Endoscopy 2024; 56(11): 820-827
DOI: 10.1055/a-2339-0146
Original article

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

Jasmin Zessner-Spitzenberg
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria (Ringgold ID: RIN606838)
,
Elisabeth Waldmann
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria (Ringgold ID: RIN606838)
,
Lisa-Maria Rockenbauer
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria (Ringgold ID: RIN606838)
,
Alexandra Demschik
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria (Ringgold ID: RIN606838)
,
Daniela Penz
3   Department of Internal Medicine I, St. John of God Hospital, Vienna, Austria
,
Michael Trauner
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
,
Monika Ferlitsch
1   Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
2   Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria (Ringgold ID: RIN606838)
› Author Affiliations


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.

Supplementary Material



Publication History

Received: 10 December 2023

Accepted after revision: 15 May 2024

Article published online:
27 June 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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