Endoscopy 2020; 52(S 01): S7-S8
DOI: 10.1055/s-0040-1704032
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 10:30 – 12:00 Colorectal Cancer (CRC) Screening (WEO-ESGE joint session) Ecocem Room
© Georg Thieme Verlag KG Stuttgart · New York

IMPACT OF LESION PHENOTYPE ON COLORECTAL CANCER MORTALITY AND OVERALL MORTALITY: INSIGHTS FROM A NATIONWIDE SCREENING COLONOSCOPY PROGRAM

E Waldmann
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
3   Harvard T.H. Chan School of Public Heath, Dept. of Biostatistics, Boston, United States of America
,
A Kammerlander
4   Massachusetts General Hospital and Harvard Medical School, Cardiovascular Imaging Research Center, Boston, United States of America
,
D Penz
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
,
A Hinterberger
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
,
B Majcher
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
,
M Trauner
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
,
M Ferlitsch
1   Medical University of Vienna, Dept. of Internal Medicine III, Div. of Gastroenterology and Hepatology, Vienna, Austria
2   Austrian Society for Gastroenterology and Hepatology, Quality Assurance Working Group, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims The long-term risk of colorectal cancer (CRC) mortality and overall mortality after screening colonoscopy is poorly investigated. Most studies analyzed mixed cohorts of screening individuals, and symptomatic or individuals with positive fecal immunhistochemical testing.

    The aim of this study was to analyze CRC mortality and overall mortality after screening colonoscopy by lesion phenotype.

    Methods Screening colonoscopies performed within the quality assurance program in Austria between 11/2007 and 06/2018 were matched with a national mortality register. The following lesion phenotypes were defined: 1) negative colonoscopy, 2) low-risk adenoma, 3) high-risk adenoma, 4) hyperplastic polyps, and 5) serrated lesions.

    Age and sex adjusted Cox regression analyses were used to analyze the association between lesion phenotypes, CRC mortality and overall mortality.

    Results 280,291 screening colonoscopies were included in the study. 7,311 deaths of any cause occurred after 55±35.6 months of follow-up, 4,730 men and 2,581women. Overall mortality rates, adjusted for age and sex, were significantly higher for individuals with high-risk adenomas (HR 1.6, 95%CI 1.5-1.7, p< 0.01), low-risk adenomas (HR 1.1, 95%CI 1.0-1.7, p=0.006), and hyperplastic polyps (HR 1.1, 95%CI 1.0-1.2, p=0.004), but not for serrated lesions (HR 1.2, 95%CI 1.0-1.5, p=0.083), compared to negative colonoscopy.

    Among a total of 232 CRC deaths (ICD 10: C19-21), 156 were observed in men and 76 in women. High-risk adenomas (HR 8.9, 95%CI 6.5-12.1, p< 0.001) and serrated lesions (HR 4.3, 95%CI 1.9-10.0, p=0.001), but not for low-risk lesions (HR 1.3, 95%CI 0.8-2.1, p=0.350) and hyperplastic polyps (HR 1.5, 95%CI 0.9-2.4, p=0.138) were at higher risk for CRC death as compared to negative colonoscopy.

    Conclusions In individuals undergoing colonoscopy, the lesion phenotype is significantly associated with both CRC-related and all-cause mortality.


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