Journal article
The Prognostic Significance of Laterality in Endoscopically Resected Colonic Adenomas with High-Grade Dysplasia
Techniques and innovations in gastrointestinal endoscopy, Vol.25(4), pp.352-360
2023
DOI: 10.1016/j.tige.2023.07.003
Abstract
•BackgroundWhile worse survival for proximal colon cancers has been established, it remains unknown whether colon laterality impacts the prognosis of advanced adenomas with high-grade dysplasia (HGD).•FindingsWhen compared to the age and sex-matched U.S. population, patients with adenomas with HGD had significantly increased mortality, and this was more pronounced for proximal (vs. distal) HGD.•Implications for Patient CareProximal adenomas with HGD are associated with worse survival compared to the general population, potentially due to increased risk of metachronous neoplasia, and may require more intensive surveillance protocols.
Advanced adenomas (AA) with high-grade dysplasia (HGD) represent a risk factor for metachronous neoplasia for which guidelines recommend short-interval endoscopic surveillance. While worse survival of proximal colon cancers has been established, the prognostic impact of laterality for AA with HGD remains unknown. We hypothesized that proximal HGD would have worse prognosis than distal lesions.
In this retrospective cohort study, adults with HGD managed with endoscopic polypectomy were identified in the National Cancer Database from 2004-2017. Survival probabilities were estimated and plotted using the Kaplan-Meier method. Cox regression models were used to assess the effect of adenoma laterality on OS while adjusting for patient and disease characteristics. One sample log-rank test was employed to compare survival of patients to that of the U.S. population.
Of 3,953 patients identified in the database, 29% had proximal lesions, which were more common in elderly, Black, publicly insured, and comorbid patients. Unadjusted 5- and 10-year overall survival (OS) was 81% and 67% for proximal vs. 89% and 78% for distal HGD (p<0.01). In multivariable analysis, proximal location did not demonstrate significantly worse OS (hazard ratio=1.09, 95% confidence interval (CI) 0.92-1.29). When compared to the age and sex-matched U.S. population, HGD patients had significantly increased mortality (standardized mortality ratio=1.54, 95% CI 1.42-1.68), which was more pronounced for right-sided AA.
Patients with HGD, particularly those with proximal lesions, had lower OS than the U.S. population. Although proximal location was not independently associated with worse survival, OS may not represent the optimal endpoint for AA given low cancer incidence and effective treatment for early-stage tumors. Future research should focus on risk of metachronous neoplasia to determine adequate surveillance protocols.
Details
- Title: Subtitle
- The Prognostic Significance of Laterality in Endoscopically Resected Colonic Adenomas with High-Grade Dysplasia
- Creators
- Sonja Boatman - University of MinnesotaJulia Kohn - University of MinnesotaSarah L. Mott - University of IowaSchelomo Marmor - University of MinnesotaRobert D. Madoff - University of MinnesotaWolfgang B. Gaertner - University of MinnesotaAasma Shaukat - NYU Langone HealthGenevieve B. Melton - University of MinnesotaImran Hassan - University of IowaPaolo Goffredo - University of Minnesota
- Resource Type
- Journal article
- Publication Details
- Techniques and innovations in gastrointestinal endoscopy, Vol.25(4), pp.352-360
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.tige.2023.07.003
- ISSN
- 2590-0307
- eISSN
- 2590-0307
- Language
- English
- Electronic publication date
- 07/2023
- Date published
- 2023
- Academic Unit
- Surgery
- Record Identifier
- 9984445621802771
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