Z Gastroenterol 2020; 58(05): e79-e80
DOI: 10.1055/s-0040-1712257
POSTER
CED

Impact of lesion phenotype on colorectal cancer mortality and overall mortality: insights from a nationwide screening colonoscopy program

E Waldmann
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
3   Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
4   Frontier Science & Tech Research, Boston, MA, United States
,
A Kammerlander
5   Massachusetts General Hospital, Department of Radiology, Boston, MA, United States
,
D Penz
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
A Hinterberger
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
B Majcher
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
M Trauner
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
,
M Ferlitsch
1   Div. of Gastroenterology and Hepatology, MUV, Department of Internal Medicine III, Vienna, Austria
2   Quality assurance working group, Austrian Society of Gastroenterology and Hepatology, Vienna, Austria
› Author Affiliations
 

Background The long-term risk of colorectal cancer (CRC) mortality and overall mortality after screening colonoscopy is poorly investigated. Most studies analyzed mixed cohorts of screening individuals, and symptomatic or individuals with positive fecal immunochemical testing.

Aim To analyze CRC mortality and overall mortality after screening colonoscopy by lesion phenotype.

Methods Screening colonoscopies performed within the quality assurance program in Austria between 11/2007 and 06/2018 were matched with a national mortality register. The following lesion phenotypes were defined: 1) negative colonoscopy, 2) low-risk adenoma, 3) high-risk adenoma, 4) hyperplastic polyps, and 5) serrated lesions. Age and sex adjusted Cox regression analyses were used to analyze the association between lesion phenotypes, CRC mortality and overall mortality.

Results 280,291 screening colonoscopies were included in the study. 7,311 deaths of any cause occurred after 55 ± 35.6 months of follow-up, 4,730 men and 2,581 women. Overall mortality rates, adjusted for age and sex, were significantly higher for individuals with high-risk adenomas (HR 1.6, 95 %CI 1.5-1.7, p < 0.01), low-risk adenomas (HR 1.1, 95 %CI 1.0-1.7, p = 0.006), and hyperplastic polyps (HR 1.1, 95 %CI 1.0-1.2, p = 0.004), but not for serrated lesions (HR 1.2, 95 %CI 1.0-1.5, p = 0.083), compared to negative colonoscopy. Among a total of 232 CRC deaths (ICD 10: C19-21), 156 were observed in men and 76 in women. High-risk adenomas (HR 8.9, 95 %CI 6.5-12.1, p < 0.001) and serrated lesions (HR 4.3, 95 %CI 1.9-10.0, p = 0.001), but not for low-risk lesions (HR 1.3, 95 %CI 0.8-2.1, p = 0.350) and hyperplastic polyps (HR 1.5, 95 %CI 0.9-2.4, p = 0.138) were at higher risk for CRC death as compared to negative colonoscopy.

Conclusion In individuals undergoing colonoscopy, the lesion phenotype is significantly associated with both CRC-related and all-cause mortality.



Publication History

Article published online:
26 May 2020

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