Validation Study of U.S. Guideline of Surveillance Colonoscopy for Colorectal Cancer Using Asian Population 260

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S149 - S150
• Main Authors: Omata, Fumio, Ishii, Naoki, Kumakura, Yasuhisa, Fukuda, Katsuyuki, Fujita, Yoshiyuki, Masuda, Katsunori
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Colonoscopy; Colorectal cancer; Family medical history; Gastroenterology; Health surveillance; Risk factors; Tumors
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-00260

Introduction: According to 2012 U. S. Multi-Society Task Force for Colorectal Cancer (CRC) surveillance guidelines, interval of screening or surveillance colonoscopy should be decided by base-line colonoscopy findings in average risk patients. Advanced adenoma (adenoma more than 10mm or high-grade dysplasia (HGD) or villous adenoma) is used as surrogate marker for risk evaluation of adenocarcinoma. The aim of this study was to determine risk factors for post-colonoscopy advanced adenoma (PCAA) to validate surveillance guideline. Methods: A retrospective cohort study was conducted in a center of preventive medicine and affiliated tertiary referral center in Tokyo, Japan. Consecutive 2099 individuals underwent initial diagnostic or screening colonoscopy between January 2004 and November 2009 and had at least one another colonoscopy. There was no patient with history of familial polyposis or inflammatory bowel disease. Baseline data included age, gender, height, weight, and family history of CRC in their IstDR, and smoking history, and initial colonoscopy findings (number of adenoma, maximum size of adenoma, HGD, villous adenoma). To determine risk factors for PCAA, we calculated Kaplan-Meier estimates within 5 years' horizon and performed multiple regression analysis using Cox proportional hazards model. Results: Mean age [SD] of 2099 patients was 55 [II] years and 1490 patients (71%) were male. At the initial colonoscopy, 961 patients were diagnosed with no colorectal neoplasia (clean colon) whilell38 patients (54%) were diagnosed with colorectal neoplasia (non-clean colon). The cumulative incidence [95%CI] of AA at 3 years after colonoscopy of clean colon group and non-clean colon group was 3.2% [1.6-4.8] and 9.4% [7-12], respectively. Adjusted hazard ratio (HR) [95%CI] of age, male gender, current smoking, family history of colorectal cancer in T'DR, non-clean colon was 1.1 [1.03-1.07], 1.2 [0.75-1.99], 1.52 [0.94-2.4], 0.69 [0.27-1.44], and 2.6 [1.7-4.3], respectively. In subgroup analysis using non-clean colon group, adjusted HR [95%CI] of age, more than 3 adenoma, maximum diameter of adenoma > 10mm was 1.03 [1.01-1.05], 1.22 [0.74-1.98], and 2.2 [1.37-3.5], respectively. Conclusion: Non-clean colon was a significant risk factor for AA in 5 years' horizon. The cut-off number of adenoma of 3 was not statistically significant risk factor for AA, but at least one adenoma with maximum diameter >=10mm was a significant risk factor for AA in non-clean colon.