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ARTICLE

Postpolypectomy Colonoscopy Surveillance Guidelines: Predictive Accuracy for Advanced Adenoma at 4 Years

right arrow Adeyinka O. Laiyemo, MD, MPH; Gwen Murphy, PhD, MPH; Paul S. Albert, PhD; Leah B. Sansbury, PhD; Zhuoqiao Wang, MS; Amanda J. Cross, PhD; Pamela M. Marcus, PhD; Bette Caan, DrPH; James R. Marshall, PhD; Peter Lance, MD; Electra D. Paskett, PhD; Joel Weissfeld, MD, MPH; Martha L. Slattery, PhD; Randall Burt, MD; Frank Iber, MD; Moshe Shike, MD; J. Walter Kikendall, MD; Elaine Lanza, PhD; and Arthur Schatzkin, MD, DrPH

18 March 2008 | Volume 148 Issue 6 | Pages 419-426

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.


Editors' Notes
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Context

  • Guidelines for surveillance colonoscopy after removing a colon polyp recommend more frequent surveillance after a high-risk finding at baseline (an advanced adenoma or ≥3 adenomas).

Contribution

  • The authors studied 1905 patients who had an adenoma at baseline colonoscopy and had follow-up colonoscopy at 1 year and 4 years. Overall, 6.6% had an advanced adenoma—considered to be high risk to become malignant—at 4 years. The advanced adenoma rates were 9% and 5% in patients with high-risk and low-risk adenomas at baseline colonoscopy, respectively.

Implication

  • The characteristics of an adenoma are not a reliable guide to the probability of recurrence of an advanced adenoma.

—The Editors

 

Author and Article Information
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From the National Cancer Institute, National Institutes of Health, Bethesda, Maryland; Information Management Services, Rockville, Maryland; Kaiser Foundation Research Institute, Oakland, California; Roswell Park Cancer Institute, Buffalo, New York; Arizona Cancer Center, Tucson, Arizona; Ohio State University Comprehensive Cancer Center, Columbus, Ohio; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Utah, Salt Lake City, Utah; Edward Hines Jr. Hospital Veterans Affairs Medical Center, Hines, Illinois; Memorial Sloan-Kettering Cancer Center, New York, New York; and Walter Reed Army Medical Center, Washington, DC.

Grant Support: By the Intramural Research Program of the National Cancer Institute, National Institutes of Health.

Potential Financial Conflicts of Interest: Consultancies: R. Burt (Myriad Genetics), M. Shike (Stryker). Stock ownership or options (other than mutual funds): M. Shike (Stryker).

Reproducible Research Statement: Study protocol: Not available. Statistical code: Available to interested readers by contacting Dr. Laiyemo (e-mail, laiyemoa{at}mail.nih.gov). Data set: Not available.

Requests for Single Reprints: Adeyinka O. Laiyemo, MD, MPH, Cancer Prevention Fellowship Program, Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, 6130 Executive Boulevard, Suite 3121, Bethesda, MD 20892; e-mail, laiyemoa{at}mail.nih.gov.

Current Author Addresses: Dr. Laiyemo: National Cancer Institute, 6130 Executive Boulevard, Suite 3121, Bethesda, MD 20892.

Dr. Murphy: National Cancer Institute, 6120 Executive Boulevard, Suite 7067, Bethesda, MD 20892.

Dr. Albert: National Cancer Institute, 6130 Executive Boulevard, Suite 8136, Bethesda, MD 20892.

Dr. Sansbury: National Cancer Institute, 6130 Executive Boulevard, Suite 5106, Bethesda, MD 20892.

Mr. Wang: Information Management Services Inc., 12501 Prosperity Drive, Silver Spring, MD 20904.

Dr. Cross: National Cancer Institute, 6120 Executive Boulevard, Suite 3050, Bethesda, MD 20892.

Dr. Marcus: National Cancer Institute, 6130 Executive Boulevard, Suite 3131, Bethesda, MD 20892.

Dr. Caan: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612.

Dr. Marshall: Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263.

Dr. Lance: Arizona Cancer Center, 1515 North Campbell, Tucson, AZ 85724.

Dr. Paskett: The Ohio State University, Comprehensive Cancer Center, A356 Starling Loving, 320 West 10th Avenue, Columbus, OH 43210.

Dr. Weissfeld: Department of Epidemiology, Suite 510, Keystone Building, University of Pittsburgh, Pittsburgh, PA 15261.

Dr. Slattery: University of Utah, 375 Chipeta Way, Salt Lake City, UT 84108.

Dr. Burt: Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112.

Dr. Iber: Edward Hines Jr. Hospital Veterans Affairs Medical Center, 5th and Roosevelt Road, Hines, IL 60141.

Dr. Shike: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.

Dr. Kikendall: Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307.

Dr. Lanza: National Cancer Institute, 6116 Executive Boulevard, Suite 702, Bethesda, MD 20892.

Dr. Schatzkin: National Cancer Institute, 6120 Executive Boulevard, Suite 3040, Bethesda, MD 20892.

Author Contributions: Conception and design: A.O. Laiyemo, L.B. Sansbury, J.R. Marshall, P. Lance, M. Shike, J.W. Kikendall, E. Lanza, A. Schatzkin.

Analysis and interpretation of the data: A.O. Laiyemo, G. Murphy, P.S. Albert, L.B. Sansbury, Z. Wang, J.R. Marshall, P. Lance, M. Shike, E. Lanza.

Drafting of the article: A.O. Laiyemo, G. Murphy, L.B. Sansbury, P.M. Marcus, A. Schatzkin.

Critical revision of the article for important intellectual content: A.O. Laiyemo, G. Murphy, P.S. Albert, L.B. Sansbury, Z. Wang, A.J. Cross, P.M. Marcus, J.R. Marshall, P. Lance, E.D. Paskett, J. Weissfeld, M.L. Slattery, F. Iber, J.W. Kikendall, E. Lanza, A. Schatzkin.

Final approval of the article: A.O. Laiyemo, G. Murphy, P.S. Albert, L.B. Sansbury, Z. Wang, A.J. Cross, P.M. Marcus, B. Caan, J.R. Marshall, P. Lance, E.D. Paskett, J. Weissfeld, M.L. Slattery, R. Burt, F. Iber, M. Shike, J.W. Kikendall, E. Lanza, A. Schatzkin.

Provision of study materials or patients: B. Caan, E.D. Paskett, J. Weissfeld, M.L. Slattery, R. Burt, F. Iber, M. Shike, J.W. Kikendall.

Statistical expertise: A.O. Laiyemo, P.S. Albert, Z. Wang, J. Weissfeld.

Obtaining of funding: B. Caan, P. Lance, E.D. Paskett, R. Burt, M. Shike, E. Lanza, A. Schatzkin.

Administrative, technical, or logistic support: A.J. Cross, E.D. Paskett, M. Shike, J.W. Kikendall, E. Lanza, A. Schatzkin.

Collection and assembly of data: B. Caan, P. Lance, R. Burt, M. Shike, J.W. Kikendall, E. Lanza, A. Schatzkin.

 

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