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 8:S1542-3565(24)00436-1. doi: 10.1016/j.cgh.2024.04.029. Online ahead of print.

Authors

Affiliations

¹ Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: mendelsr@mskcc.org.
² Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY USA.
³ Collaborative Research Centers Department, Memorial Sloan Kettering Cancer Center, New York, NY USA.
⁴ Solid Tumor Gastrointestinal Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA.
⁵ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA; Division of Gastroenterology, University of Massachusetts Chan Medical School-Baystate, Springfield, MA.
⁶ Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
⁷ Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

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

Abstract

Background: 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 to average onset colorectal cancer (AO-CRC) patients 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, three serial surveillance colonoscopies were evaluated. Statistical analyses were performed utilizing log-ranked Kaplan-Meier method and Cox proportional hazards.

Results: A total of 1259 CRC patients were identified, with 612 and 647 patients in the EO-CRC and AO-CRC groups, respectively. Compared to AO-CRC patients, EO-CRC patients had a 29% decreased risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy (HR=0.71, 95% CI 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=0.003), and EO-CRC were found to have less advanced neoplasia compared to AO-CRC counterparts (12.4% vs 16.0%, respectively). Subsequent colonoscopies found that while EO-CRC patients returned for follow-up surveillance colonoscopy earlier than AO-CRC patients, the EO-CRC cohort did not have more advanced neoplasia nor non-advanced adenomas.

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

Keywords: Early-onset colorectal cancer; adenoma; colonoscopy; neoplasia; surveillance.