ArticleAnnals of gastroenterology
Risk of colorectal cancer incidence and mortality after removals of polyps: a cohort study using the UK Biobank.
Article in Annals of gastroenterology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
Background: Colorectal cancer (CRC) is a leading cause of cancer death worldwide, however, the risk of newly-diagnosed CRC and its related mortality after polypectomy have not been conclusively determined. Methods: Prospective cases with polypectomy were identified in the UK Biobank. The age- and sex-standardized incidence ratio (SIR) and standardized mortality ratio (SMR) were calculated to assess the risk of CRC between the removal group and both the non-index-colonoscopy group (no record of diagnostic colonoscopy) from the UK Biobank and the general population in England. We also estimated the effect of removal compared with the polyp-free group using a competing risk model. Results: During a median follow up of 10 (1-44) years (51,136 person-years), 78 incident CRCs (153/100,000 person-years), and 16 CRC-specific deaths (31/100,000 person-years) were identified in the removal group. Compared with the general population in England, the removal group had a similar risk of incident CRC (SIR 0.81, 95% confidence interval [CI] 0.64-1.01; P=0.060), whereas the CRC-specific mortality was 52% lower (SMR 0.48, 95%CI 0.28-0.78; P=0.004). Compared with the non-index-colonoscopy group, CRC-specific deaths after polyp removal were not significantly different (SMR 1.64, 95%CI 0.94-2.66; P=0.050). Compared with the polyp-free group, the risks of incidence and mortality in the removal group were both greater (incidence: adjusted hazard ratio [HR] 6.17, 95%CI 4.36-8.74; P<0.001; mortality: adjusted HR 3.25, 95%CI 1.65-6.41; P<0.001). Conclusion: Polypectomy reduced but not eliminated the risk of CRC for polyp-positive participants to the level of the general population, reinforcing the importance of procedural quality and tailored surveillance strategies.
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