As reported in JAMA Network Open by Awan et al, both histopathologic and demographic factors show distinct time-dependent associations with colorectal adenoma recurrence in postpolypectomy surveillance.
In this retrospective cohort study, high-grade dysplasia demonstrated the strongest association with early recurrence, whereas villous histology exhibited a late-phase resurgence. Sex displayed temporal heterogeneity, with female vs male patients with high-risk adenomas experiencing higher late-term recurrence risk.
“Current colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and personalized care,” the investigators commented. “These findings support a paradigm shift toward dynamic, time-dependent surveillance that extends monitoring for patients with specific histologic and demographic risk profiles.”
Study Details
The investigators focused on 59,667 patients who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center. This large, longitudinal surveillance cohort had a mean age of 60 years and included 29,401 (49.3%) females. Follow-up data were provided for a median of 4 years.
The study considered demographic information on race and ethnicity, sex, obesity (body mass index > 30), family history of colorectal cancer or polyps, and age at adenoma onset (< 50 vs ≥ 50 years). Adenoma characteristics included histology, size, number, and dysplasia.
Recurrence-free survival, defined as the time from initial polypectomy to histologically confirmed recurrence, was the primary outcome. The investigators fitted time-varying coefficient Cox models to handle the nonconstant associations of exposure over the follow-up time. Follow-up was categorized into three periods—less than 5 years, 5 to 10 years, and 10 or more years—and likelihood ratio tests were used to assess the heterogeneity of exposure associations across these intervals.
Key Findings
A total of 17,596 patients (29.5%) experienced overall recurrence within 5 years. High-grade dysplasia showed the largest association in the early phase (adjusted hazard ratio [aHR] = 4.00, 95% confidence interval [CI] = 3.56–4.50), with complete attenuation in the midterm and late phases; villous histology displayed biphasic patterns, with early elevation (aHR = 2.89, 95% CI = 2.63–3.18) and late-phase reemergence (> 10 years; aHR = 2.71, 95% CI = 2.15–3.41). The investigators reported that obesity conferred persistent risk across all surveillance intervals (early: aHR = 1.16, 95% CI = 1.11–1.21; late: aHR = 1.22, 95% CI = 1.09–1.35). Among patients with high-risk adenomas, females exhibited a greater late-term elevation than their male counterparts (female: aHR = 1.73, 95% CI = 1.43–2.08; male: aHR = 1.29, 95% CI = 1.06–1.58).
Summarizing these findings, the investigators stated that “colorectal adenoma recurrence demonstrated distinct temporal heterogeneity rather than constant risk. While high-grade dysplasia was a dominant early association, villous histology exhibited a specific late-phase resurgence that static guidelines may overlook. Obesity conferred sustained risk across all intervals, challenging assumptions of diminishing metabolic influence. Most notably, female patients with high-risk adenomas experienced a significant late-term recurrence surge that exceeded that of male patients, suggesting current surveillance cessation policies may underserve women.”
Xingyi Guo, PhD, and Zhijun Yin, PhD, of Vanderbilt University Medical Center, Nashville, are the corresponding authors of the JAMA Network Open article.
DISCLOSURE: For full disclosures of the study authors, visit jamanetwork.com.
