Long-term risk of colorectal cancer in individuals with serrated polyps
Long-term risk of colorectal cancer in individuals with serrated polyps
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DOI：
10.1136/gutjnl-2014-307793
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发表时间：
2015-06-01
期刊：
影响因子：
24.5
通讯作者：
Hoff, Geir
中科院分区：
文献类型：
--
作者：
Holme, Oyvind;Bretthauer, Michael;Hoff, Geir
目的：虽然锯齿状息肉可能是结直肠癌（CRC）的前兆，但缺乏关于锯齿状息肉患者长期结直肠癌风险的前瞻性数据。在一项基于人群的随机试验中，12955名年龄在50-64岁之间的人接受了乙状结肠镜检查，78220人作为对照组。我们使用Cox模型来估计有1个大锯齿状息肉（直径10mm）的CRC患者的hr (95% ci)，与筛查时的腺瘤患者和人群对照进行比较，并使用多变量logistic回归来评估CRC的息肉危险因素。结果103例有大锯齿状息肉，其中81例纳入分析。非晚期腺瘤1488例，晚期腺瘤701例。中位随访时间为10.9年。与对照组相比，大锯齿状息肉患者的CRC风险比为2.5 (95% CI 0.8 - 7.8)，晚期腺瘤患者的风险比为2.0 (95% CI 1.3 - 2.9)，非晚期腺瘤患者的风险比为0.6 （95% CI 0.4 - 1.1）。经组织学、大小和合并腺瘤的多样性调整后，大的锯齿状息肉是结直肠癌的独立危险因素（OR 3.3; 95% CI 1.3 - 8.6）。在筛查中发现的23个大的锯齿状息肉被留在原位，中位数为11.0年。没有一个发展成恶性肿瘤。结论：与晚期腺瘤患者相比，大锯齿状息肉患者发生结直肠癌的风险增加。然而，这种风险可能与锯齿状息肉的恶性生长无关。挪威结直肠癌筛查试验已在clinicaltrials.gov注册（NCT00119912）。
Objective Although serrated polyps may be precursors of colorectal cancer (CRC), prospective data on the long-term CRC risk in individuals with serrated polyps are lacking.Design In a population-based randomised trial, 12955 individuals aged 50-64years were screened with flexible sigmoidoscopy, while 78220 individuals comprised the control arm. We used Cox models to estimate HRs with 95% CIs for CRC among individuals with 1 large serrated polyp (10mm in diameter), compared with individuals with adenomas at screening, and to population controls, and multivariate logistic regression to assess polyp risk factors for CRC.Results A total of 103 individuals had large serrated polyps, of which 81 were included in the analyses. Non-advanced adenomas were found in 1488 individuals, advanced adenomas in 701. Median follow-up was 10.9years. Compared with the control arm, the HR for CRC was 2.5 (95% CI 0.8 to 7.8) in individuals with large serrated polyps, 2.0 (95% CI 1.3 to 2.9) in individuals with advanced adenomas and 0.6 (95% CI 0.4 to 1.1) in individuals with non-advanced adenomas. A large serrated polyp was an independent risk factor for CRC, adjusted for histology, size and multiplicity of concomitant adenomas (OR 3.3; 95% CI 1.3 to 8.6). Twenty-three large serrated polyps found at screening were left in situ for a median of 11.0years. None developed into a malignant tumour.Conclusions Individuals with large serrated polyps have an increased risk of CRC, comparable with individuals with advanced adenomas. However, this risk may not be related to malignant growth of the serrated polyp.Trial registration number The Norwegian Colorectal Cancer Screening trial is registered at clinicaltrials.gov (NCT00119912).