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How to identify patients who are less likely to have metachronous neoplasms after a colon cancer: a predictive model.

Abstract：

BACKGROUND:Patients with prior colon cancer have increased risk of metachronous colorectal neoplasms; therefore, endoscopic surveillance is indicated. Current recommendations are not risk-stratified. We investigated predictive factors for colorectal neoplasms to build a model to spare colonoscopies for low-risk patients. METHODS:This was a multicenter, retrospective study including patients who underwent surgery for colon cancer in 2001 - 2008 (derivation cohort) and 2009 - 2013 (validation cohort). A predictive model for neoplasm occurrence at second surveillance colonoscopy was developed and validated. RESULTS:421 and 203 patients were included in derivation and validation cohort, respectively. At second surveillance colonoscopy, 112 (26.6 %) and 55 (27.1 %) patients had metachronous neoplasms in derivation and validation groups; three cancers were detected in the latter. History of left-sided colon cancer (OR 1.64, 95 %CI 1.02 - 2.64), ≥ 1 advanced adenoma at index colonoscopy (OR 1.90, 95 %CI 1.05 - 3.43), and ≥ 1 adenoma at first surveillance colonoscopy (OR 2.06, 95 %CI 1.29 - 3.27) were independently predictive of metachronous colorectal neoplasms at second surveillance colonoscopy. For patients without such risk factors, diagnostic accuracy parameters were: 89.3 % (95 %CI 82.0 %-94.3 %) and 78.2 % (95 %CI 65.0 %-88.2 %) sensitivity, and 28.5 % (95 %CI 23.5 %-33.9 %) and 33.8 % (95 %CI 26.2 %-42.0 %) specificity in derivation and validation group, respectively. No cancer would be missed. CONCLUSIONS:Patients with prior left-sided colon cancer or ≥ 1 advanced adenoma at index colonoscopy or ≥ 1 adenoma at first surveillance colonoscopy had a significantly higher risk of neoplasms at second surveillance colonoscopy; patients without such factors had much lower risk and could safely skip the second surveillance colonoscopy. A prospective, multicenter validation study is needed.

journal_name

Endoscopy

journal_title

Endoscopy

authors

Frazzoni L,Laterza L,Mussetto A,Zagari RM,Trovato C,De Bellis M,Paggi S,Piccirelli S,Ricciardiello L,Cesaro P,Spada C,Dal Piaz G,La Marca M,Fabbian F,Petrella L,Smania V,Marone P,Tatangelo F,Bazzoli F,Radaelli F,R

doi

10.1055/a-1041-2945

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

220-226

issue

eissn

0013-726X

issn

1438-8812

journal_volume

pub_type

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How to identify patients who are less likely to have metachronous neoplasms after a colon cancer: a predictive model.