PREDICTORS OF PRESENCE, MULTIPLICITY, SIZE AND DYSPLASIA OF COLORECTAL ADENOMAS - A NECROPSY STUDY IN NEW-ZEALAND
PREDICTORS OF PRESENCE, MULTIPLICITY, SIZE AND DYSPLASIA OF COLORECTAL ADENOMAS - A NECROPSY STUDY IN NEW-ZEALAND
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DOI：
10.1136/gut.33.11.1508
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发表时间：
1992-11-01
期刊：
影响因子：
24.5
通讯作者：
ROBINSON, EM
中科院分区：
文献类型：
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作者：
JASS, JR;YOUNG, PJ;ROBINSON, EM
检查了336份大肠法医尸检标本，以确定独立预测以下腺瘤特征的受试者相关变量：存在、大小（最大）、多样性和高度异型增生。变量包括年龄、性别、体重指数、种族（欧洲血统与毛利人/波利尼西亚人）和是否存在增生性（化生性）息肉。受试者包括303名欧洲裔新西兰人（M = 185，F = 118），产生149个腺瘤和251个增生性息肉，33名毛利人/波利尼西亚人（M = 25，F = 8）产生5个腺瘤和1个增生性息肉。通过回归分析确定的腺瘤存在的独立预测因素是年龄（p = 0.0001）、增生性息肉（p = 0.0001）和男性（p = 0.05）。模型在解释大小、多样性和发育异常的变化方面很差。多发性腺瘤受试者中较大腺瘤的发生率更高（p = 0.03），多发性腺瘤可能与增生性息肉（p = 0.09）和欧洲男性（p = 0.09）相关。高度异型增生在女性中更常见（p = 0.05），可能在增生性息肉受试者中更常见（p = 0.2）。体重指数和种族不能预测任何腺瘤特征，但增生性息肉的患病率受欧洲血统（p = 0.04）的影响，受体重指数（p = 0.08）以及腺瘤（p = 0.0002）和年龄（p = 0.005）的影响较小。增生性息肉与腺瘤的存在、多样性而非大小以及与结直肠癌高危人群（欧洲裔新西兰人）的相关性表明，增生性息肉可作为影响肿瘤发生/转化阶段（而非促进阶段）肿瘤演变的因素的标志物。59%的腺瘤患者没有增生性息肉，强调增生性息肉仅作为人群的标志，而不是肠癌高风险的个体。结肠内低丁酸盐可能是连接两种类型息肉表达的因素。
Three hundred and thirty six forensic necropsy specimens of large bowel were examined in order to identify subject related variables that independently predicted the following adenoma characteristics: presence, size (largest), multiplicity and high grade dysplasia. The variables were age, gender, body mass index, race (European origin versus Maori/Polynesian) and presence of hyperplastic (metaplastic) polyp(s). Subjects included 303 New Zealanders of European origin (M = 185, F = 118) yielding 149 adenomas and 251 hyperplastic polyps and 33 Maori/Polynesians (M = 25, F = 8) yielding five adenomas and one hyperplastic polyp. Independent predictors of adenoma presence as determined by regression analysis were age (p = 0.0001), presence of hyperplastic polyps (p = 0.0001) and male gender (p = 0.05). Models were poor at explaining variation in size, multiplicity, and dysplasia. Larger adenomas occurred more frequently in subjects with multiple adenomas (p = 0.03) and multiple adenomas were probably associated with hyperplastic polyps (p = 0.09) and male gender (p = 0.09) in Europeans. High grade dysplasia was more frequent in women (p = 0.05) and possibly in subjects with hyperplastic polyps (p = 0.2). Body mass index and ethnicity did not predict any adenoma characteristics, but hyperplastic polyp prevalence was influenced by European origin (p = 0.04) and to a lesser extent by body mass index (p = 0.08) as well as presence of adenoma (p = 0.0002) and age (= 0.005). The association of hyperplastic polyp with presence, multiplicity but not size of adenoma and with a high risk group for colorectal cancer (New Zealanders of European origin) suggests that the hyperplastic polyp serves as a marker for a factor which influences neoplastic evolution at the stages of initiation/transformation but not promotion. Fifty nine per cent of individuals with adenoma(s) did not have hyperplastic polyp(s), emphasising that the last would serve only as a marker of populations and not individuals at high risk of bowel cancer. Low intracolonic butyrate may be the factor linking the expression of the two types of polyp.