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Colorectal Adenoma Characteristics as Predictors of Recurrence

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE

The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics of the three-year recurrence.

METHODS

The study population was composed of 552 patients with resected colorectal adenomas who completed the European Fiber-Calcium Intervention trial. At both baseline and three-year examinations, the characteristics of adenomas were recorded according to a standardized protocol. The main outcomes measured were the three-year overall recurrence, recurrence of multiple adenomas, recurrence of advanced adenomas (size ≥ 1 cm or tubulovillous/villous architecture or moderate/severe dysplasia), and proximal and distal recurrence.

RESULTS

A three-year recurrence was observed in 122 patients (22.1 percent), and more than one-half of them had recurrent adenomas on the proximal colon. After adjustment for patient characteristics and treatment allocation, the number of adenomas and their proximal location at baseline were the main predictors of recurrence. In comparison with patients who had one or two adenomas on the distal colon, patients with three or more adenomas with at least one of them located on the proximal colon had a much higher risk of overall recurrence (5.3; 95 percent confidence interval, 2.7–10.3), proximal recurrence (8.5; 95 percent confidence interval, 4.1–18), and advanced adenoma recurrence (5.5; 95 percent confidence interval, 2.4–12.6).

CONCLUSIONS

Follow-up colonoscopies in patients with adenomas should include careful examination of the proximal colon. The time interval between follow-up examinations could probably be extended beyond three years in patients who have only one or two distal adenomas.

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REFERENCES

  1. TJ Eide H Stalsberg (1978) ArticleTitlePolyps of the large intestine in Northern Norway Cancer 42 2839–48

    Google Scholar 

  2. RR Rickert O Auerbach L Garfinkel EC Hammond JM Frasca (1979) ArticleTitleAdenomatous polyps of the large bowel. An autopsy study Cancer 43 1847–57

    Google Scholar 

  3. MH Vatn H Stalsberg (1982) ArticleTitleThe prevalence of polyps of the large intestine in Oslo: an autopsy study Cancer 49 819–25

    Google Scholar 

  4. C Michiels J Faivre C Milan P Hillon C Klepping (1990) ArticleTitlePrévalence des adénomes rectocoliques: résultats d’une série autopsique en Côte d’Or Gastroenterol Clin Biol 14 A52

    Google Scholar 

  5. TJ Eide (1991) ArticleTitleNatural history of adenoma World J Surg 15 3–6

    Google Scholar 

  6. JD Hardcastle JO Chamberlain MH Robinson et al. (1996) ArticleTitleRandomised controlled trial of faecal-occult-blood screening for colorectal cancer Lancet 348 1742–77

    Google Scholar 

  7. O Kronborg C Fenger J Olsen OD Jorgensen O Sondergaard (1996) ArticleTitleRandomised study of screening for colorectal cancer with faecal-occult-blood test Lancet 348 1467–71

    Google Scholar 

  8. JS Mandel JH Bond TR Church et al. (1993) ArticleTitleReducing mortality from colorectal cancer by screening for fecal occult blood N Engl J Med 328 1365–71

    Google Scholar 

  9. SJ Winawer AG Zauber MN Ho et al. (1993) ArticleTitlePrevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup N Engl J Med 329 1977–81

    Google Scholar 

  10. OD Jorgensen O Kronborg C Fenger (1993) ArticleTitleThe Funen adenoma follow-up study. Incidence and death from colorectal carcinoma in an adenoma surveillance program Scand J Gastroenterol 28 869–74

    Google Scholar 

  11. F Citarda G Tomaselli R Capocaccia S Barcherini M Crespi (2001) ArticleTitlethe Multicentre Study Group. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence Gut 48 812–5

    Google Scholar 

  12. RU Stolk ParticleVan GJ Beck JA Baron R Haile R Summers (1998) ArticleTitleAdenoma characteristics at first colonoscopy as predictors of adenoma recurrence and characteristics at follow-up Gastroenterology 115 13–8

    Google Scholar 

  13. ME Martinez R Sampliner JR Marshall AK Bhattacharyya ME Reid DS Alberts (2000) ArticleTitleAdenoma characteristics as risk factors for recurrence of advanced adenomas Gastroenterology 120 1077–83

