Demographic and Clinicopathologic Risk Factors for Colorectal Polyp Recurrence: A Large-Scale Surveillance Cohort Study
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Importance
Current post-polypectomy surveillance guidelines prioritize polyp characteristics but insufficiently address demographic disparities and modifiable risk factors, potentially contributing to inequities in colorectal polyp recurrence.
Objective
To evaluate the association of demographic factors, obesity, and polyp characteristics with polyp recurrence risk.
Design, Setting, and Participants
This retrospective Polypectomy Cohort study included 68,480 adults undergoing their first polypectomy at a tertiary medical center (January 1990-July 2024), with a median follow-up of 4 years.
Exposures
Risk factors included race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic, Asian/Pacific Islander [API]), polyp onset age (≤50, 51–75, ≥76 years), sex, obesity (BMI >30), and polyp characteristics (size, number, location, histology, dysplasia grade).
Main Outcomes and Measures
The primary outcome was polyp recurrence-free survival, defined as the time to recurrence following the initial polypectomy. Cox regression analyses assessed associations between recurrence and demographic/clinical factors, adjusting for confounders.
Results
Among 68,480 patients (median age 57.8 years; 50.0% female; 86.6% NHW, 10.5% NHB), 19,450 (28.4%) experienced recurrence. Males had higher 5-year recurrence risk (aHR, 1.12 [95% CI, 1.08-1.17]; P = 3.49 × 10) than females, with females showing elevated villous histology risk (HR, 2.57 [95% CI, 2.26-2.93] vs males 2.42 [95% CI, 2.09-2.8]). NHB patients had lower 5-year recurrence (24.9% vs 29.1% NHW; aHR, 0.87 [95% CI, 0.81-0.93]; P = 2.92 × 10), rising beyond 10 years (aHR, 1.24 [95% CI, 1.06-1.45]; P = 7.59 × 10 3 ). Age ≤50 (aHR, 0.87) and ≥76 (aHR, 0.73) was protective vs 51–75. Early-onset polyps were higher in Hispanic (40.9%) and API (32.7%) vs NHW (26.5%). Villous histology (aHR, 2.40 [95% CI, 2.18-2.65]; P = 5.26 × 10) and high-grade dysplasia (aHR, 2.91 [95% CI, 2.59-3.27]; P = 7.06 × 10 2 ) surpassed polyp size (aHR, 1.65 [95% CI, 1.56-1.75]; P = 2.15 × 10 3 ) as recurrence predictors, while obesity elevated early risk (aHR, 1.14 [95% CI, 1.09-1.18]; P = 5.32 × 10 1 )
Conclusions and Relevance
Demographic factors, histologic features, and obesity are critical predictors of polyp recurrence. Surveillance guidelines should incorporate histologic risk, obesity management, and equity-focused strategies to optimize outcomes across diverse populations.
Key Question
Which demographic and histopathologic factors influence polyp recurrence in post-polypectomy surveillance, and what are their long-term impacts?
Findings
In a cohort of 68,480 patients, villous histology and high-grade dysplasia were strong predictors of polyp recurrence. Males and obese patients demonstrated a higher early risk, while non-Hispanic Black (NHB) patients showed an increased recurrence over time. Both early-onset and older-onset were protective against recurrence compared to the 51–75 age group.
Meaning
Post-polypectomy surveillance guidelines should incorporate histopathological, demographic, and obesity, to improve precision and equity in surveillance strategies. Addressing population-specific risk can optimize long-term outcomes.
