Demographic and Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence.
[IMPORTANCE] Current colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and
- 95% CI 3.56-4.50
- 연구 설계 cohort study
APA
Awan UA, Song Q, et al. (2026). Demographic and Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence.. JAMA network open, 9(2), e2556853. https://doi.org/10.1001/jamanetworkopen.2025.56853
MLA
Awan UA, et al.. "Demographic and Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence.." JAMA network open, vol. 9, no. 2, 2026, pp. e2556853.
PMID
41637071
Abstract
[IMPORTANCE] 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.
[OBJECTIVE] To evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort.
[DESIGN, SETTING, AND PARTICIPANTS] This retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center.
[EXPOSURES] Demographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at adenoma onset (<50 vs ≥50 years). Adenoma features included histology, size, number, and dysplasia.
[MAIN OUTCOMES AND MEASURES] The primary outcome was recurrence-free survival, defined as time from initial polypectomy to histologically confirmed recurrence. Time-varying coefficient Cox models were fitted to handle the nonconstant associations of exposure over the follow-up time. The follow-up time was categorized into 3 periods (less than 5 years, 5 to 10 years, and 10 or more years). The heterogeneity of exposure associations across the 3 follow-up periods was assessed with likelihood ratio tests.
[RESULTS] Among 59 667 patients (mean [SD] age, 60 years [11.2]; 29 401 [49.3%] female; 1007 [1.7%] Asian and Pacific Islander, 646 [1.1%] Hispanic, 5972 [10.0%] non-Hispanic Black, and 52 042 [87.2%] non-Hispanic White; median [IQR] follow-up, 4 [1-9] years), 17 596 (29.5%) experienced overall recurrence within 5 years. High-grade dysplasia demonstrated the largest early phase association (adjusted hazard ratio [aHR], 4.00; 95% CI, 3.56-4.50) with complete midterm and late attenuation, while villous histology exhibited biphasic patterns with early elevation (aHR, 2.89; 95% CI, 2.63-3.18) and late-phase (>10 years) reemergence (aHR, 2.71; 95% CI, 2.15-3.41). 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). Female patients with high-risk adenomas exhibited marked late-term (>10 years) elevation exceeding male patients (female patients: aHR, 1.73; 95% CI, 1.43-2.08 vs male patients: aHR, 1.29; 95% CI, 1.06-1.58).
[CONCLUSIONS AND RELEVANCE] Both histopathologic features and demographic factors demonstrated distinct time-dependent patterns in adenoma recurrence, underscoring the need for surveillance strategies that account for temporal variation and population-specific risk profiles.
[OBJECTIVE] To evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort.
[DESIGN, SETTING, AND PARTICIPANTS] This retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center.
[EXPOSURES] Demographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at adenoma onset (<50 vs ≥50 years). Adenoma features included histology, size, number, and dysplasia.
[MAIN OUTCOMES AND MEASURES] The primary outcome was recurrence-free survival, defined as time from initial polypectomy to histologically confirmed recurrence. Time-varying coefficient Cox models were fitted to handle the nonconstant associations of exposure over the follow-up time. The follow-up time was categorized into 3 periods (less than 5 years, 5 to 10 years, and 10 or more years). The heterogeneity of exposure associations across the 3 follow-up periods was assessed with likelihood ratio tests.
[RESULTS] Among 59 667 patients (mean [SD] age, 60 years [11.2]; 29 401 [49.3%] female; 1007 [1.7%] Asian and Pacific Islander, 646 [1.1%] Hispanic, 5972 [10.0%] non-Hispanic Black, and 52 042 [87.2%] non-Hispanic White; median [IQR] follow-up, 4 [1-9] years), 17 596 (29.5%) experienced overall recurrence within 5 years. High-grade dysplasia demonstrated the largest early phase association (adjusted hazard ratio [aHR], 4.00; 95% CI, 3.56-4.50) with complete midterm and late attenuation, while villous histology exhibited biphasic patterns with early elevation (aHR, 2.89; 95% CI, 2.63-3.18) and late-phase (>10 years) reemergence (aHR, 2.71; 95% CI, 2.15-3.41). 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). Female patients with high-risk adenomas exhibited marked late-term (>10 years) elevation exceeding male patients (female patients: aHR, 1.73; 95% CI, 1.43-2.08 vs male patients: aHR, 1.29; 95% CI, 1.06-1.58).
[CONCLUSIONS AND RELEVANCE] Both histopathologic features and demographic factors demonstrated distinct time-dependent patterns in adenoma recurrence, underscoring the need for surveillance strategies that account for temporal variation and population-specific risk profiles.
MeSH Terms
Retrospective Studies; Humans; Male; Female; Adult; Middle Aged; Longitudinal Studies; Colorectal Neoplasms; Adenoma; Sentinel Surveillance; Neoplasm Recurrence, Local; Obesity; Risk Factors; Proportional Hazards Models; Demography; Time Factors; Risk Assessment; Early Detection of Cancer; Aged