Endoscopy 2019; 51(04): S207-S208
DOI: 10.1055/s-0039-1681788
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Friday, April 5, 2019 09:00 – 17:00: Colon and rectum ePosters
Georg Thieme Verlag KG Stuttgart · New York

A PREDICTIVE MODEL IDENTIFIES PATIENTS LESS LIKELY TO HAVE ADENOMAS AFTER A COLON CANCER

L Frazzoni
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
M Scagliarini
2   Department of Statistics, University of Bologna, Bologna, Italy
,
L Laterza
3   Endoscopy Unit, AUSL Reggio Emilia, Reggio Emilia, Italy
,
C Trovato
4   Division of Endoscopy, European Institute of Oncology, Milan, Italy
,
A Mussetto
5   Division of Gastroenterology, S. Maria delle Croci Hospital, Ravenna, Italy
,
M De Bellis
6   Department of Abdominal Oncology, Istituto Nazionale Tumori – IRCCS – Fondazione G. Pascale, Naples, Italy
,
S Paggi
7   Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
C Spada
8   Gemelli University Hospital, Rome, Italy
9   Fondazione Poliambulanza, Brescia, Italy
,
L Petrella
2   Department of Statistics, University of Bologna, Bologna, Italy
,
V Smania
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
N De Bortoli
10   Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
,
F Bazzoli
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
L Ricciardiello
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
,
F Radaelli
7   Division of Digestive Endoscopy and Gastroenterology, Valduce Hospital, Como, Italy
,
C Hassan
11   Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
,
L Fuccio
1   Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Patients with prior colorectal cancer (CRC) are at slightly increased risk of metachronous colorectal neoplasms, therefore endoscopic surveillance is indicated. Current recommendations of repeating examinations at 1, 3 and 5 years after surgery, are not tailored according to risk stratification. Our aim was to find predictive factors of colorectal neoplasms to build a predictive model, to spare colonoscopies for low-risk patients.

Tab. 1:

Predictive model for developing metachronous colorectal adenomas at 2nd surveillance colonoscopy

Variable

Beta coefficient

Adjusted OR (95% CI)

P Value

Age > 65 y.o.

0.44

1.56 (0.99 – 2.47)

0.056

Left colon resection

0.70

2.01 (1.23 – 3.27)

0.01

≥1 advanced adenoma at index colonoscopy

0.74

2.10 (1.13 – 3.90)

0.02

≥1 adenoma at 1st surveillance colonoscopy

0.94

2.56 (1.60 – 4.09)

< 0.01

Methods:

Multicenter retrospective study including patients with colon carcinoma surgically resected from 2001 to 2008 (training cohort) and from 2009 to 2013 (validation cohort). A predictive model for neoplasms occurrence at second surveillance colonoscopy was developed and externally validated.

Results:

396 and 131 patients were included in training and validation cohort, respectively. Patients with ≥1 adenoma at 2nd surveillance colonoscopy were 113/396 (28.5%) and 21/131 (16.5%) in the two groups. In validation cohort, 3 cancers were found.

Four variables identified the low-risk patient's profile of developing metachronous colorectal adenomas: age ≤65 years old, right colectomy, no advanced adenoma at basal colonoscopy and no adenoma at first surveillance colonoscopy. The predictive model showed fair discrimination, with an area under the ROC curve of 0.69 and 0.64, in training and validation cohort.

In validation group, If patients with a low-risk profile skip the 2nd surveillance colonoscopy, 25/131 (19.1%) exams would be saved while missing 2/21 (9.5%) patients with ≥1 adenoma; no advanced adenoma nor cancer would be missed.

Conclusions:

We provided a risk-stratification tool for adenoma occurrence after colon surgery, which could prove cost-effective to select patients who could skip the second surveillance colonoscopy.