Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines
Por:
Cubiella J, Carballo F, Portillo I, Cruzado Quevedo J, Salas D, Binefa G, Milà N, Hernández C, Andreu M, Terán Á, Arana-Arri E, Ono A, Valverde MJ, Bujanda L, Hernández V, Morillas JD, Jover R and Castells A
Publicada:
1 nov 2016
Ahead of Print:
2 ago 2016
Categoría:
Gastroenterology
Resumen:
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 10-19mm 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.
Filiaciones:
Cubiella J:
Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Ourense, Spain
Carballo F:
Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Portillo I:
Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain
Cruzado Quevedo J:
Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain
:
Programa Poblacional de Cribado de Cáncer Colorrectal, Dirección General de Salud Pública, Conselleria de Sanitat, Valencia, Spain
Binefa G:
Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Spain
Milà N:
Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L'Hospitalet de Llobregat, Spain
Hernández C:
Servicio de Epidemiología y Evaluación, Parc de Salut Mar, IMIM, Barcelona, Spain
Andreu M:
Servicio de Gastroenterología, Parc de Salut Mar, IMIM, Barcelona, Spain
Terán Á:
Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Arana-Arri E:
BioCruces, Hospital Universitario Cruces, Bizkaia, Spain
Ono A:
Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
Valverde MJ:
Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain
Bujanda L:
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
Hernández V:
Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Vigo, Spain
Morillas JD:
Servicio de Gastroenterología, Hospital Clínico Universitario San Carlos, Madrid, Spain
Jover R:
Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
Castells A:
Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain
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