Early-onset Colorectal Cancer Patients Do Not Require Shorter Intervals for Post-surgical Surveillance Colonoscopy

Robin B Mendelsohn; Anne I Hahn; Randze Lerie Palmaira; Asha R Saxena; Pavan Kedar Mukthinuthalapati; Mark A Schattner; Arnold J Markowitz; Emmy Ludwig; Pari Shah; Delia Calo; Hans Gerdes; Rona Yaeger; Zsofia Stadler; Ann G Zauber; Andrea Cercek

doi:10.1016/j.cgh.2024.04.029

Early-onset Colorectal Cancer Patients Do Not Require Shorter Intervals for Post-surgical Surveillance Colonoscopy

Clin Gastroenterol Hepatol. 2024 May 9:S1542-3565(24)00436-1. doi: 10.1016/j.cgh.2024.04.029. Online ahead of print.

Authors

Affiliations

¹ Department of Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: mendelsr@mskcc.org.
² Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.
³ Collaborative Research Centers Department, Memorial Sloan Kettering Cancer Center, New York, New York.
⁴ Solid Tumor Gastrointestinal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
⁵ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Gastroenterology, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts.
⁶ Department of Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

PMID: 38729386
DOI: 10.1016/j.cgh.2024.04.029

Abstract

Background & aims: Early-onset colorectal cancer (EO-CRC), diagnosed before age 50, is rising in incidence worldwide. Although post-surgical colonoscopy surveillance strategies exist, appropriate intervals in EO-CRC remain elusive, as long-term surveillance outcomes remain scant. We sought to compare findings of surveillance colonoscopies of EO-CRC with patients with average onset colorectal cancer (AO-CRC) to help define surveillance outcomes in these groups.

Methods: Single-institution retrospective chart review identified EO-CRC and AO-CRC patients with colonoscopy and no evidence of disease. Surveillance intervals and time to development of advanced neoplasia (CRC and advanced polyps [adenoma/sessile serrated]) were examined. For each group, 3 serial surveillance colonoscopies were evaluated. Statistical analyses were performed utilizing log-ranked Kaplan-Meier method and Cox proportional hazards.

Results: A total of 1259 patients with CRC were identified, with 612 and 647 patients in the EO-CRC and AO-CRC groups, respectively. Compared with patients with AO-CRC, patients with EO-CRC had a 29% decreased risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy (hazard ratio, 0.71; 95% confidence interval, 0.52-1.0). Average follow-up time from surgical resection to first surveillance colonoscopy was 12.6 months for both cohorts. Overall surveillance findings differed between cohorts (P = .003), and patients with EO-CRC were found to have less advanced neoplasia compared with their counterparts with AO-CRC (12.4% vs 16.0%, respectively). Subsequent colonoscopies found that, while patients with EO-CRC returned for follow-up surveillance colonoscopy earlier than patients with AO-CRC, the EO-CRC cohort did not have more advanced neoplasia nor non-advanced adenomas.

Conclusions: Patients with EO-CRC do not have an increased risk of advanced neoplasia compared with patients with AO-CRC and therefore do not require more frequent colonoscopy surveillance than current guidelines recommend.

Keywords: Adenoma; Colonoscopy; Early-onset Colorectal Cancer; Neoplasia; Surveillance.