Predictors of Metachronous Risk Polyps After Index Colonoscopy

We included patients with high-risk lesions (HRLs), defined as advanced adenoma (AA), large serrated polyps (SPs), and multiplicity (≥3 of any adenomas/SPs). Data on age, sex, cardiovascular risk factors, pharmacological treatment, and the histological characteristics in each individual, and mutatio...

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Authors: Carot, Laura|||0000-0001-6507-9571, Navarro Viu, Gemma|||0000-0001-7906-5437, Naranjo-Hans, Dolores|||0000-0002-4089-047X, Iglesias, Mar|||0000-0002-2274-4671, Dalmases, Alba, Fernández Ibarrondo, Lierni|||0000-0003-2612-0484, Seoane, Agustín|||0000-0001-8023-4445, Buron, Andrea|||0000-0003-3590-1303, Bellosillo Paricio, Beatriz|||0000-0002-5335-2726, Bessa Caserras, Xavier|||0000-0003-4680-1228, Andreu, Montserrat|||0000-0003-4286-1098, Alvarez-Urturi, Cristina|||0000-0002-7305-9973
Format: article
Publication Date:2021
Country:España
Institution:Universitat Autònoma de Barcelona
Repository:Dipòsit Digital de Documents de la UAB
Language:English
OAI Identifier:oai:ddd.uab.cat:237190
Online Access:https://ddd.uab.cat/record/237190
https://dx.doi.org/urn:doi:10.14309/ctg.0000000000000304
Access Level:Open access
Keyword:Adenoma
Epidemiology
Colonic Neoplasms
Colonic Polyps
Colonoscopy
Risk Assessment
Description
Summary:We included patients with high-risk lesions (HRLs), defined as advanced adenoma (AA), large serrated polyps (SPs), and multiplicity (≥3 of any adenomas/SPs). Data on age, sex, cardiovascular risk factors, pharmacological treatment, and the histological characteristics in each individual, and mutations in genes involved in the most advanced index polyp, were collected. Parameters independently associated with a metachronous HRL diagnosis were evaluated through univariate and multivariate analyses. The results are reported as odds ratios and 95% confidence intervals along with P values. A total of 537 cases (median age: 60.7 years; 66% male) were included. Dyslipidemia and smoking correlated with metachronous HRLs. Multivariate logistic regression analysis showed that the presence of multiplicity with ≥3 polyps on the index colonoscopy was significantly associated with metachronous HRL, AA, proximal AA, and ≥3 polyps at 3 years. In addition, independent predictors of metachronous proximal AA were increasing age, female sex, and the loss of expression of the MLH1 protein. Multiplicity was a strong predictor of HRLs at 3 years, although the inclusion of other clinical variables (age, sex, smoking status, and dyslipidemia) improves surveillance recommendations. Without these risk factors, the surveillance could be extended to 5 years; we propose examining the somatic expression of MHL1 in all patients.

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