Risk factors for hyperplastic and adenomatous polyps: evidence for malignant potential?
Risk factors for hyperplastic and adenomatous polyps: evidence for malignant potential?
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发表时间：
2002-10
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通讯作者：
L. Morimoto;P. Newcomb;C. Ulrich;R. Bostick;C. Lais;J. Potter
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作者：
L. Morimoto;P. Newcomb;C. Ulrich;R. Bostick;C. Lais;J. Potter
最近的研究表明，增生性息肉可能是结直肠肿瘤的一个独特亚群的良性前驱病变。我们进行了一项以临床为基础的病例对照研究，以评估增生性息肉的危险因素。1991-1994年间，在明尼阿波利斯地区的一家胃肠病学诊所发现了增生性息肉（n = 219）、腺瘤（n = 437）和两种类型的息肉（n = 138），以及结肠镜检查阴性的对照组（n = 708）。采用自填问卷收集危险因素信息。增生性息肉和腺瘤性息肉的危险因素与结直肠癌大体相似。男性、吸烟和饮酒与所有息肉组的风险增加有关；非甾体抗炎药的使用、激素替代疗法的使用和钙的摄入与风险降低有关。在该分析中，年龄增加与增生性息肉风险之间没有明显的关联（P = 0.21），尽管它是腺瘤的一个很强的危险因素(25包-年吸烟的P为4.1[95%可信区间（CI）， 2.2-7.6]，而腺瘤单独的OR为1.3 （95% CI, 0.8-2.3）。诊断为两种息肉类型的个体的OR估计为4.2 （95% CI, 1.9-9.3）。这些结果表明，作为一种可能性，先前研究中观察到的腺瘤和吸烟的一致关联可能部分归因于腺瘤病例组中同时患有腺瘤和增生性息肉的个体。相反，患有两种息肉类型的个体可能与仅患有腺瘤的个体表现出不同的表型，应单独考虑。需要进一步的研究来确定哪些息肉表型与吸烟有关。总的来说，结直肠增生性息肉、腺瘤和癌症的风险特征的相似性为越来越多的证据提供了额外的支持，即一些增生性息肉可能具有肿瘤潜力。
Recent studies have suggested that hyperplastic polyps may be benign precursor lesions for a distinct subset of colorectal tumors. We conducted a clinic-based case-control study to evaluate risk factors for hyperplastic polyps. Cases with hyperplastic polyps (n = 219), adenomas (n = 437), and both types of polyps (n = 138), along with colonoscopy-negative controls (n = 708), were identified at a gastroenterology practice in the Minneapolis area during 1991-1994. A self-administered questionnaire was used to collect risk factor information. Risk factors for hyperplastic and adenomatous polyps were generally similar to those for colorectal cancer. Male sex, smoking, and alcohol consumption were associated with increased risk of all polyp groups; nonsteroidal anti-inflammatory drug use, hormone replacement therapy use, and calcium intake were associated with reduced risk. There was no apparent association between increasing age and hyperplastic polyp risk (P = 0.21) in this analysis, although it was a strong risk factor for adenoma (P 25 pack-years of smoking was 4.1 [95% confidence interval (CI), 2.2-7.6], whereas the OR for adenoma alone was 1.3 (95% CI, 0.8-2.3). The OR estimate for individuals diagnosed with both polyp types was 4.2 (95% CI, 1.9-9.3). These results suggest, as one possibility, that the consistent association of adenoma and smoking observed in previous studies may be partially attributable to the inclusion of individuals with both adenomas and hyperplastic polyps in the adenoma case group. To the contrary, individuals with both polyp types may be expressing a phenotype distinct from those who have only adenomas and should be considered separately. Further studies are necessary to establish which polyp phenotypes are related to smoking. Overall, the similarity of the risk profiles of colorectal hyperplastic polyps, adenoma, and cancer provides additional support for the growing body of evidence that some hyperplastic polyps may have neoplastic potential.