Predictors of metachronous colorectal neoplasms in sporadic adenoma patients
Predictors of metachronous colorectal neoplasms in sporadic adenoma patients
复制标题
DOI：
10.1002/ijc.11036
复制
发表时间：
2003-05-20
影响因子：
6.4
通讯作者：
Spinelli, P
中科院分区：
文献类型：
--
作者：
Bertario, L;Russo, A;Spinelli, P
我们的目的是评估一组行内镜下结直肠腺瘤息肉切除术的患者中，后续结直肠肿瘤（癌症或腺瘤）的总体风险与索引病变的各种特征的关系。米兰国家癌症研究所在1979年至1999年的结肠直肠癌筛查计划中，共报告了1,086例大肠腺瘤患者。前瞻性收集接受结肠镜检查和治疗的患者数据。根据考克斯比例风险模型，通过计算风险比（HR）值和相应的置信区间（95% CI）评估结直肠癌（CRC）和腺瘤特征之间的关系。在1，086名合格患者（487名女性，579名男性）中，736名患有单发腺瘤（67.7%），350名患有多发腺瘤（32.3%）。组织学检查管状腺瘤772例（73%），管状绒毛状腺瘤205例，绒毛状腺瘤80例（7.5%）。重度异型增生占3.3%。在11,393人年的随访中，平均监测时间为10.5年，10例患者（0.8%）发生结直肠癌，323例患者（29%）发生新腺瘤。多因素分析显示，男性（HR 1.6; 95% CI 1.3-2.0），多发性息肉（HR 1.6; 95% CI 1.3-2.0），息肉大于2 cm（HR 1.5; 95% CI 1.1-2.1），管状绒毛和绒毛组织学（HR 1.3; 95% CI 1.0-1.6和HR 1.8; 95%CI分别为1.2-2.6）是发生异时性腺瘤性息肉的统计学显著风险因素。CRC的标准化发病率（SIR）为0.52（95%CI 0.25-0.95）。严重异型增生受试者的SIR增加（2.8; 95% CI 0.34-1.02）。大肠腺瘤的某些特征与异时性腺瘤和结直肠癌的风险增加密切相关。然而，内镜下息肉切除术能够减少50%的大肠腺瘤患者的CRC发病率。(C)2003 Wiley-Liss，Inc.
Our objective was to assess the overall risk of subsequent colorectal neoplasms (cancer or adenoma) in relation with the various characteristics of the index lesion in a cohort of patients who underwent endoscopic polypectomies of colorectal adenomas. A total of 1,086 patients with adenomas of the large bowel were reported between 1979 and 1999 at the National Cancer Institute of Milan during a screening program for colorectal carcinoma. Data on patients who had colonoscopic examinations and treatments were collected prospectively. The relation between colorectal cancer (CRC) and adenoma features was assessed by computing the hazard ratio (HR) values and corresponding confidence intervals (95% CI) according to Cox proportional hazard models. Of the 1,086 eligible patients (487 females, 579 males), 736 had single adenomas (67.7%) and 350 had multiple adenomas (32.3%). Histologic examination revealed 772 cases of tubular adenoma (73%), 205 cases of tubulovillous adenoma and 80 cases of villous adenoma (7.5%). Severe dysplasia was found in 3.3% of the cases. During the 11,393 person-years of follow-up, with an average time of surveillance of 10.5 years, colorectal carcinomas developed in 10 patients (0.8%) and a new adenoma in 323 patients (29%). Multivariate analysis showed that male gender (HR 1.6; 95% CI 1.3-2.0), multiple polyps (HR 1.6; 95% CI 1.3-2.0), polyps larger than 2 cm (HR 1.5; 95% CI 1.1-2.1), tubulovillous and villous histology (HR 1.3; 95% CI 1.0-1.6 and HR 1.8; 95% CI 1.2-2.6, respectively) at index polypectomy were statistically significant risk factors for developing metachronous adenomatous polyps. The standardized incidence rates (SIR) for CRC was 0.52 (95% CI 0.25-0.95). The SIR was increased in subjects with severe dysplasia (2.8; 95% CI 0.34-1.02). Some features of large bowel adenomas are strongly correlated with an increased risk of metachronous adenomas and colorectal cancer. However, the endoscopic polypectomy is able to reduce by 50% the incidence of CRC in patients with large bowel adenomas. (C) 2003 Wiley-Liss, Inc.