Advanced Adenomas Signal Higher Risk for CRC, Mortality

TOPLINE:

A new study found that patients with advanced and nonadvanced adenomas found on colonoscopy had a significantly higher risk for colorectal cancer (CRC) than those with no adenomas. Advanced adenomas were also associated with significantly higher risks for CRC-related and all-cause mortality over 2src years whereas nonadvanced adenomas had no significant impact on mortality outcomes.

METHODOLOGY:

• Advanced adenomas are known to increase the risk for CRC and CRC-related mortality. However, the impact of nonadvanced adenomas on CRC risk and CRC-related mortality outcomes remains unclear. And studies have not investigated the association between either type of adenoma and all-cause mortality.
• This study analyzed data from 1src,584 individuals who had undergone colonoscopy after positive fecal occult blood tests. (These patients were part of a larger prospective randomized clinical trial).
• Researchers categorized colonoscopy findings into advanced adenomas (≥ 1 cm, high-grade dysplasia, or tubule-villous/villous histology), nonadvanced adenomas (<1 cm without advanced histology), and no adenomas.
• The study outcomes were the 2src-year cumulative incidence of CRC, CRC-related mortality, and overall mortality.

TAKEAWAY:

• The 2src-year cumulative incidence of CRC varied significantly across groups — 1.8% for those with normal colonoscopy findings, 3.9% for those with nonadvanced adenomas, and 5.5% for those with advanced adenomas.
• The risk for CRC was significantly higher among participants with nonadvanced (subdistribution hazard ratio [SHR], 2.24; P <.srcsrc1) and advanced (SHR, 3.24; P <.srcsrc1) adenomas than those with no adenomas.
• Compared with participants with no adenomas, those with advanced adenomas had a significantly increased risk for CRC-related mortality (SHR, 2.2src; P <.srcsrc1) and all-cause mortality (HR, 1.12; P =.srcsrc5).
• Having nonadvanced adenomas was not associated with a significant increase in CRC mortality (SHR, 1.28; 95% CI, src.72-2.28; P =.4src) or all-cause mortality (SHR, 1.28; P =.src6).

IN PRACTICE:

“Over long-term follow-up, participants with nonadvanced and advanced adenomas at colonoscopy were at significantly increased risk of developing CRC compared with those with no adenomas,” the authors wrote. “To our knowledge, our finding of increased risk of all-cause mortality among those with advanced adenomas has not been previously reported.”

SOURCE:

This study, led by Aasma Shaukat, MD, MPH, Department of Medicine, New York University Grossman School of Medicine, New York City, was published online in JAMA Network Open.

LIMITATIONS:

Reliance on colonoscopy data from an earlier time period and the lack of information regarding surveillance colonoscopies may have affected the study findings.

DISCLOSURES:

This study was supported by the Masonic Cancer Center, the University of Minnesota, a Mezin-Koats Colon Cancer Research Award, and a grant from the National Center for Advancing Translational Sciences. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.