A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.
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DOI：
10.1053/j.gastro.2008.12.007
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发表时间：
2009-03
期刊：
影响因子：
29.4
通讯作者：
Greenberg ER
中科院分区：
文献类型：
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作者：
Martínez ME;Baron JA;Lieberman DA;Schatzkin A;Lanza E;Winawer SJ;Zauber AG;Jiang R;Ahnen DJ;Bond JH;Church TR;Robertson DJ;Smith-Warner SA;Jacobs ET;Alberts DS;Greenberg ER
关于息肉切除术后发生晚期腺瘤和癌症的实际风险或决定风险的因素，数据有限。我们汇集了8项前瞻性研究的个人数据，这些研究包括9167名年龄在22岁到80岁之间的男性和女性，他们之前切除了结直肠腺瘤，以量化他们随后发展为晚期腺瘤或癌症的风险，并在监测期间确定与晚期结直肠肿瘤发展相关的因素。在47.2个月的中位随访期间，1082例(11.8%)患者被诊断为晚期结直肠肿瘤，其中58例(0.6%)为浸润性癌。基线腺瘤大于或等于5个的患者(24.1%；SE=2.2)和腺瘤大小为20 mm或更大的患者(19.3%；SE=1.5)发生异时性晚期腺瘤的风险较高。晚期腺瘤和浸润性癌的危险因素模式相似。在多因素分析中，高龄(P<；0.0001代表趋势)、男性(优势比[OR]1.40；95%可信区间[CI]1.19-1.65)、腺瘤的数目和大小(趋势代表P<；0.0001)、绒毛特征(OR，1.28；95%CI 1.07-1.52)和近端位置(OR，1.68；95%CI 1.43-1.98)与异时性晚期肿瘤的风险显著相关。在调整其他腺瘤特征后，高度不典型增生与异时性晚期肿瘤并不独立相关。息肉切除术后，晚期大肠肿瘤的发生是很常见的。与晚期肿瘤风险最相关的因素是患者的年龄以及既往腺瘤的数量和大小。
Limited data exist regarding the actual risk of developing advanced adenomas and cancer following polypectomy or the factors that determine risk. We pooled individual data from 8 prospective studies comprising 9167 men and women aged 22 to 80 with previously-resected colorectal adenomas to quantify their risk of developing subsequent advanced adenoma or cancer as well as identify factors associated with development of advanced colorectal neoplasms during surveillance. During a median follow-up of 47.2 months, advanced colorectal neoplasia was diagnosed in 1082 (11.8%) of the patients, 58 of whom (0.6%) had invasive cancer. Risk of a metachronous advanced adenoma was higher among patients with 5 or more baseline adenomas (24.1%; SE=2.2) and those with an adenoma 20 mm in size or greater (19.3%; SE=1.5). Risk factor patterns were similar for advanced adenomas and invasive cancer. In multivariate analyses, older age (P <0.0001 for trend) and male sex (odds ratio [OR], 1.40; 95% confidence interval [CI] 1.19–1.65) were significantly associated with increased risk of metachronous advanced neoplasia, as were the number and size of prior adenomas (P <0.0001 for trend), the presence of villous features (OR, 1.28; 95% CI 1.07–1.52), and proximal location (OR, 1.68; 95% CI 1.43–1.98). High-grade dysplasia was not independently associated with metachronous advanced neoplasia after adjustment for other adenoma characteristics. Occurrence of advanced colorectal neoplasia is common following polypectomy. Factors that are most strongly associated with risk of advanced neoplasia are patient age and the number and size of prior adenomas.
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影响因子：
158.5
作者：
Bertagnolli, Monica M.;Eagle, Craig J.;Hawk, Ernest T.
通讯作者：
Hawk, Ernest T.
影响因子：
8.4
作者：
Butterworth, AS;Higgins, JPT;Pharoah, P
通讯作者：
Pharoah, P
影响因子：
158.5
作者：
ATKIN, WS;MORSON, BC;CUZICK, J
通讯作者：
CUZICK, J
影响因子：
6.4
作者：
Bertario, L;Russo, A;Spinelli, P
通讯作者：
Spinelli, P
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N