Related Experiment Video
Updated: Oct 3, 2025
Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
Adenoma characteristics associated with post-polypectomy proximal colon cancer incidence: a retrospective cohort
Rhea Harewood1,2, Kate Wooldrage3, Emma C Robbins3
1Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. r.harewood18@imperial.ac.uk.
Background:
Colorectal cancer (CRC) screening is less effective at reducing cancer incidence in the proximal colon compared to the distal colorectum. We aimed to identify adenoma characteristics associated with proximal colon cancer (PCC).
Methods:
Endoscopy and pathology data for patients with ≥1 adenoma detected at baseline colonoscopy were obtained from 17 UK hospitals between 2001 and 2010. Multivariable Cox regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for PCC, and, for comparison, distal CRC incidence, by adenoma characteristics.
Results:
Among 18,431 patients, 152 and 105 developed PCC and distal CRC, respectively, over a median follow-up of 9.8 years. Baseline adenoma characteristics positively associated with PCC incidence included number (≥3 vs. < 3: aHR 2.10, 95% CI: 1.42-3.09), histology (tubulovillous/villous vs. tubular: aHR 1.61, 95% CI: 1.10-2.35) and location (any proximal vs. distal only: aHR 1.70, 95% CI: 1.20-2.42), for which there was borderline evidence of heterogeneity by subsite (p = 0.055). Adenoma dysplasia (high vs. low grade) was associated with distal CRC (aHR 2.42, 95% CI: 1.44-4.04), but not PCC (p-heterogeneity = 0.023).
Conclusions:
Baseline adenoma number, histology and proximal location were independently associated with PCC and may be important to identify patients at higher risk for post-polypectomy PCC.
