Colorectal cancer in patients under close colonoscopic surveillance
Colorectal cancer in patients under close colonoscopic surveillance
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DOI：
10.1053/j.gastro.2005.05.012
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发表时间：
2005-07-01
期刊：
影响因子：
29.4
通讯作者：
Baron, JA
中科院分区：
文献类型：
--
作者：
Robertson, DJ;Greenberg, ER;Baron, JA
背景和目标：结肠镜息肉切除术被认为是有效的预防结直肠癌（CRC），但在结肠镜监测下的患者癌症的发病率很少被调查。我们确定了结肠镜监测下患者的CRC发病率，并检查了CRC和腺瘤伴高度异型增生的情况和危险因素。方法：患者来自3个腺瘤化学预防试验。所有患者均接受了基线结肠镜检查，切除了至少一个腺瘤，并被视为无剩余病变。我们确定了随后诊断为浸润性癌或腺瘤伴高度异型增生的患者。时间，位置和结果的所有情况下，癌症和高度异型增生确定的描述和风险与他们的发展进行了探讨。结果：在平均随访3.7年（发病率，1.74癌症/1000人年）的29：15例患者中，有19例被诊断为CIRC。癌症位于结肠的所有区域; 10例位于肝曲或肝曲附近。虽然大多数癌症（84%）是早期癌症，但2名参与者死于CRC。7例患者在随访期间被诊断为腺瘤伴高度异型增生。年龄较大的患者和有较多腺瘤病史的患者被诊断为浸润性癌或腺瘤伴高度异型增生的风险较高。结论：CIRC是诊断在临床上重要比例的患者后，完整的结肠镜检查和息肉切除术。需要对接受监测检查的患者中的CRC发病率和死亡率进行更精确和有代表性的估计。
Background & Aims: Colonoscopic polypectomy is considered effective for preventing colorectal cancer (CRC), but the incidence of cancer in patients under colonoscopic surveillance has rarely been investigated. We determined the incidence of CRC in patients under colonoscopic surveillance and examined the circumstances and risk factors for CRC and adenoma with high-grade dysplasia. Methods: Patients were drawn from 3 adenoma chemoprevention trials. All underwent baseline colonoscopy with removal of at least one adenoma and were deemed free of remaining lesions. We identified patients subsequently diagnosed with invasive cancer or adenoma with high-grade dysplasia. The timing, location, and outcome of all cases of cancer and high-grade dysplasia identified are described and risks associated with their development explored. Results: CIRC was diagnosed in 19 of the 29:15 patients over a mean follow-up of 3.7 years (incidence, 1.74 cancers/1000 person-years). The cancers were located in all regions of the colon; 10 were at or proximal to the hepatic flexure. Although most of the cancers (84%) were of early stage, 2 participants died of CRC. Seven patients were diagnosed with adenoma with high-grade dysplasia during follow-up. Older patients and those with a history of more adenomas were at higher risk of being diagnosed with invasive cancer or adenoma with high-grade dysplasia. Conclusions: CIRC is diagnosed in a clinically important proportion of patients following complete colonoscopy and polypectomy. More precise and representative estimates of CRC incidence and death among patients undergoing surveillance examinations are needed.