Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals
Relationship of colonoscopy-detected serrated polyps with synchronous advanced neoplasia in average-risk individuals
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DOI：
10.1016/j.gie.2013.03.003
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发表时间：
2013-08-01
影响因子：
7.7
通讯作者：
Bessa, Xavier
中科院分区：
文献类型：
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作者：
Alvarez, Cristina;Andreu, Montserrat;Bessa, Xavier
背景：锯齿状癌占所有结直肠癌 (CRC) 的 10% 至 20%，占间期癌的 30% 以上。近端锯齿状息肉和大（>= 10 mm）锯齿状息肉（LSP）的存在与结直肠肿瘤相关。 目的：评估平均风险人群中锯齿状息肉的患病率及其与同步晚期肿瘤的关系，并评估一次性结肠镜检查和每两年一次粪便免疫化学检测对降低结直肠癌相关死亡率的效果。本研究重点关注结肠镜检查组的 5059 名个体样本。设计：多中心、随机、对照试验。背景：ColonPrev 研究，一项基于人群的、多中心、全国性、随机、对照试验。患者：总共 5059 名年龄 50 至 69 岁的无症状男性和女性。干预：结肠镜检查。主要结果测量：锯齿状息肉的患病率及其与同步进展的关联结果：520 名个体 (10.3%) 中检测到晚期肿瘤（27 例 [0.5%] 中检测到结直肠癌，493 例 [9.7%] 中检测到晚期腺瘤）。 1054 人（20.8%）发现锯齿状息肉。共有 329 人（6.5%）患有近端锯齿状息肉，90 人（1.8%）患有 LSP。近端锯齿状息肉或 LSP 与男性相关（比值比 [OR] 2.08，95% 置信区间 [CI]，1.76-4.45 和 OR 1.65，95% CI，1.31-2.07）。此外，LSP 与晚期肿瘤相关（OR 2.49，95% CI，1.47-4.198），无论其位于近端（OR 4.15，95% CI，1.69-10.15）或远端（OR 2.61，95% CI，1.48-4.58）位置。当我们分析锯齿状息肉的亚型时，近端增生性息肉与晚期肿瘤相关（OR 1.61，95% CI，1.13-2.28），尽管与晚期肿瘤的位置没有相关性。 局限性：锯齿状息肉诊断的病理学标准尚未集中审查。没有记录增生性息肉的形态（突出或平坦）。最后，由于在平均风险患者中进行的基于人群的研究的特点，CRC患者的比例相对较小。结论：LSP，而不是近端锯齿状息肉，与同步晚期肿瘤的存在相关。需要进一步的研究来确定近端增生性息肉的风险。
Background: Serrated cancers account for 10% to 20% of all colorectal cancers (CRC) and more than 30% of interval cancers. The presence of proximal serrated polyps and large (>= 10 mm) serrated polyps (LSP) has been correlated with colorectal neoplasia.Objective: To evaluate the prevalence of serrated polyps and their association with synchronous advanced neoplasia in a cohort of average-risk population and to assess the efficacy of one-time colonoscopy and a biennial fecal immunochemical test for reducing CRC-related mortality. This study focused on the sample of 5059 individuals belonging to the colonoscopy arm.Design: Multicenter, randomized, controlled trial.Setting: The ColonPrev study, a population-based, multicenter, nationwide, randomized, controlled trial.Patients: A total of 5059 asymptomatic men and women aged 50 to 69 years.Intervention: Colonoscopy.Main Outcome Measurements: Prevalence of serrated polyps and their association with synchronous advanced neoplasia.Results: Advanced neoplasia was detected in 520 individuals (10.3%) (CRC was detected in 27 [0.5%] and advanced adenomas in 493 [9.7%]). Serrated polyps were found in 1054 individuals (20.8%). A total of 329 individuals (6.5%) had proximal serrated polyps, and 90 (1.8%) had LSPs. Proximal serrated polyps or LSPs were associated with male sex (odds ratio [OR] 2.08, 95% confidence interval [CI], 1.76-4.45 and OR 1.65, 95% CI, 1.31-2.07, respectively). Also, LSPs were associated with advanced neoplasia (OR 2.49, 95% CI, 1.47-4.198), regardless of their proximal (OR 4.15, 95% CI, 1.69-10.15) or distal (OR 2.61, 95% CI, 1.48-4.58) locations. When we analyzed subtypes of serrated polyps, proximal hyperplasic polyps were related to advanced neoplasia (OR 1.61, 95% CI, 1.13-2.28), although no correlation with the location of the advanced neoplasia was observed.Limitations: Pathology criteria for the diagnosis of serrated polyps were not centrally reviewed. The morphology of the hyperplasic polyps (protruded or flat) was not recorded. Finally, because of the characteristics of a population-based study carried out in average-risk patients, the proportion of patients with CRC was relatively small.Conclusion: LSPs, but not proximal serrated polyps, are associated with the presence of synchronous advanced neoplasia. Further studies are needed to determine the risk of proximal hyperplastic polyps.