Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults
Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults
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DOI：
10.1001/jama.299.9.1027
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发表时间：
2008-03-05
影响因子：
120.7
通讯作者：
Friedland, Shai
中科院分区：
文献类型：
--
作者：
Soetikno, Roy M.;Kaltenbach, Tonya;Friedland, Shai
结直肠癌是美国癌症死亡的第二大原因。预防的重点是息肉样肿瘤的检测和切除。关于非息肉样结直肠肿瘤的意义的数据有限目的确定NP-CRN在退伍军人医院人群中的患病率并描述其与结直肠癌的关系。患者交叉-在加州的一家退伍军人医院进行的一项横断面研究，纳入了1819例从2003年7月至2004年6月接受选择性结肠镜检查的患者。结果NP-CRN的总患病率为9.35%（95%可信区间[95%CI]，8.05%- 10.78%; n= 170）。NP-CRN在筛查、监测和症状亚群中的患病率分别为5.84%（95%CI，4.13%- 8.00%; n= 36）、15.44%（95%CI，12.76%- 18.44%; n= 101）和6.01%（95%CI，4.17%-8.34%; n= 33）。原位或粘膜下浸润性癌的NP-CRN的总体患病率为0.82%（95%CI，0.46%- 1.36%; n= 15）;在筛查人群中，患病率为0.32%（95%CI，0.04%- 1.17%; n= 2）。总体而言，无论大小，NP-CRN比息肉样病变更可能包含癌（比值比，9.78; 95%CI，3.93-24.4）。在筛选亚群（优势比，2.01; 95%CI，0.27- 15.3）和监测亚群（优势比，63.7; 95%CI，9.41- 431）中也观察到NP-CRN与原位或粘膜下浸润性癌的正的尺寸调整相关性.抑郁型的风险最高（33%）。含癌的非息肉样结直肠肿瘤的直径小于息肉样结直肠肿瘤（平均[ SD]直径分别为15.9 [ 10.2] mm vs 19.2 [ 9.6] mm）。与历史controls.Conclusion相比，在这组老兵患者中，NP- CRNs是在常规结肠镜检查中诊断的相对常见的病变，与息肉样肿瘤相比，无论大小，与癌的相关性更大。
Context Colorectal cancer is the second leading cause of cancer death in the United States. Prevention has focused on the detection and removal of polypoid neoplasms. Data are limited on the significance of nonpolypoid colorectal neoplasms ( NP- CRNs).Objectives To determine the prevalence of NP- CRNs in a veterans hospital population and to characterize their association with colorectal cancer.Design, Setting, and Patients Cross- sectional study at a veterans hospital in California with 1819 patients undergoing elective colonoscopy from July 2003 to June 2004.Main Outcome Measures Endoscopic appearance, location, size, histology, and depth of invasion of neoplasms.Results The overall prevalence of NP- CRNs was 9.35% ( 95% confidence interval [ 95% CI], 8.05%- 10.78%; n= 170). The prevalence of NP- CRNs in the subpopulations for screening, surveillance, and symptoms was 5.84% ( 95% CI, 4.13%- 8.00%; n= 36), 15.44% ( 95% CI, 12.76%- 18.44%; n= 101), and 6.01% ( 95% CI, 4.17%-8.34%; n= 33), respectively. The overall prevalence of NP- CRNs with in situ or submucosal invasive carcinoma was 0.82% ( 95% CI, 0.46%- 1.36%; n= 15); in the screening population, the prevalence was 0.32% ( 95% CI, 0.04%- 1.17%; n= 2). Overall, NP- CRNs were more likely to contain carcinoma ( odds ratio, 9.78; 95% CI, 3.93-24.4) than polypoid lesions, irrespective of the size. The positive size- adjusted association of NP- CRNs with in situ or submucosal invasive carcinoma was also observed in subpopulations for screening ( odds ratio, 2.01; 95% CI, 0.27- 15.3) and surveillance ( odds ratio, 63.7; 95% CI, 9.41- 431). The depressed type had the highest risk ( 33%). Nonpolypoid colorectal neoplasms containing carcinoma were smaller in diameter as compared with the polypoid ones ( mean [ SD] diameter, 15.9 [ 10.2] mm vs 19.2 [ 9.6] mm, respectively). The procedure times did not change appreciably as compared with historical controls.Conclusion In this group of veteran patients, NP- CRNs were relatively common lesions diagnosed during routine colonoscopy and had a greater association with carcinoma compared with polypoid neoplasms, irrespective of size.