SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Thomas APARICIO
Coup de coeur :
 
 
Gut
  2016/01  
 
  2015 Dec 11. pii: gutjnl-2015-310196  
  doi: 10.1136/gutjnl-2015-310196. [Epub ahead of print]  
 
  Risk stratification of individuals with low-risk colorectal adenomas using clinical characteristics: a pooled analysis.  
 
  Gupta S, Jacobs ET, Baron JA, Lieberman DA, Murphy G, Ladabaum U, Cross AJ, Jover R, Liu L, Martinez ME  
  http://www.ncbi.nlm.nih.gov/pubmed/26658145  
 
 

OBJECTIVE: For individuals with 1-2 small (<1 cm) low-risk colorectal adenomas, international guidelines range from no surveillance to offering surveillance colonoscopy in 5-10 years. We hypothesised that the risks for metachronous advanced neoplasia (AN) among patients with low-risk adenomas differ based on clinical factors distinct from those currently used.

DESIGN: We pooled data from seven prospective studies to assess the risk of metachronous AN. Two groups with 1-2 small adenomas were defined based on guidelines from the UK (n=4516) or the European Union (EU)/US (n=2477).

RESULTS: Absolute risk of metachronous AN ranged from a low of 2.9% to a high of 12.2%, depending on specific risk factor and guideline used. For the UK group, the highest absolute risks for metachronous AN were found among individuals with a history of prior polyp (12.2%), villous histology (12.2%), age ≥70 years (10.9%), high-grade dysplasia (10.9%), any proximal adenoma (10.2%), distal and proximal adenoma (10.8%) or two adenomas (10.1%). For the EU/US group, the highest absolute risks for metachronous AN were among individuals with a history of prior polyp (11.5%) or the presence of both proximal and distal adenomas (11.0%). In multivariate analyses, strong associations for increasing age and history of prior polyps and odds of metachronous AN were observed, whereas more modest associations were shown for baseline proximal adenomas and those with villous features.

CONCLUSIONS: Risks of metachronous AN among individuals with 1-2 small adenomas vary according to readily available clinical characteristics. These characteristics may be considered for recommending colonoscopy surveillance and require further investigation

 
Question posée
 
Quel est le risque de récidive d’adénome avancé après résection d’un adénome non avancé ?
 
Question posée
 
Ce risque varie fortement en fonction des caractéristiques du patient et des adénomes préalablement réséqués.
 
Commentaires

Une adaptation du protocole de surveillance en fonction des caractéristiques du patient devrait être évaluée.

 
www.snfge.org