    Google Scholar 

  14. J Faivre C Couillault O Kronborg et al. (1997) ArticleTitleChemoprevention of metachronous adenomas of the large bowel: design and interim results of a randomised trial of calcium and fibre Eur J Cancer Prev 6 132–8

    Google Scholar 

  15. C Bonithon-Kopp O Kronborg A Giacosa U Rôth J Faivre (2000) ArticleTitleCalcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial Lancet 356 1300–6

    Google Scholar 

  16. MJ O’Brien SJ Winawer AG Zauber et al. (1990) ArticleTitleThe National Polyp study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas Gastroenterology 98 371–9

    Google Scholar 

  17. W Matek I Guggenmoos-Holzmann L Demling (1985) ArticleTitleFollow-up of patients with colorectal adenomas Endoscopy 17 175–81

    Google Scholar 

  18. I Kellokumpu A Husa (1987) ArticleTitleColorectal adenomas: morphologic features and the risk of developing metachronous adenomas and carcinomas in the colorectum Scand J Gastroenterol 22 833–41

    Google Scholar 

  19. SJ Winawer AG Zauber MJ O’Brien et al. (1993) ArticleTitleRandomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps N Engl J Med 328 901–6

    Google Scholar 

  20. AI Neugut JS Jacobson H Ahsan et al. (1995) ArticleTitleIncidence and recurrence rates of colorectal adenomas: a prospective study Gastroenterology 108 402–8

    Google Scholar 

  21. M Fornasarig M Valentini M Poletti et al. (1998) ArticleTitleEvaluation of the risk of metachronous colorectal neoplasms following intestinal polypectomy: a clinical, endoscopic and pathological study Hepatogastroenterology 45 1565–72

    Google Scholar 

  22. G Yang W Zheng QR Sun et al. (1998) ArticleTitlePathologic features of initial adenomas as predictors for metachronous adenomas of the rectum J Natl Cancer Inst 90 1661–5

    Google Scholar 

  23. KC Noshirwani RU Stolk Particlevan LA Rybicki GJ Beck (2000) ArticleTitleAdenoma size and number are predictive of adenoma recurrence: implications for surveillance colonoscopy Gastrointest Endosc 51 433–7

    Google Scholar 

  24. B Avidan A Sonnenberg TG Schnell J Leya A Metz SJ Sontag (2002) ArticleTitleNew occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy Am J Gastroenterol 97 1524–9

    Google Scholar 

  25. LG Henry RE Condon WJ Schulte C Aprahamian JJ DeCosse (1975) ArticleTitleRisk of recurrence of colon polyps Ann Surg 182 511–5

    Google Scholar 

  26. LJ Hixson MB Fennerty RE Sampliner D McGee H Garewal (1990) ArticleTitleProspective study of the frequency and size distribution of polyps missed by colonoscopy J Natl Cancer Inst 82 1769–72

    Google Scholar 

  27. DK Rex CS Cutler GT Lemmel et al. (1997) ArticleTitleColonoscopic miss rates of adenomas determined by back-to-back colonoscopies Gastroenterology 112 24–8

    Google Scholar 

  28. TJ Eide (1986) ArticleTitleRisk of colorectal cancer in adenoma-bearing individuals within a defined population Int J Cancer 38 173–6

    Google Scholar 

  29. BD Simons AS Morrison R Lev W Verhock-Oftedahl (1992) ArticleTitleRelationship of polyps to cancer of the large intestine J Natl Cancer Inst 84 962–6

    Google Scholar 

  30. WS Atkin BC Morson J Cuzick (1992) ArticleTitleLong-term risk of colorectal cancer after excision of rectosigmoid adenomas N Engl J Med 326 658–62

    Google Scholar 

  31. HT Lynch TC Smyrk P Watson et al. (1993) ArticleTitleGenetics, natural history, tumor spectrum, and pathology of hereditary nonpolyposis colorectal cancer: an updated review Gastroenterology 104 1535–49

