P4761 - Comparing the Risk of Metachronous Advanced Neoplasia on Post-Operative Surveillance Lower Endoscopy in Patients With Early Onset vs Average Onset Colorectal Cancer
Zehra Naseem, MD1, Leandro Sierra, MD2, Kailash Singh, 3, Jared Hendren, MD1, John McMichael, PhD4, Qijun Yang, MS1, Queqi Wu, MPH1, Joshua Sommovilla, MD1, David Liska, MD, MA1, Carole Macaron, MD1, Carol A.. Burke, MD, MACG1 1Cleveland Clinic, Cleveland, OH; 2Department of Internal Medicine, Cleveland Clinic, Cleveland, OH; 3Cleveland Clinic Lerner College of Medicine, Cleveland, OH; 4Cleveland Clinic Foundation, Cleveland, OH Introduction: Whether the post-operative risk of metachronous advanced neoplasia (MAN) differs between patients with early-onset colorectal cancer (EOCRC: < 50 years) and average-onset colorectal cancer (AOCRC: ≥50 years) is inconclusive. We compared the characteristics of patients with EOCRC and AOCRC, postoperative surveillance lower endoscopy findings, and identified factors associated with MAN. Methods: Patients with EOCRC and AOCRC randomly selected at 1:2 ratio, matched ± 6 months at time of diagnosis, treated surgically at Cleveland Clinic between 2011 – 2021 with ≥ 1 post-operative surveillance lower endoscopy performed ≥6 months after surgery were included. Inflammatory bowel disease, hereditary colorectal cancer syndromes, and total proctocolectomy patients were excluded. Post-op endoscopic findings were categorized as: 1) Normal: no polyps/hyperplastic polyps < 10mm, 2) Non-advanced neoplasia (NAN): tubular adenoma < 10mm, sessile serrated adenoma < 10 mm without dysplasia 3) Advanced neoplasia: serrated polyps ≥ 10 mm or with dysplasia, tubular adenoma ≥10 mm or with high-grade dysplasia or villous features, or CRC. Distal CRC was defined as CRC in the descending or sigmoid colon. Clinical features and surveillance endoscopy findings were compared by Fischer’s, Pearson’s chi-square, Wilcoxon, and t tests. Categorical variables were presented as percentages and continuous variables as median and IQR. Results: 230 EOCRC patients and 504 AOCRC patients diagnosed at a median age of 44 and 66 years were included (Table 1a). Sex, race, ethnicity, BMI, and alcohol use were similar between groups. Tobacco use, hyperlipidemia, hypertension, diabetes, aspirin/statin use and history of non-CRC were significantly commoner in the AOCRC group. Vitamin D levels were significantly lower in EOCRC patients.
MAN was similar between groups, 13% in EOCRC vs. 16.1% in AOCRC (p=0.342). EOCRC patients had longer median post-op follow-up and fewer months between exams (Table 1b). On univariate analysis, MAN was not associated with age but with prior tobacco use, hyperlipidemia, and a history of distal CRC (Table 2). Discussion: EOCRC patients undergo fewer months between 1st and follow-up surveillance lower endoscopy; however, the incidence of MAN is no different than AOCRC. Smoking, hyperlipidemia, and distally located primary CRC are associated with MAN. These data corroborate some previous studies and support similar post-operative CRC surveillance strategies for EOCRC and AOCRC patients.
Figure: Table 1a: Baseline patient and clinical characteristics for patients with early-onset colorectal cancer and average-onset colorectal cancer
Figure: Table 1b: Post-operative surveillance findings on lower endoscopy in patients with early-onset colorectal cancer and average-onset colorectal cancer Table 2: Univariate model for factors associated with metachronous advanced neoplasia
Disclosures: Zehra Naseem indicated no relevant financial relationships. Leandro Sierra indicated no relevant financial relationships. Kailash Singh indicated no relevant financial relationships. Jared Hendren indicated no relevant financial relationships. John McMichael indicated no relevant financial relationships. Qijun Yang indicated no relevant financial relationships. Queqi Wu indicated no relevant financial relationships. Joshua Sommovilla indicated no relevant financial relationships. David Liska indicated no relevant financial relationships. Carole Macaron indicated no relevant financial relationships. Carol Burke: emtora biosciences – Grant/Research Support. lumabridge – Consultant. myriad – Food and beverage. Natera – Food and beverage.
Zehra Naseem, MD1, Leandro Sierra, MD2, Kailash Singh, 3, Jared Hendren, MD1, John McMichael, PhD4, Qijun Yang, MS1, Queqi Wu, MPH1, Joshua Sommovilla, MD1, David Liska, MD, MA1, Carole Macaron, MD1, Carol A.. Burke, MD, MACG1. P4761 - Comparing the Risk of Metachronous Advanced Neoplasia on Post-Operative Surveillance Lower Endoscopy in Patients With Early Onset vs Average Onset Colorectal Cancer, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
