P2229 - Cancer-Specific 5-Year Survival Following Endoscopic Polypectomy versus Surgery for Malignant Colorectal Polyps

Mark M. Aloysius, MD, PhD¹, Hemant Goyal, MD¹, Aman Ali, MD², Niraj J. Shah, MD³, Mahesh Gajendran, MD⁴, Patrick Basu, MD, FACG⁵, Rajiv Chhabra, MD, MRCP^6
1Wright Center for Graduate Medical Education, Scranton, PA; ²The Commonwealth Medical College, Wilkes-Barre, PA; ³University of Mississippi Medical Center, Jackson, MS; ⁴University of Texas Health Science Center, San Antonio, TX; ⁵VA Medical Center Orlando, Orlando, FL; ⁶Saint Lukes Hospital/University of Missouri Kansas City, Overland Park, KS

Introduction: Current guidelines recommend polyp resection strategies, endoscopic resection (ER) or surgical resection (SR) based on high-risk histological features and depth of invasion to ensure complete removal of the malignant lesion, minimizing the risk of progression through micrometastasis. Data comparing cancer-specific survival following ER or SR for localized malignant polyps based on the AJCC staging (Stage 0, I & II & grade) are scarce.

Methods: We used the Surveillance Epidemiology and End Results (SEER) database (2004-2015) on patients diagnosed with at least a single malignant colorectal polyp (Table 1) on the colonoscopies performed for any indication or screening. Data extraction was through a case listing session using SEER*Stat v8.3.9 on combined SEER 18 incidence registries using specific codes for CRC polyps with cancer. Statistical analysis was performed using SPSS v27 for Mac.

Results: A total of 63,147 patients with a diagnosis of a colorectal polyp with a malignant component were identified. The mean age was 47.48 years (± 12.15 SD), 45.6% were females. T stages ranged T1-T3. Patients with stage 0 (carcinoma in situ) polyps showed equivalent 5-year cancer-specific survival regardless of ER or SR (mean 170 vs. 169 months, 94.2% vs 93.7%, p=0.429, Fig 1a). Stage I and II patients showed superior 5-year survival with SR than ER (mean 165 vs. 159 months, 91.1% vs. 88%, p< 0.001, Fig 1b). Patients with well-differentiated histological grade demonstrated no survival differences regardless of ER or SR (mean 165 vs. 166 months, 92.7% vs. 93%, p=0.175, Fig 1c). In contrast, those with polyps of poor differentiation or anaplastic features showed superior 5-year cancer-specific survival with SR than ER (mean 161 vs. 145months, 90% vs. 88%, p=< 0.001, Fig 1e). Patients with polyps of moderate differentiation showed superior 5-year cancer-specific survival with SR compared with ER (mean 164 vs. 159months, 92% vs. 90% p< 0.001, Fig 1d)

Discussion: Our results show that cancer-specific survival improved in patients with malignant polyps with AJCC Stage I or II who underwent SR compared with ER, but not Stage 0 (carcinoma in situ). Another novel finding was superior 5-year cancer-specific survival in patients with polyps of moderately-differentiated histological grade, in addition to poorly differentiated and anaplastic grades, which has not been reported before. These novel findings warrant further corroboration from well-constructed clinical trials.


Figure: Five year cancer specific survival comparing endoscopic resection versus surgical resection for colorectal polyps by cancer stage and histological grade

Year		2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
Derived AJCC Stage Group, (2004-2015)	0 (carcinoma in situ)	1067	1096	1000	1096	1031	948	985	996	923	884	921	862
	I	3443	3560	3547	4068	4031	4031	3814	3765	3722	3605	3638	3620
	II (unclassified)	2	4	3	5	0	3	2	4	3	3	3	4
	IIA	290	306	302	422	442	461	428	415	482	437	515	524

Table: Number of patients diagnosed with polyps with a malignant component by stage and year of diagnosis


Disclosures:
Mark Aloysius indicated no relevant financial relationships.
Hemant Goyal indicated no relevant financial relationships.
Aman Ali indicated no relevant financial relationships.
Niraj Shah indicated no relevant financial relationships.
Mahesh Gajendran indicated no relevant financial relationships.
Patrick Basu indicated no relevant financial relationships.
Rajiv Chhabra indicated no relevant financial relationships.


Mark M. Aloysius, MD, PhD¹, Hemant Goyal, MD¹, Aman Ali, MD², Niraj J. Shah, MD³, Mahesh Gajendran, MD⁴, Patrick Basu, MD, FACG⁵, Rajiv Chhabra, MD, MRCP⁶. P2229 - Cancer-Specific 5-Year Survival Following Endoscopic Polypectomy versus Surgery for Malignant Colorectal Polyps, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.