Details

Autor(en) / Beteiligte

• Lieberman, David
• Sullivan, Brian A.
• Hauser, Elizabeth R.
• Qin, Xuejun
• Musselwhite, Laura W.
• O’Leary, Meghan C.
• Redding, Thomas S.
• Madison, Ashton N.
• Bullard, A. Jasmine
• Thomas, Reana
• Sims, Kellie J.
• Williams, Christina D.
• Hyslop, Terry
• Weiss, David
• Gupta, Samir
• Gellad, Ziad F.
• Robertson, Douglas J.
• Provenzale, Dawn

Titel

Baseline Colonoscopy Findings Associated With 10-Year Outcomes in a Screening Cohort Undergoing Colonoscopy Surveillance

Ist Teil von

• Gastroenterology (New York, N.Y. 1943), 2020-03, Vol.158 (4), p.862-874.e8

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

ScienceDirect

Beschreibungen/Notizen

• 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. 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. 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. 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.