Key takeaways:

• Cardiometabolic risk factor reduction was linked to lower risk for metachronous advanced colorectal neoplasia in patients with MASLD.
• Those with highest baseline risk benefited most from metabolic improvements.

Patients with metabolic dysfunction-associated steatotic liver disease who improved their metabolic health after polypectomy significantly lowered their risk for metachronous advanced colorectal neoplasia, study results showed.

Findings also suggested that those with the highest metabolic burden or any advanced colorectal neoplasia at baseline benefited most from lifestyle interventions to reduce this risk.

“Postpolypectomy care should extend beyond scheduling the next surveillance colonoscopy,” Han-Mo Chiu, MD, PhD, attending physician and clinical professor in the department of internal medicine at National Taiwan University Hospital, told Healio. “Rather than asking patients to wait passively for the next examination, clinicians should actively encourage improvements in metabolic health during the surveillance interval. By addressing modifiable metabolic abnormalities, patients can take an active role in reducing their future risk of metachronous advanced neoplasia.”

Previous research has established a link between cardiometabolic risk factors (CMRFs) —abdominal obesity, impaired fasting glucose, high blood pressure, hypertriglyceridemia and low HDL cholesterol — development of colorectal cancer, according to Chiu and colleagues.

The risk for advanced colorectal neoplasia and CRC is even greater among those with MASLD, a condition defined by the presence of at least one of those risk factors.

“Although patients with MASLD are known to be at increased risk for colorectal neoplasia, it remains unclear whether MASLD also contributes to the future development of neoplasia after adenoma removal and — more importantly — what patients can do to mitigate this risk,” Chiu said.

“Current postpolypectomy care largely consists of advising patients when to return for surveillance colonoscopy according to their colonoscopic finding and the corresponding recommended surveillance interval,” he added.

“However, little is known about what interventions should be implemented during this interval to reduce the risk of metachronous neoplasia — that is, how to effectively integrate primary prevention into postpolypectomy care.”

Chiu and colleagues conducted a retrospective cohort study of 2,331 individuals aged 40 years and older (mean age, 56.7 years; 74.9% men) with MASLD who underwent initial and surveillance colonoscopy at National Taiwan University Hospital from 2009 to 2021. All participants had at least one colorectal adenoma removed during the initial procedure.

Metachronous advanced colorectal neoplasia — an adenoma with a minimum diameter of 10 mm and villous components or high-grade dysplasia — served as the primary outcome.

At mean follow-up of 4 years, incidence of metachronous neoplasia per 1,000 patient-years was not significantly different between patients with increased CMRF count (16.7; 95% CI, 11.4-23.6) and those whose count remained unchanged (17.6; 95% CI, 12.9-23.9).

However, incidence significantly dropped among patients with a CMRF reduction of one (11.9; 95% CI, 8.3-16.4) or at least two (9.9; 95% CI, 5.8-15.7).

Overall, any CMRF reduction was linked to significantly lower risk for metachronous advanced colorectal neoplasia (adjusted HR = 0.49; 95% CI, 0.33-0.73).

Additional subgroup analyses found that among patients with five CMRFs at baseline, those with any reduction in count lowered their risk for neoplasia recurrence vs. those who did not reduce their count (aHR = 0.4; 95% CI, 0.17-0.92). Patients in another high-risk group — those with an advanced colorectal neoplasia at baseline — also lowered their risk by reducing their CMRF count (aHR = 0.27; 95% CI, 0.11-0.65).

CMRF reductions were linked to lower prevalence of metachronous lesions at least 1 cm in diameter, as well.

“Patients with large adenomas at the index colonoscopy and those with the highest baseline metabolic burden — a baseline CMRF count of five — who achieved greater reductions in CMRF counts experienced the greatest reduction in recurrence risk,” Chiu said. “These findings suggest that primary prevention after adenoma removal should move beyond a one-size-fits-all approach toward a strategy of precision prevention, targeting patients most likely to benefit from metabolic risk reduction.”

Study limitations included potential selection bias from excluding patients without follow-up data, possibility of missed external colonoscopy histories from the single-institution study design and reliance on point-in-time measurements of CMRFs.

“The most important point in caring for patients with MASLD is that we do not have to fatalistically accept their elevated risk of metachronous advanced neoplasia — or even colorectal cancer — as inevitable,” Chui said. “Instead, we have an opportunity to actively reduce that risk by improving metabolic dysfunction, shifting postpolypectomy care from passive surveillance to proactive prevention.”

For more information:

Han-Mo Chiu, MD, PhD, can be reached at hanmochiu@ntu.edu.tw.