THE NATIONAL POLYP STUDY - PATIENT AND POLYP CHARACTERISTICS ASSOCIATED WITH HIGH-GRADE DYSPLASIA IN COLORECTAL ADENOMAS
THE NATIONAL POLYP STUDY - PATIENT AND POLYP CHARACTERISTICS ASSOCIATED WITH HIGH-GRADE DYSPLASIA IN COLORECTAL ADENOMAS
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DOI：
10.1016/0016-5085(90)90827-n
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发表时间：
1990-02-01
期刊：
影响因子：
29.4
通讯作者：
SZPORN, A
中科院分区：
文献类型：
--
作者：
OBRIEN, MJ;WINAWER, SJ;SZPORN, A
国家息肉研究 (NPS) 是一项随机临床试验，旨在评估对发现患有一个或多个结直肠腺瘤的患者的有效监测，该试验是该统计分析的框架，该统计分析使用多重逻辑模型来评估与腺瘤高度不典型增生相关的患者和息肉特征的独立危险因素。该数据库包含来自 1867 名患者的 3371 个腺瘤。发现腺瘤大小和绒毛成分的范围是与高度不典型增生相关的主要独立息肉危险因素（p < 0.0001）。相对于小腺瘤，中等大小腺瘤的调整优势比为3.3，大腺瘤相对于小腺瘤为7.7，相对于管状腺瘤，绒毛A腺瘤为2.7，绒毛B腺瘤为3.4，绒毛C和D腺瘤为8.1。位于脾曲远端的腺瘤中高度不典型增生的频率增加主要归因于尺寸和绒毛成分的增加，而不是位置本身。对于左侧位置，调整后的优势比为 1.4 (p < 0.11)。腺瘤的多样性影响患者高度不典型增生的风险，但取决于腺瘤大小和绒毛成分，而不是独立因素。对于多重性，调整后的优势比为 1.3 (p < 0.17)。年龄的增加与患者发生高度不典型增生的风险相关，并且这种影响独立于腺瘤大小和组织学类型的影响。对于年龄 .gtoreq，调整后的优势比为 1.8 (p < 0.0016)。 60岁性别与高度不典型增生无关。男性的调整后优势比为 1.0 (p < 0.95)。患者系列的规模、数据收集的前瞻性、所有患者信息的完整性、对整个结肠进行完整检查和对遇到的所有病变进行病理检查的要求，以及排除先前诊断的腺瘤患者，这些都是本研究的独特特征。分析提供的详细模型整合了与结直肠腺瘤高度不典型增生相关的多个患者和腺瘤因素。
The National Polyp Study (NPS), a randomized clinical trial to evaluate effective surveillance of patients discovered to have one or more colorectal adenomas, was the framework for this statistical analysis which used a multiple logistic model to assess the independent risk factors of patient and polyp characteristics associated with high-grade dysplasia in adenomas. The database included 3371 adenomas from 1867 patients. Adenoma size and the extent of the villous component were found to be the major independent polyp risk factors associated with high-grade dysplasia (p < 0.0001). The adjusted odds ratios were 3.3 for medium-sized adenomas and 7.7 for large adenomas relative to small adenomas and 2.7 for villous A adenomas, 3.4 for villous B adenomas, and 8.1 for villous C and D adenomas relative to tubular adenomas. Increased frequency of high-grade dysplasia in adenomas located distal to the splenic flexure was attributable mainly to increased size and villous component rather than to location per se. The adjusted odds ratio was 1.4 (p < 0.11) for left-sided location. Multiplicity of adenomas affected the risk for high-grade dysplasia in patients but was dependent on adenoma size and villous component and was not an independent factor. The adjusted odds ratio was 1.3 (p < 0.17) for multiplicity. Increasing age was associated with risk for high-grade dysplasia in patients, and this effect was independent of the effect of adenoma size and histological type. The adjusted odds ratio was 1.8 (p < 0.0016) for age .gtoreq. 60 yr. Gender was not associated with high-grade dysplasia. The adjusted odds ratio was 1.0 (p < 0.95) for men. The size of the patient series, the prospective nature of the data collection, the completeness of information on all patients, the requirements of complete examination of the entire colon and pathological examination of all lesions encountered, and the exclusion of patients with previously diagnosed adenomas are, collectively, features unique to this study. The detailed model provided by the analysis integrates multiple patient and adenoma factors associated with high-grade dysplasia in colorectal adenomas.