Patient and Adenoma Characteristics As Predictors of Colorectal Adenoma Recurrence: A Preliminary Result of the KASID Multi-Center Study

Patient and Adenoma Characteristics As Predictors of Colorectal Adenoma Recurrence: A Preliminary Result of the KASID Multi-Center Study Hyun-Soo Kim, Myeong Gwan Jee, Tae Il Kim, Won Ho Kim, Bong Min Koh, Moon Sung Lee, Jin Oh Kim, Il Kwon Jung, Suk Ho Lee, Chang Soo Eun, Cheol Hee Park, Ilhyun Baek, Dong Il Park, Dong Kyung Chang, Suk-Kyun Yang, Jeong-Sik Byeon, Bo in Lee, Seun Ja Park, Ki Myung Lee, Ki-Nam Shim, Kyu Yong Choi Aim/Background: The identification of groups with a high risk of colorectal adenoma recurrence remains a controversial issue for clinicians. This study was designed to assess the predictive value of initial patient and adenoma characteristics during surveillance colonoscopy. Methods: The study population was composed of 1,037 patients (683 males) with resected colorectal adenomas or colorectal cancer at 15 tertiary endoscopic centers. At both baseline and follow-up examinations, the characteristics of patients and adenomas were recorded according to a standardized protocol. The main outcomes measured were the follow-up overall recurrence and recurrence of advanced adenomas (AA; size O 1 cm, tubulovillous/villous architecture, high grade dysplasia or cancer). Survival analysis for cumulative adenoma recurrence was performed as Kaplan-Meyer survival curves, and comparative stratification for various parameters was performed by log-rank test. Mean follow-up is 37 months (11-153). Results: Mean age was 59 years (range 40-84 years). Overall recurrence was observed in 418 patients (40.3%) including 70 (6.8%) patients with multiple non-AA, 18 (1.7%) with AA, 4 (0.4%) with mucosal cancer, and 3 (0.3%) with invasive cancer during surveillance colonoscopy. Also, more than one-half of them (54.8%) had recurrent adenomas on the proximal colon. On Kaplan-Meyer curve, overall cumulative adenoma recurrence rates were 10.5% at 1 year, 39.4% at 3 years, and 76.6% at 5 years. As results of log-rank tests, male sex (p Z 0.011), older age (O59 years; p Z 0.001), current or former smoking (p Z 0.011), low physical activity (!3 times for 30 minutes/week; p Z 0.004), multiple or advanced adenomas (p Z 0.043), and right location of adenomas (p Z 0.003) at baseline were the main predictors of cumulative adenoma recurrence. However, the cumulative adenoma recurrence was not different according to past history of cardiovascular disease, diabetes, hyperlipidemia, or chronic arthritis, aspirin use, and alcohol use. Conclusions: Multiple or advanced adenomas at baseline, male sex, older age, cigarette smoking, and low physical activity are important indicators of colorectal adenoma recurrence. Because most recurrences were detected in the proximal colon, careful surveillance of this area is warranted. Abstracts