    Google Scholar 

  32. J Faivre L Bedenne MC Boutron R Collonges (1989) ArticleTitleEpidemiological evidence for distinguishing subsites of colorectal cancers J Epidemiol Comm Health 43 356–61

    Google Scholar 

  33. C Bonithon-Kopp AM Benhamiche (1999) ArticleTitleAre there several colorectal cancers? Epidemiological data Eur J Cancer Prev 8 S3–12

    Google Scholar 

  34. M Toyota M Ohe-Toyota M Ahuja JP Issa (2000) ArticleTitleDistinct genetic profiles in colorectal tumors with and without the CpG island methylator phenotype Proc Natl Acad Sci U S A 97 710–5

    Google Scholar 

  35. SE Halford AJ Rowan L Lipton et al. (2003) ArticleTitleGermline mutations but not somatic changes at the MYH locus contribute to the pathogenesis of unselected colorectal cancers Am J Pathol 162 1545–8

    Google Scholar 

  36. OM Sieber L Lipton M Crabtree et al. (2003) ArticleTitleMultiple colorectal adenomas, classic adenomatous polyposis, and germ-line mutations in MYH N Engl J Med 348 845–7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Registre Bourguignon des Tumeurs Digestives (INSERM EPI 01-06), Faculté de Médecine de Dijon, Dijon, France

    C. Bonithon-Kopp M.D., F. Piard M.C. & J. Faivre M.D. for the European Cancer Prevention Organisation Study Group

  2. Department of Pathology, Odense University Hospital, Odense, Denmark

    C. Fenger M.D.

  3. Unitat Epidemiologia I, Universitat de les Illes Baleares, Palma de Mallorca, Spain

    E. Cabeza M.D.

  4. Gastroenterology Center, Tallaght, Dublin, Ireland

    C. O’Morain M.C.

  5. Department of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark

    O. Kronborg M.D.

Authors
  1. C. Bonithon-Kopp M.D.
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  2. F. Piard M.C.
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  3. C. Fenger M.D.
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  4. E. Cabeza M.D.
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  5. C. O’Morain M.C.
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  6. O. Kronborg M.D.
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  7. J. Faivre M.D. for the European Cancer Prevention Organisation Study Group
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Corresponding author

Correspondence to C. Bonithon-Kopp M.D..

Additional information

Other Investigators in the Study Group are listed in Appendix 1.

Supported by the Europe Against Cancer Programme, the Association Contre le Cancer (Brussels), the Association Luxembourgeoise Contre le Cancer, INSERM (France, grant 91-1002), the French Ministry of Health (PHRC), the Deutsches Krebsforschungzentrum, the Danish Cancer Society, the FISS (Spain), Hospital Supplies (Ireland), the University of Coimbra (Portugal), and Istituto Tumori Genova (Italy). The calcium and its placebo treatment were provided by Sandoz France. The fiber and its placebo treatment were provided by Reckitt and Coleman (United Kingdom).

Appendix 1

Appendix 1

Other European Cancer Prevention Organisation Study Group Investigators

Belgium: M. Buset; France: C. Belghiti, M. C. Boutron, B. Crespon, F. Doyon, J. Estève, A. M. Justum, J. L. Legoux, C. Milan, B. Paillot, P. Pienkowski, J. F. Seitz; Germany: W. Matek, R. W. Owen, U. Räth, F. Richter, J. Rudi, I. Wankműller; Ireland: M. Buckley; Israel: P. Rozen; Italy: R. Andreatta, A. Giacosa, B. Omazzi, A. Prada, G. C. Sturniolo, A. Zambelli; Portugal: H. Salhandra De Oliveira, L. Santos; Spain: J. Boadas, A. Obrador, J. Pujol; United Kingdom: M. Hill, C. Marks, G. Kerr

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Bonithon-Kopp, C., Piard, F., Fenger, C. et al. Colorectal Adenoma Characteristics as Predictors of Recurrence. Dis Colon Rectum 47, 323–333 (2004). https://doi.org/10.1007/s10350-003-0054-1

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  • DOI: https://doi.org/10.1007/s10350-003-0054-1

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