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Ann Surg Oncol Early Release, published online ahead of print Sep 15 2003
Annals of Surgical Oncology, 10.1245/ASO.2003.03.037
 © 2003 Society of Surgical Oncology
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Original Articles

Adenoma Recurrences After Resection of Colorectal Carcinoma: Results From the Southwest Oncology Group 9041 Calcium Chemoprevention Pilot Study

David Z. J. Chu, MD, Kari Chansky, MS,, David S. Alberts, MD, Frank L. Meyskens Jr., MD, Cecilia M. Fenoglio-Preiser, MD, Saul E. Rivkin, MD, Glenn M. Mills, MD, Jeffrey K. Giguere, MD, Gary E. Goodman, MD, James L. Abbruzzese, MD, Scott M. Lippman, MD

From the City of Hope National Medical Center (DZJC), Duarte, California; Southwest Oncology Group Statistical Center (KC), Seattle, Washington; University of Arizona Cancer Center (DSA), Tucson, Arizona; University of California (FLM), Irvine, Orange, California; University of Cincinnati Medical Center (CMF-P), Cincinnati, Ohio; Puget Sound Oncology Consortium (SER, GEG), Seattle, Washington; Louisiana State University (GMM), Shreveport, Louisiana; Greenville Community Clinical Oncology Program (JKG), Greenville, South Carolina; and M. D. Anderson Cancer Center (JLA, SML), Houston, Texas.

Address correspondence and reprint requests to: Southwest Oncology Group (SWOG-9041) Operations Office, 14980 Omicron Drive, San Antonio, TX 78245-3217.


  Abstract

Background: Colorectal adenomas are the usual precursors to carcinoma in sporadic and hereditary colorectal cancers (CRC).

Methods: A total of 220 CRC patients (stages 0, I, and II) were randomized prospectively in a double-blind pilot study of calcium chemoprevention by using recurrent colorectal adenomas as a surrogate end point. This trial is still in progress, and we report the preliminary findings on adenoma recurrence rates.

Results: Synchronous adenomas were present in 60% of patients, and cancer confined in a polyp was present in 23% of patients. The overall cumulative adenoma recurrence rate was 31% (19% in the first year, 29% for 2 years, and 35% for 3 years). The recurrence rates were greater for patients with synchronous adenomas: 38% at 3 years (P = .01). Lower stage was associated with higher adenoma recurrence rates (P = .04). Factors including age, sex, site of primary cancer, and whether the cancer was confined to a polyp were not significantly associated with differences in adenoma recurrence rates.

Conclusions: The substantial adenoma recurrence rate in patients resected of CRC justifies colonoscopic surveillance on a periodic basis. Patients with higher rates of adenoma recurrences, such as CRC with synchronous adenomas, are ideal subjects for chemoprevention trials.

Key Words: Adenoma, Colorectal cancer, Synchronous adenoma, Adenoma recurrence rate.




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