Postpolypectomy colonoscopy surveillance guidelines: Predictive accuracy for advanced adenoma at 4 years Journal Article


Authors: Laiyemo, A. O.; Murphy, G.; Albert, P. S.; Sansbury, L. B.; Wang, Z.; Cross, A. J.; Marcus, P. M.; Caan, B.; Marshall, J. R.; Lance, P.; Paskett, E. D.; Weissfeld, J.; Slattery, M. L.; Burt, R.; Iber, F.; Shike, M.; Kikendall, J. W.; Lanza, E.; Schatzkin, A.
Article Title: Postpolypectomy colonoscopy surveillance guidelines: Predictive accuracy for advanced adenoma at 4 years
Abstract: Background: Lack of confidence in postpolypectomy surveillance guidelines may be a factor in the observed low adherence rates among providers. Objective: To assess the 2006 postpolypectomy colonoscopy surveillance guidelines, which recommend 3-year follow-up colonoscopy for individuals with high-risk adenomas (defined as ≥3 adenomas or any advanced adenomas) and 5- to 10-year follow-up for patients with 2 or fewer nonadvanced adenomas, who are considered to be at low risk. Design: Analysis of prospective data from the Polyp Prevention Trial. Setting: United States. Participants: 1905 patients who had colorectal adenomas removed at baseline screening or diagnostic colonoscopy and completed the trial. Measurements: Baseline adenoma characteristics, risk-stratified according to definitions used in the guidelines, were examined as predictors for advanced adenoma recurrence. Results: 125 patients (6.6%) had advanced and 629 (33.0%) had nonadvanced adenoma recurrence; 1151 (60.4%) had no recurrence within 4 years of follow-up. The probability of advanced adenoma recurrence was 0.09 (95% CI, 0.07 to 0.11) among patients with high-risk adenomas at baseline and 0.05 (CI, 0.04 to 0.06) among those with low-risk adenomas at baseline. The relative risk for advanced adenoma recurrence for patients with high-risk adenomas versus those with low-risk adenomas at baseline was 1.68 (CI, 1.19 to 2.38) when advanced adenoma recurrence was compared with no advanced adenoma recurrence and 1.76 (CI, 1.26 to 2.46) when advanced adenoma recurrence was compared with no adenoma recurrence. The c-statistics for these 2 comparisons were 0.68 and 0.72, respectively. Limitation: Participants were self-selected and had restrictions on the degree of obesity. Conclusion: Although the risk for recurrence of advanced adenoma within 4 years is greater for patients with high-risk adenomas at baseline than for those with low-risk adenomas, the discrimination of this risk stratification scheme is relatively low.
Keywords: adult; controlled study; aged; middle aged; cancer surgery; major clinical study; clinical trial; cancer recurrence; advanced cancer; cancer risk; comparative study; follow up; prospective study; controlled clinical trial; neoplasm recurrence, local; randomized controlled trial; analytic method; practice guideline; time; time factors; risk assessment; colorectal neoplasms; confidence interval; standard; adenoma; colonoscopy; colorectal adenoma; multicenter study; colorectal tumor; tumor recurrence; practice guidelines as topic; colon polyp; colonic polyps; adenomatous polyp; adenomatous polyps
Journal Title: Annals of Internal Medicine
Volume: 148
Issue: 6
ISSN: 0003-4819
Publisher: American College of Physicians  
Date Published: 2008-03-18
Start Page: 419
End Page: 426
Language: English
PUBMED: 18347350
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 37" - "Export Date: 17 November 2011" - "CODEN: AIMEA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Moshe Shike
    168 Shike