Year 2025 / Volume 117 / Number 4
Original
New predictors of recurrence in post-polypectomy surveillance - A retrospective analysis of risk stratification for advanced adenomas and polyps

188-197

DOI: 10.17235/reed.2024.10832/2024

Jun Zhang, You Deng, Hailing Tang, Jiaming Liu, Wangli Si, Baihe Sun, Kun Zhuang,

Abstract
Background and aims: recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. This study aimed to analyze the recurrence risk factors for advanced adenomas and investigated the difference from any polyp recurrence. Methods: this retrospective observational study included patients who underwent colonoscopy and at least one post-polypectomy surveillance. Multivariate regression models identified risk factors for the recurrence of polyps and advanced adenomas. The Youden index determined the optimal cut-off value for risk factors. Kaplan-Meier curve estimated the cumulative recurrence rates, and the log-rank tests compared the differences between these curves. Results: a total of 1,818 patients had polyps at baseline examination. During post-polypectomy surveillance, 1,063 patients had recurrent polyps, and 64 patients experienced recurrent advanced adenomas. Multivariate logistic analysis identified age as an independent risk factor for both advanced adenoma (OR [95 % CI]: 1.028 [1.003-1.056]) and polyps (OR [95 % CI]: 1.019 [1.009-1.028]), with cut-off values of 57 years and 53 years, respectively. A cut-off value of 40 years can increase the predictive sensitivity to 95 %. Polyps size (OR [95 % CI]: 1.070 [1.014-1.147]) and high-risk pathology (OR [95 % CI]: 6.339 [2.057-23.919]) were significantly associated with recurrence of advanced adenomas, but not with any polyps, with a size cut-off value of 7.5 mm. Except for high-risk pathology, neither hyperplastic polyps nor tubular adenomas with low-grade dysplasia increased the recurrence risk of advanced adenomas. Conclusions: a cut-off value of 40 years can increase the predictive sensitivity to 95 % for both advanced adenomas and any polyps. Polyps size and high-risk pathology were associated with the recurrence of advanced adenoma, but not with any polyps.
Lay Summary
Recent guidelines emphasized that not all patients with recurrent polyps benefit from post-polypectomy surveillance, except for advanced adenomas recurrence. Our study distinguished risk factors for any polyps and advanced adenomas recurrence, contributing to stratify risk and produce a personalized surveillance strategy. High-risk patients can be monitored more closely, while low-risk patients can avoid unnecessary procedures. In addition, 40 years can increase the predictive sensitivity to 95% in our study, indicating that earlier screening is need for increased incidence of colorectal cancer in younger patients.
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Zhang J, Deng Y, Tang H, Liu J, Si W, Sun B, et all. New predictors of recurrence in post-polypectomy surveillance - A retrospective analysis of risk stratification for advanced adenomas and polyps. 10832/2024


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Publication history

Received: 01/10/2024

Accepted: 04/11/2024

Online First: 19/11/2024

Published: 03/04/2025

Article Online First time: 49 days

Article editing time: 184 days


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