Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines

Joaquín Cubiella; Fernando Carballo; Isabel Portillo; José Cruzado Quevedo; Dolores Salas; Gemma Binefa; Núria Milà; Cristina Hernández; Montse Andreu; Álvaro Terán; Eunate Arana-Arri; Akiko Ono; María José Valverde; Luis Bujanda; Vicent Hernández; Juan Diego Morillas; Rodrigo Jover; Antoni Castells

doi:10.1055/s-0042-112571

Endoscopy, Table of Contents

Endoscopy 2016; 48(11): 995-1002
DOI: 10.1055/s-0042-112571

Original article

Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines

Joaquín Cubiella

¹Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Ourense, Spain

,

Fernando Carballo

²Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

,

Isabel Portillo

³Colorectal Cancer Screening Programme Coordinating Centre, Basque Health Service, Bizkaia, Spain

,

José Cruzado Quevedo

⁴Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain

,

Dolores Salas

⁵Programa Poblacional de Cribado de Cáncer Colorrectal, Dirección General de Salud Pública, Conselleria de Sanitat, Valencia, Spain

,

Gemma Binefa

⁶Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L’Hospitalet de Llobregat, Spain

,

Núria Milà

⁶Programa de Prevención y Control del Cáncer, Instituto Catalán de Oncología-IDIBELL, L’Hospitalet de Llobregat, Spain

,

Cristina Hernández

⁷Servicio de Epidemiología y Evaluación, Parc de Salut Mar, IMIM, Barcelona, Spain

,

Montse Andreu

⁸Servicio de Gastroenterología, Parc de Salut Mar, IMIM, Barcelona, Spain

,

Álvaro Terán

⁹Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Spain

,

Eunate Arana-Arri

¹⁰BioCruces, Hospital Universitario Cruces, Bizkaia, Spain

,

Akiko Ono

²Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

,

María José Valverde

⁴Programa de Cribado de Cáncer Colorrectal de la Región de Murcia, IMIB Arrixaca, Servicio Murciano de Salud, Murcia, Spain

,

Luis Bujanda

¹¹Servicio 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

,

Vicent Hernández

¹²Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Vigo, Spain

,

Juan Diego Morillas

¹³Servicio de Gastroenterología, Hospital Clínico Universitario San Carlos, Madrid, Spain

,

Rodrigo Jover

¹⁴Unidad de Gastroenterología, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain

,

Antoni Castells

¹⁵Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBERehd, Universitat de Barcelona, Barcelona, Spain

› Author Affiliations

Abstract

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 – 19 mm 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.

Full Text

References

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