For management of malignant colonic polyps in patients with comparable clinical characteristics
FRIDAY, Jan. 27 (HealthDay News) -- For patients with malignant colonic polyps who have similar clinical characteristics, management with either polypectomy or surgical resection results in comparable outcomes, according to a study published in the Feb. 1 issue of Cancer.
Using the linked Surveillance Epidemiology and End Results-Medicare database from 1992 to 2005, Gregory S. Cooper, M.D., from Case Western Reserve University in Cleveland, and colleagues identified 2,077 patients aged ≥66 years with an initial diagnosis of stage T1N0M0 malignant polyp. Depending on the most invasive treatment, patients were classified as surgical or polypectomy, and were divided into quintiles of likelihood of polypectomy to adjust for potential selection bias in treatment assignment; outcomes were compared in each quintile.
The researchers found that surgical resection was carried out in 64.5 percent of patients, and polypectomy in 35.5 percent. Older age, greater comorbidity, no history of polyps, diagnosis in 2002 or later, left colon site of cancer, well-differentiated tumors, and colonoscopy performed in an outpatient setting were identified as significant predictors for undergoing polypectomy. In the surgical group, one- and five-year survival were higher (92 and 75 percent, respectively) compared with the polypectomy group (88 and 62 percent, respectively), with an unadjusted hazard ratio of 1.51, and a hazard ratio of 1.15 after adjustment for propensity quintile. The risk of death was similar between the two treatment groups within each propensity quintile (interaction test P = 0.96).
"Under usual practice conditions, patients with similar clinical characteristics have comparable outcomes with polypectomy or surgical resection, and polypectomy could be offered to patients who meet appropriate clinical criteria," the authors write.
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