How to identify patients who are less likely to have metachronous neoplasms after a colon cancer: a predictive model.
Endoscopy
; 52(3): 220-226, 2020 03.
Article
em En
| MEDLINE
| ID: mdl-31858510
ABSTRACT
BACKGROUND:
Patients with prior colon cancer have increased risk of metachronous colorectal neoplasms; therefore, endoscopic surveillance is indicated. Current recommendations are not risk-stratified. We investigated predictive factors for colorectal neoplasms to build a model to spare colonoscopies for low-risk patients.METHODS:
This was a multicenter, retrospective study including patients who underwent surgery for colon cancer in 2001â-â2008 (derivation cohort) and 2009â-â2013 (validation cohort). A predictive model for neoplasm occurrence at second surveillance colonoscopy was developed and validated.RESULTS:
421 and 203 patients were included in derivation and validation cohort, respectively. At second surveillance colonoscopy, 112 (26.6â%) and 55 (27.1â%) patients had metachronous neoplasms in derivation and validation groups; three cancers were detected in the latter. History of left-sided colon cancer (OR 1.64, 95â%CI 1.02â-â2.64), ≥â1 advanced adenoma at index colonoscopy (OR 1.90, 95â%CI 1.05â-â3.43), and ≥â1 adenoma at first surveillance colonoscopy (OR 2.06, 95â%CI 1.29â-â3.27) were independently predictive of metachronous colorectal neoplasms at second surveillance colonoscopy. For patients without such risk factors, diagnostic accuracy parameters were 89.3â% (95â%CI 82.0â%-94.3â%) and 78.2â% (95â%CI 65.0â%-88.2â%) sensitivity, and 28.5â% (95â%CI 23.5â%-33.9â%) and 33.8â% (95â%CI 26.2â%-42.0â%) specificity in derivation and validation group, respectively. No cancer would be missed.CONCLUSIONS:
Patients with prior left-sided colon cancer or ≥â1 advanced adenoma at index colonoscopy or ≥â1 adenoma at first surveillance colonoscopy had a significantly higher risk of neoplasms at second surveillance colonoscopy; patients without such factors had much lower risk and could safely skip the second surveillance colonoscopy. A prospective, multicenter validation study is needed.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
/
Segunda Neoplasia Primária
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Neoplasias do Colo
Tipo de estudo:
Etiology_studies
/
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article