Novel risk stratification for recurrence after endoscopic resection of advanced XXXX .

@entity1 @entity5 @entity29 @entity14 @entity652 @entity1141 @entity2513
BACKGROUND: Advanced @entity2513 (ACA) refers to @entity652 with the following predictive characteristics:  >= 1 cm in diameter, and/or villous component, and/or high-grade @entity1141 . ACA has high risk of transforming to @entity14 , and the recurrence rate is relatively high. OBJECTIVE: To assess the outcomes of @entity1 with ACA undergoing endoscopic resection and to identify risk factors for local recurrence and development of metachronous advanced @entity5 . DESIGN: Retrospective cohort study. SETTING: Tertiary care medical center. @entity1 : From 2005 to 2011, the records of 3625 @entity1 who underwent colonoscopic polypectomy at Seoul National University Hospital were retrospectively reviewed. @entity1 with synchronous @entity14 , @entity29 , previous colorectal resection, loss to follow-up, and incomplete resection were excluded. INTERVENTION: Endoscopic resection for ACA. MAIN OUTCOME MEASUREMENTS: Local recurrence and metachronous advanced @entity5 . RESULTS: The study included 917 @entity1 with 1206 ACAs. The median duration of follow-up was 28.5 months (interquartile range, 12.8-51.7). Independent risk factors for local recurrence included ACA with 2 or more predictive characteristics (adjusted hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.11-5.48; P  = .027) and piecemeal resection (adjusted HR, 6.96; 95% CI, 1.58-30.71; P  = .010). Independent risk factors for metachronous advanced @entity5 were male gender (adjusted HR, 1.65; 95% CI, 1.02-2.65; P  = .041),  >= 3 @entity652 (adjusted HR, 2.56; 95% CI, 1.72-3.82; P  < .001), and  >= 3 ACAs (adjusted HR, 1.44; 95% CI, 1.01-2.06; P  = .045). LIMITATIONS: Retrospective design. CONCLUSION: ACAs with 2 or more predictive characteristics recurred locally at a higher rate than ACAs with 1 predictive characteristic. These results suggest that @entity1 who are found to have ACAs with 2 or more predictive factors at index colonoscopy are at higher risk for local recurrence, and follow-up colonoscopy should be performed sooner.
