What Types of Polyps Are Associated With an Increased Risk for Colorectal Cancer?
Posted: Monday, April 27, 2020
A recent article published in The Lancet Gastroenterology & Hepatology found that any polyp, regardless of subtype, may increase the risk of developing colorectal cancer. Jonas F. Ludvigsson, MD, of Karolinska Institutet, Stockholm, and colleagues, investigated the incidence and mortality rate of colorectal cancer after a polypectomy. They also found an increased risk of colorectal mortality in patients with sessile serrated polyps, tubulovillous adenomas, and villous adenomas—but not hyperplastic polyps or tubular adenomas.
“Our findings suggest that patients with any of [these] three lesions might benefit from colonoscopy surveillance,” concluded the authors.
Researchers used a matched cohort study to assess the risk of incidence and mortality in 178,377 Swedish patients with colorectal polyps and 864,831 people from the general population at 3, 5, 10, and 15 years. At a median of 6.6 years of follow-up, 4,278 colorectal cancer cases and 1,269 colorectal cancer–related deaths were reported in patients with a polyp compared with 14,350 colorectal cancer cases and 5,242 colorectal cancer deaths in the general population. After 10 years, the cumulative incidence of colorectal cancer was 1.6% for hyperplastic polyps. 2.5% for sessile serrated polyps, 2.7% for tubular adenomas, 5.1% for tubulovillous adenomas, and 8.6% for villous adenomas compared with a 2.1% incidence in the general population.
Patients with any polyp showed an increased risk of developing colorectal cancer (hazard ratio [HR] = 1.11 for hyperplastic polyps; HR = 1.77 for sessile serrated polyps; HR = 1.41 for tubular adenomas; HR = 2.56 for tubulovillous adenomas; and HR = 3.82 for villous adenomas). In addition, there was a higher incidence of proximal colon cancer in patients with serrated polyps than with conventional adenomas (52%–57% vs. 30%–46%, respectively). Colorectal cancer mortality was positively correlated in patients with three types of polyps: sessile serrated polyps, tubulovillous adenomas, and villous adenomas (HR = 1.74, 1.95, 3.45, respectively).
Disclosure: For full disclosures of the study authors, visit thelancet.com.