Demographic and Clinicopathologic Factors Associated With Colorectal Adenoma Recurrence

Importance: Current colorectal surveillance guidelines emphasize adenoma characteristics but overlook temporal, racial, and sex-based heterogeneity in recurrence risk, a gap that limits equitable and personalized care. Objective: To evaluate the associations of demographic factors, obesity, and adenoma features with recurrence risk over time in a large longitudinal surveillance cohort. Design, Setting, and Participants: This retrospective cohort study included adults who underwent their first colonoscopic polypectomy between January 1990 and July 2024 at a tertiary medical center. Exposures: Demographic variables included race and ethnicity, sex, obesity (body mass index >30), family history of colorectal cancer (CRC) or polyps, and age at adenoma onset (10 years) reemergence (aHR, 2.71; 95% CI, 2.15-3.41). Obesity conferred persistent risk across all surveillance intervals (early: aHR, 1.16; 95% CI, 1.11-1.21; late: aHR, 1.22; 95% CI, 1.09-1.35). Female patients with high-risk adenomas exhibited marked late-term (>10 years) elevation exceeding male patients (female patients: aHR, 1.73; 95% CI, 1.43-2.08 vs male patients: aHR, 1.29; 95% CI, 1.06-1.58). Conclusions and Relevance: Both histopathologic features and demographic factors demonstrated distinct time-dependent patterns in adenoma recurrence, underscoring the need for surveillance strategies that account for temporal variation and population-specific risk profiles.