Polyp size is associated with colorectal cancer death across histologic polyp subtypes: a retrospective study of a screening colonoscopy registry

Abstract

Background Surveillance colonoscopy after polyps have been detected at screening aims to reduce the risk for subsequent colorectal cancer, so-called post-colonoscopy colorectal cancer (PCCRC). Inconsistencies exist as to whether the risk should be stratified by histologic subtype. We aimed to compare the risk for PCCRC mortality in screening participants with sessile serrated lesions (SSLs)/traditional serrated adenomas (TSAs), hyperplastic polyps (HPPs), or conventional adenomas.

Methods Screening colonoscopy registry data were linked to death registry data between 2010 and 2022. We assessed the association of PCCRC death after a diagnosis of SSL/TSA, conventional adenoma, or HPP by Cox regression, and stratified by polyp size ≥10 and <10 mm.

Results 383,801 participants were included in the analysis. There were 1490 HPPs ≥10 mm (2.6%), compared with 1853 SSL/TSAs (19.6%) and 10,960 conventional adenomas (12.9%). When adjusted for polyp location, the association of polyp size ≥10 mm with PCCRC death was of similar magnitude in participants with conventional adenomas (hazard ratio [HR] 3.68, 95%CI 2.49–5.44), SSL/TSAs (HR 2.55, 95%CI 1.13–5.72), and HPPs (HR 5.01, 95%CI 2.45–10.22). Participants with HPPs mostly died of tumors in the distal colon (54.1%; n = 20), while participants with SSL/TSAs more frequently died of proximal tumors (33.3%; n = 3).

Conclusions Across all histologic types, participants with polyps ≥10 mm had at least a two-fold increase in the likelihood of PCCRC death compared with those with polyps <10 mm. These data suggest that size, rather than histologic subtype, should be a determinant for risk stratification after screening colonoscopy.

