Cancer-specific survival of colorectal adenocarcinomas according to the type of pre-existing adenoma: A Surveillance, Epidemiology, and End Results registry analysis.

Abstract

More than 90% of colorectal cancers originate from preexisting adenomas. The present study aimed to assess the association between the type of preexisting adenomas and cancer-specific survival of subsequent colorectal cancer. This retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results registry 2000-2020 on patients surgically treated for colorectal adenocarcinomas with known types of preexisting adenomas. Kaplan-Meier statistics and Cox regression analyses were used to assess 5-year cancer-specific survival according to the adenoma types. The study included 65,365 patients (52.7% male, median age 67 years). Overall, 75.7% of tumors were associated with tubulovillous adenomas, 23.4% with villous adenomas, 0.66% with tubular adenomas, and 0.1% with serrated adenomas. The 5-year cancer-specific survival was best for serrated adenoma-associated carcinomas (87.9%), followed by tubular adenoma-associated carcinomas (84.2%) and tubulovillous adenomas-associated carcinomas (81.5%) whereas villous adenomas-associated carcinomas had the lowest cancer-specific survival (74.1%). The same finding was noted when cancer-specific survival was stratified by disease location and stage. Patients with villous adenomas-associated carcinomas had a lower likelihood of cancer-specific survival compared to tubular adenoma-associated carcinomas (hazard ratio, 1.56, P < .001) whereas tubulovillous adenomas and serrated adenoma-associated carcinomas had a similar risk. However, when adjusted for other survival confounders, the type of preexisting adenoma was not independently associated with cancer-specific survival. Colorectal adenocarcinomas originating from serrated adenomas and tubular adenomas had the highest 5-year cancer-specific survival. Conversely, villous adenomas-associated adenocarcinomas had the lowest cancer-specific survival. The type of preexisting adenoma was not independently associated with 5-year cancer-specific survival.