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Adenoma recurrences after resection of colorectal carcinoma: results from the Southwest Oncology Group 9041 calcium chemoprevention pilot study.

  • Author(s): Chu, David Z J
  • Chansky, Kari
  • Alberts, David S
  • Meyskens, Frank L, Jr
  • Fenoglio-Preiser, Cecilia M
  • Rivkin, Saul E
  • Mills, Glenn M
  • Giguere, Jeffrey K
  • Goodman, Gary E
  • Abbruzzese, James L
  • Lippman, Scott M
  • et al.
Abstract

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

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.

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.

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.

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