Publication History

Received: 10 December 2023

Accepted after revision: 15 May 2024

Article published online:
27 June 2024

• References

• 1 Morgan E, Arnold M, Gini A. et al. Global burden of colorectal cancer in 2020 and 2040: incidence and mortality estimates from GLOBOCAN. Gut 2023; 72: 338-344
• 2 Cho KR, Vogelstein B. Genetic alterations in the adenoma–carcinoma sequence. Cancer 1992; 70: 1727-1731 DOI: 10.1002/1097-0142(19920915)70:4+<1727::aid-cncr2820701613>3.0.co;2-p. (PMID: 1516027)
• 3 Crockett SD, Nagtegaal ID. Terminology, molecular features, epidemiology, and management of serrated colorectal neoplasia. Gastroenterology 2019; 157: 949-966.e944 DOI: 10.1053/j.gastro.2019.06.041. (PMID: 31323292)
• 4 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188 DOI: 10.1111/his.13975. (PMID: 31433515)
• 5 Snover DC. Update on the serrated pathway to colorectal carcinoma. Hum Pathol 2011; 42: 1-10 DOI: 10.1016/j.humpath.2010.06.002. (PMID: 20869746)
• 6 IJspeert JEG, Vermeulen L, Meijer GA. et al. Serrated neoplasia-role in colorectal carcinogenesis and clinical implications. Nature Reviews Gastroenterol Hepatol 2015; 12: 401-409 DOI: 10.1038/nrgastro.2015.73. (PMID: 25963511)
• 7 Vennelaganti S, Cuatrecasas M, Vennalaganti P. et al. Interobserver agreement among pathologists in the differentiation of sessile serrated from hyperplastic polyps. Gastroenterology 2021; 160: 452-454.e451
• 8 Hassan C, Antonelli G, Dumonceau JM. et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2020. Endoscopy 2020; 52: 687-700 DOI: 10.1055/a-1185-3109. (PMID: 32572858)
• 9 Rutter MD, East J, Rees CJ. et al. British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England post-polypectomy and post-colorectal cancer resection surveillance guidelines. Gut 2020; 69: 201 DOI: 10.1136/gutjnl-2019-319858. (PMID: 31776230)
• 10 Gupta S, Lieberman D, Anderson JC. et al. Recommendations for follow-up after colonoscopy and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2020; 158: 1131-1153.e1135
• 11 Sollecito WA, Johnson JK. McLaughlin and Kaluzny's Continuous Quality Improvement in Health Care. 5th edn. Burlington, Massachusetts, USA: Jones & Bartlett Learning; 2020
• 12 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2017; 49: 378-397 DOI: 10.1177/2050640617700014. (PMID: 28507745)
• 13 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297 DOI: 10.1055/s-0043-102569. (PMID: 28212588)
• 14 Hamilton SR, Aaltonen LA. Tumours of the Digestive System, WHO Classification of Tumours. 3rd edn.. Geneve: IARC Press; 2000
• 15 Song M, Emilsson L, Bozorg SR. et al. Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. Lancet Gastroenterol Hepatol 2020; 5: 537-547 DOI: 10.1016/S2468-1253(20)30009-1. (PMID: 32192628)
• 16 Wieszczy P, Kaminski MF, Franczyk R. et al. Colorectal cancer incidence and mortality after removal of adenomas during screening colonoscopies.. Gastroenterology 2020; 158: 875-883.e875
• 17 Holme Ø, Bretthauer M, Eide TJ. et al. Long-term risk of colorectal cancer in individuals with serrated polyps. Gut 2015; 64: 929
• 18 Erichsen R, Baron JA, Hamilton-Dutoit SJ. et al. Increased risk of colorectal cancer development among patients with serrated polyps. Gastroenterology 2016; 150: 895-902.e895
• 19 He X, Hang D, Wu K. et al. Long-term risk of colorectal cancer after removal of conventional adenomas and serrated polyps. Gastroenterology 2020; 158: 852-861.e854
• 20 Anderson JC, Butterly LF, Robinson CM. et al. Risk of metachronous high-risk adenomas and large serrated polyps in individuals with serrated polyps on index colonoscopy: data from the New Hampshire Colonoscopy Registry. Gastroenterology 2018; 154: 117-127.e112
• 21 Zessner-Spitzenberg J, Jiricka L, Waldmann E. et al. Polyp characteristics at screening colonoscopy and post-colonoscopy colorectal cancer mortality: a retrospective cohort study. Gastrointest Endosc 2023; 97: 1109-1118.e2
• 22 et al. WHO Classification of Tumors: Digestive System Tumours. Bosman FT, Carneiro F, Hruban RH. 4th edn.. Geneve: IARC Press; 2010
• 23 WHO Classification of Tumours Editorial Board. WHO Classification of Tumors: Digestive System Tumours. 5th edn.. Geneve: IARC Press; 2019
• 24 Li D, Doherty AR, Raju M. et al. Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps. Gut 2022; 71: 2022-2029
• 25 Hetzel JT, Huang CS, Coukos JA. et al. Variation in the detection of serrated polyps in an average risk colorectal cancer screening cohort. Am J Gastroenterol 2010; 105: 2656-2664 DOI: 10.1038/ajg.2010.315. (PMID: 20717107)
• 26 Nagtegaal ID, Odze RD, Klimstra D. et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020; 76: 182-188 DOI: 10.1111/his.13975. (PMID: 31433515)
• 27 Lu FI, van Niekerk de W, Owen D. et al. Longitudinal outcome study of sessile serrated adenomas of the colorectum: an increased risk for subsequent right-sided colorectal carcinoma. Am J Surg Pathol 2010; 34: 927-934 DOI: 10.1097/PAS.0b013e3181e4f256. (PMID: 20551824)
• 28 Morales TG, Sampliner RE, Garewal HS. et al. The difference in colon polyp size before and after removal. Gastrointest Endosc 1996; 43: 25-28