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Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance.
Gastroenterology. 2020 03; 158(4):862-874.e8.G

Abstract

BACKGROUND & AIMS

Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes.

METHODS

We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia by Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination after baseline, adjusting for multiple colonoscopies within individuals.

RESULTS

Through 10 years of follow-up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI 13.0%-74.4%), followed by those with baseline advanced adenoma (AA) (21.9%; 95% CI 15.7-28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI 4.1%-8.5%) and 4.1% (95% CI 2.7%-5.4%) for baseline 1 to 2 small adenomas (<1cm, and without villous histology or high-grade dysplasia) and no neoplasia, respectively (log-rank P = .10). After adjusting for prior surveillance, the risk of advanced neoplasia at each subsequent examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio 0.96; 95% CI 0.67-1.41) compared with veterans with no baseline neoplasia.

CONCLUSIONS

Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, could be considered for these individuals.

Authors+Show Affiliations

VA Portland Health Care System, Portland, Oregon; Oregon Health & Science University, Portland, Oregon.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.Perry Point Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point, Maryland.San Diego VA Medical Center, San Diego, California; University of California San Diego, San Diego, California.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina.White River Junction VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire.Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina; Duke University, Durham, North Carolina. Electronic address: dawn.provenzale@va.gov.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31376388

Citation

Lieberman, David, et al. "Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance." Gastroenterology, vol. 158, no. 4, 2020, pp. 862-874.e8.
Lieberman D, Sullivan BA, Hauser ER, et al. Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance. Gastroenterology. 2020;158(4):862-874.e8.
Lieberman, D., Sullivan, B. A., Hauser, E. R., Qin, X., Musselwhite, L. W., O'Leary, M. C., Redding, T. S., Madison, A. N., Bullard, A. J., Thomas, R., Sims, K. J., Williams, C. D., Hyslop, T., Weiss, D., Gupta, S., Gellad, Z. F., Robertson, D. J., & Provenzale, D. (2020). Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance. Gastroenterology, 158(4), 862-e8. https://doi.org/10.1053/j.gastro.2019.07.052
Lieberman D, et al. Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance. Gastroenterology. 2020;158(4):862-874.e8. PubMed PMID: 31376388.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance. AU - Lieberman,David, AU - Sullivan,Brian A, AU - Hauser,Elizabeth R, AU - Qin,Xuejun, AU - Musselwhite,Laura W, AU - O'Leary,Meghan C, AU - Redding,Thomas S,4th AU - Madison,Ashton N, AU - Bullard,A Jasmine, AU - Thomas,Reana, AU - Sims,Kellie J, AU - Williams,Christina D, AU - Hyslop,Terry, AU - Weiss,David, AU - Gupta,Samir, AU - Gellad,Ziad F, AU - Robertson,Douglas J, AU - Provenzale,Dawn, Y1 - 2019/07/31/ PY - 2019/04/04/received PY - 2019/07/25/revised PY - 2019/07/29/accepted PY - 2019/8/4/pubmed PY - 2020/4/23/medline PY - 2019/8/4/entrez KW - Cancer Prevention KW - Colon Cancer KW - Prognostic Factors KW - Tumor SP - 862 EP - 874.e8 JF - Gastroenterology JO - Gastroenterology VL - 158 IS - 4 N2 - BACKGROUND & AIMS: Few studies have evaluated long-term outcomes of ongoing colonoscopic screening and surveillance in a screening population. We aimed to determine the 10-year risk for advanced neoplasia (defined as adenomas ≥10mm, adenomas with villous histology or high-grade dysplasia, or colorectal cancer [CRC]) and assessed whether baseline colonoscopy findings were associated with long-term outcomes. METHODS: We collected data from the Department of Veterans Affairs Cooperative Studies Program Study on 3121 asymptomatic veterans (50-75 years old) who underwent a screening colonoscopy from 1994 through 1997 at 13 medical centers and were then followed for 10 years or until death. We included 1915 subjects with at least 1 surveillance colonoscopy and estimated cumulative incidence of advanced neoplasia by Kaplan-Meier curves. We then fit a longitudinal joint model to estimate risk of advanced neoplasia at each subsequent examination after baseline, adjusting for multiple colonoscopies within individuals. RESULTS: Through 10 years of follow-up, there were 146 individuals among all baseline colonoscopy groups found to have at least 1 incident advanced neoplasia. The cumulative 10-year incidence of advanced neoplasia was highest among those with baseline CRC (43.7%; 95% CI 13.0%-74.4%), followed by those with baseline advanced adenoma (AA) (21.9%; 95% CI 15.7-28.1). The cumulative 10-year incidence of advanced neoplasia was 6.3% (95% CI 4.1%-8.5%) and 4.1% (95% CI 2.7%-5.4%) for baseline 1 to 2 small adenomas (<1cm, and without villous histology or high-grade dysplasia) and no neoplasia, respectively (log-rank P = .10). After adjusting for prior surveillance, the risk of advanced neoplasia at each subsequent examination was not significantly increased in veterans with 1 or 2 small adenomas at baseline (odds ratio 0.96; 95% CI 0.67-1.41) compared with veterans with no baseline neoplasia. CONCLUSIONS: Baseline screening colonoscopy findings associate with advanced neoplasia within 10 years. Individuals with only 1 or 2 small adenomas at baseline have a low risk of advanced neoplasia over 10 years. Alternative surveillance strategies, could be considered for these individuals. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/31376388/Baseline_Colonoscopy_Findings_Associated_With_10_Year_Outcomes_in_a_Screening_Cohort_Undergoing_Colonoscopy_Surveillance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(19)41149-9 DB - PRIME DP - Unbound Medicine ER -