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Endoscopy. 2016 Nov;48(11):995-1002. Epub 2016 Aug 2.

Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines.

Author information

1
Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Ourense, Spain.
2
Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
3
Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain.
4
Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain.
5
Programa Poblacional de Cribado de Cáncer Colorrectal, Dirección General de Salud Pública, Conselleria de Sanitat, Valencia, Spain.
6
Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Spain.
7
Servicio de Epidemiología y Evaluación, Parc de Salut Mar, IMIM, Barcelona, Spain.
8
Servicio de Gastroenterología, Parc de Salut Mar, IMIM, Barcelona, Spain.
9
Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
10
BioCruces, Hospital Universitario Cruces, Bizkaia, Spain.
11
Servicio de Gastroenterología, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain.
12
Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Vigo, Spain.
13
Servicio de Gastroenterología, Hospital Clínico Universitario San Carlos, Madrid, Spain.
14
Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain.
15
Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain.

Abstract

Background and study aims: The European guidelines for quality assurance in colorectal cancer (CRC) screening have established high-risk (≥ 5 adenomas or an adenoma ≥ 20 mm) and intermediate-risk (3 - 4 adenomas or at least one adenoma 10 - 19 mm in size, or villous histology, or high grade dysplasia) groups with different endoscopic surveillance intervals. The aim of this study was to evaluate the difference in the incidence of advanced neoplasia (advanced adenoma or CRC) between the two risk groups. Patients and methods: This retrospective group study included patients meeting high- or intermediate-risk criteria for adenomas detected in CRC screening programs and the COLONPREV study before European guidelines were adopted in Spain (June 2011) with a 3-year surveillance recommendation according to Spanish guidelines. The primary outcome measure was the incidence of advanced neoplasia in patients undergoing surveillance. The secondary outcome measure was the CRC incidence. We used an adjusted proportional hazards regression model to control confounding variables. Results: The study included 5401 patients (3379 intermediate risk, 2022 high risk). Endoscopic surveillance was performed in 65.5 % of the patients (2.8 ± 1 years). The incidence of advanced neoplasia in the high- and intermediate-risk groups was 16.0 % (59.0 cases/1000 patient-years) and 12.3 % (41.2 cases/1000 patient-years), respectively. The CRC incidence was 0.5 % (1.4 cases/1000 patient-years) and 0.4 % (1 case/1000 patient-years), respectively. The advanced neoplasia and CRC attributable risk to the high risk group was of 3.7 % and 0.1 %, respectively. In the proportional hazards analysis, the risk of advanced neoplasia was greater in the high-risk group (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2 - 1.8), with no significant differences in the CRC incidence (HR 1.6, 95 %CI 0.6 - 3.8). Conclusions: Patients meeting high-risk criteria have a higher incidence of advanced neoplasia during endoscopic surveillance. No differences were found in the CRC incidence at a 3-year surveillance recommendation.

Comment in

PMID:
27485482
DOI:
10.1055/s-0042-112571
[Indexed for MEDLINE]

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