Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings
Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings
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DOI：
10.1056/nejm200007203430302
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发表时间：
2000-07-20
影响因子：
158.5
通讯作者：
Ransohoff, DF
中科院分区：
文献类型：
--
作者：
Imperiale, TF;Wagner, DR;Ransohoff, DF
背景和方法：远端结直肠息肉的临床意义是不确定的。我们确定了晚期近端瘤形成的风险，定义为具有绒毛特征的息肉，具有高度异型增生的息肉，或癌症，与无远端息肉的人相比，远端增生或肿瘤性息肉的人。我们分析了1994例连续无症状成年人（年龄50岁或以上）的数据，这些人在1995年9月至1998年12月期间首次接受结肠镜筛查，作为雇主赞助的计划的一部分。记录所有息肉的位置和组织学特征。结肠镜检查至盲肠水平的患者占97.0%。结果：远端结肠病变61例（3.1%），其中5例为结肠癌;近端结肠病变50例（2.5%），其中7例为结肠癌。23例晚期近端肿瘤患者（46%）没有远端息肉。在无远端息肉的患者中，晚期近端肿瘤的患病率为1.5%（1564人中有23例; 95%置信区间为0.9%至2.1%）。在远端增生性息肉、远端管状腺瘤和晚期远端息肉患者中，晚期近端肿瘤的患病率分别为4.0%（201例患者中8例）、7.1%（168例患者中12例）和11.5%（61例患者中7例）。与远端无息肉的患者相比，经年龄和性别校正后，远端增生性息肉患者发生晚期近端肿瘤的相对风险为2.6，远端管状腺瘤患者为4.0，晚期远端息肉患者为6.7。年龄较大和男性与晚期近端肿瘤的风险增加相关（相对风险，每5岁为1.3，男性为3.3）。结论：无症状的人50岁或以上的人在远端结肠息肉更有可能比没有远端息肉的人有晚期近端肿瘤。然而，如果结肠镜筛查只在远端息肉的人进行，大约一半的情况下，先进的近端肿瘤将无法检测到。（N Engl J Med 2000;343：169-74.）（C）2000年，马萨诸塞州医学会。
Background and Methods: The clinical significance of a distal colorectal polyp is uncertain. We determined the risk of advanced proximal neoplasia, defined as a polyp with villous features, a polyp with high-grade dysplasia, or cancer, among persons with distal hyperplastic or neoplastic polyps as compared with the risk among persons with no distal polyps. We analyzed data from 1994 consecutive asymptomatic adults (age, 50 years or older) who underwent colonoscopic screening for the first time between September 1995 and December 1998 as part of a program sponsored by an employer. The location and histologic features of all polyps were recorded. Colonoscopy to the level of the cecum was completed in 97.0 percent of the patients.Results: Sixty-one patients (3.1 percent) had advanced lesions in the distal colon, including 5 with cancer, and 50 (2.5 percent) had advanced proximal lesions, including 7 with cancer. Twenty-three patients with advanced proximal neoplasms (46 percent) had no distal polyps. The prevalence of advanced proximal neoplasia among patients with no distal polyps was 1.5 percent (23 cases among 1564 persons; 95 percent confidence interval, 0.9 to 2.1 percent). Among patients with distal hyperplastic polyps, those with distal tubular adenomas, and those with advanced distal polyps, the prevalence of advanced proximal neoplasia was 4.0 percent (8 cases among 201 patients), 7.1 percent (12 cases among 168 patients), and 11.5 percent (7 cases among 61 patients), respectively. The relative risk of advanced proximal neoplasia, adjusted for age and sex, was 2.6 for patients with distal hyperplastic polyps, 4.0 for those with distal tubular adenomas, and 6.7 for those with advanced distal polyps, as compared with patients who had no distal polyps. Older age and male sex were associated with an increased risk of advanced proximal neoplasia (relative risk, 1.3 for every five years of age and 3.3 for male sex).Conclusions: Asymptomatic persons 50 years of age or older who have polyps in the distal colon are more likely to have advanced proximal neoplasia than are persons without distal polyps. However, if colonoscopic screening is performed only in persons with distal polyps, about half the cases of advanced proximal neoplasia will not be detected. (N Engl J Med 2000;343:169-74.) (C)2000, Massachusetts Medical Society.