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Endoscopy 1997; 29(7): 626-631
DOI: 10.1055/s-2007-1004268
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Invasive Carcinoma in Colorectal Adenomas: Multivariate Analysis of Patient and Adenoma Characteristics

G. Nusko1 , U. Mansmann5 , U. Partzsch5 , A. Altendorf-Hofmann4 , H. Groitl2 , C. Wittekind3 , C. Ell1 , E. G. Hahn1
  • 1Dept. of Medicine I, University of Erlangen, Germany
  • 2Dept. of Surgery, University of Erlangen, Germany
  • 3Dept. of Pathology, University of Erlangen, Germany
  • 4Tumor Registry, University of Erlangen, Germany
  • 5Institute of Medical Statistics, Free University of Berlin, Berlin, Germany
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Publication History

Publication Date:
17 March 2008 (online)

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Abstract

Background and Study Aims: The risk of invasive carcinoma developing in colorectal adenomas is influenced by a number of characteristics, relating both to the patients and to the adenomas, and by the composition of the sample analyzed. The aim of the present study was use a multivariate analysis to investigate the risk of invasive carcinoma in endoscopically and surgically removed adenomas.

Patients and Methods: Between 1978 and 1993, more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps. A multivariate analysis of 11,188 adenomas detected at the first total colonoscopy was carried out in order to investigate the risks associated with size and site - both of which can be assessed by endoscopic inspection alone - and the extent to which these may be modified by other patient and adenoma characteristics, with an influence on the risk of invasive carcinoma in colorectal adenomas.

Results: The size of the adenoma proved to be the most important influencing factor. Invasive carcinoma was never found in 5027 small adenomas (≤ 5 mm). Adenomas in the right colon had a lower risk than those in the left colon or rectum. But with increasing adenoma size, the malignancy rate showed a right-sided shift, with a significant interactive effect of size and right-sided location. However, the risk determined by the size and site of the adenoma was significantly modified by a number of patient and adenoma characteristics, including histological type, presence of multiple adenomas, and patient age and sex.

Conclusions: The risk of invasive carcinoma in colorectal adenomas can only be adequately described by a complex model of the interactive effects of patient and adenoma characteristics on the main factors of size and site.