Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study

Yasushi Sano; Kinichi Hotta; Takahisa Matsuda; Yoshitaka Murakami; Takahiro Fujii; Shin-Ei Kudo; Yasushi Oda; Hideki Ishikawa; Yutaka Saito; Nozomu Kobayashi; Masau Sekiguchi; Hiroaki Ikematsu; Atsushi Katagiri; Kazuo Konishi; Yoji Takeuchi; Hiroyasu Iishi; Masahiro Igarashi; Kiyonori Kobayashi; Miwa Sada; Shozo Osera; Tomoaki Shinohara; Yuichiro Yamaguchi; Kiwamu Hasuda; Toshitaka Morishima; Isao Miyashiro; Tadakazu Shimoda; Hirokazu Taniguchi; Takahiro Fujimori; Yoichi Ajioka; Shigeaki Yoshida; Japan Polyp Study Workgroup

doi:10.1016/j.cgh.2023.07.021

Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study

Clin Gastroenterol Hepatol. 2024 Mar;22(3):542-551.e3. doi: 10.1016/j.cgh.2023.07.021. Epub 2023 Aug 6.

Authors

Yasushi Sano¹, Kinichi Hotta², Takahisa Matsuda³, Yoshitaka Murakami⁴, Takahiro Fujii⁵, Shin-Ei Kudo⁶, Yasushi Oda⁷, Hideki Ishikawa⁸, Yutaka Saito⁹, Nozomu Kobayashi¹⁰, Masau Sekiguchi¹¹, Hiroaki Ikematsu¹², Atsushi Katagiri¹³, Kazuo Konishi¹³, Yoji Takeuchi¹⁴, Hiroyasu Iishi¹⁵, Masahiro Igarashi¹⁶, Kiyonori Kobayashi¹⁷, Miwa Sada¹⁷, Shozo Osera¹⁸, Tomoaki Shinohara¹⁸, Yuichiro Yamaguchi¹⁹, Kiwamu Hasuda²⁰, Toshitaka Morishima²¹, Isao Miyashiro²¹, Tadakazu Shimoda²², Hirokazu Taniguchi²³, Takahiro Fujimori²⁴, Yoichi Ajioka²⁵, Shigeaki Yoshida²⁶; Japan Polyp Study Workgroup

Affiliations

¹ Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan. Electronic address: ys_endoscopy@hotmail.com.
² Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan. Electronic address: k.hotta@scchr.jp.
³ Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan. Electronic address: takahisa.matsuda@med.toho-u.ac.jp.
⁴ Department of Medical Statistics, Toho University, Tokyo, Japan.
⁵ TF Clinic, Tokyo, Japan.
⁶ Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
⁷ Oda Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan.
⁸ Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁹ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
¹⁰ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan.
¹¹ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
¹² Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan.
¹³ Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹⁴ Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
¹⁵ Department of Gastroenterology, Itami City Hospital, Itami, Japan.
¹⁶ Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
¹⁷ Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan.
¹⁸ Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan.
¹⁹ Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan.
²⁰ Hattori Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan.
²¹ Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
²² Division of Pathology, Shizuoka Cancer Center, Sunto, Japan.
²³ Pathology and Clinical Laboratory Division, JR Tokyo General Hospital, Tokyo, Japan.
²⁴ Department of Pathology, Shinko Hospital, Kobe, Japan.
²⁵ Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
²⁶ Aomori Prefectural Central Hospital, Aomori, Japan.

PMID: 37544420
DOI: 10.1016/j.cgh.2023.07.021

Abstract

Background & aims: To date, no regional evidence of long-term colorectal cancer (CRC) risk reduction after endoscopic premalignant lesion removal has been established. We aimed to analyze this over a long-term follow-up evaluation.

Methods: This was a prospective cohort study of participants from the Japan Polyp Study conducted at 11 Japanese institutions. Participants underwent scheduled follow-up colonoscopies after a 2-round baseline colonoscopy process. The primary outcome was CRC incidence after randomization. The observed/expected ratio of CRC was calculated using data from the population-based Osaka Cancer Registry. Secondary outcomes were the incidence and characteristics of advanced neoplasia (AN).

Results: A total of 1895 participants were analyzed. The mean number of follow-up colonoscopies and the median follow-up period were 2.8 years (range, 1-15 y) and 6.1 years (range, 0.8-11.9 y; 11,559.5 person-years), respectively. Overall, 4 patients (all males) developed CRCs during the study period. The observed/expected ratios for CRC in all participants, males, and females, were as follows: 0.14 (86% reduction), 0.18, and 0, respectively, and 77 ANs were detected in 71 patients (6.1 per 1000 person-years). Of the 77 ANs detected, 31 lesions (40.3%) were laterally spreading tumors, nongranular type. Nonpolypoid colorectal neoplasms (NP-CRNs), including flat (<10 mm), depressed, and laterally spreading, accounted for 59.7% of all detected ANs. Furthermore, 2 of the 4 CRCs corresponded to T1 NP-CRNs.

Conclusions: Endoscopic removal of premalignant lesions, including NP-CRNs, effectively reduced CRC risk. More than half of metachronous ANs removed by surveillance colonoscopy were NP-CRNs. The Japan Polyp Study: University Hospital Medical Information Network Clinical Trial Registry: University Hospital Medical Information Network Clinical Trial Registry, C000000058; cohort study: UMIN000040731.

Keywords: Advanced Neoplasia; Colonoscopy; Nonpolypoid Colorectal Neoplasm; Polypectomy.

MeSH terms

Cohort Studies
Colonic Polyps*
Colonoscopy
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / pathology
Colorectal Neoplasms* / surgery
Female
Humans
Japan / epidemiology
Male
Multicenter Studies as Topic
Polyps*
Prospective Studies
Randomized Controlled Trials as Topic