02, 95% CI 1.80 to 5.06) were independent predictors. CONCLUSIONS: The surveillance interval for low-risk patients could be extended beyond 5 years. Colonoscopic surveillance should be targeted to high-risk patients, and 3-year follow-up after initial polypectomy may be appropriate. SN - 1468-3288 UR - https://www.unboundmedicine.com/medline/citation/21427200/Five_year_risk_for_advanced_colorectal_neoplasia_after_initial_colonoscopy_according_to_the_baseline_risk_stratification:_a_prospective_study_in_2452_asymptomatic_Koreans_ L2 - https://gut.bmj.com/lookup/pmidlookup?view=long&amp;pmid=21427200 DB - PRIME DP - Unbound Medicine ER -