Predicting the Risk of Recurrent Adenoma and Incident Colorectal Cancer Based on Findings of the Baseline Colonoscopy
Predicting the Risk of Recurrent Adenoma and Incident Colorectal Cancer Based on Findings of the Baseline Colonoscopy
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DOI：
10.1038/ctg.2014.11
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发表时间：
2014-12-01
影响因子：
3.6
通讯作者：
Erlich, Porat
中科院分区：
文献类型：
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作者：
Fairley, Kimberly J.;Li, Jinhong;Erlich, Porat
目的：当前息肉切除术后监测实践指南的决策树依赖于基于筛查结肠镜检查切除的腺瘤所收集的预测属性的风险分层。我们的主要目的是评估基线腺瘤属性与腺瘤复发和侵袭性结直肠腺癌(CRC)风险之间的关联程度。我们的次要目标是评估与筛查结肠镜检查相比的腺瘤发现率(ADR)，并描述预防性结肠镜检查使用的时间趋势。方法：我们对从电子健康记录中回溯收集的临床数据进行前瞻性分析。符合结直肠癌筛查条件的初级保健患者队列包括110,452名受试者，其中3,300名在筛查检查时切除了腺瘤。在研究期间记录的随访监测结肠镜检查的患者(定义为先前结肠镜检查有记录的腺瘤患者)中，537例腺瘤复发。结果：在这些复发的腺瘤中，354例具有高危属性。高危特征被描述为3个腺瘤、至少一个10 mm大小的腺瘤、高度不典型增生或绒毛特征。在息肉切除术患者中，如果基线腺瘤表现出以下任何一种特征，则发生侵袭性结直肠癌的风险显著增加：腺瘤数量超过3个(风险增加4.3倍，95%可信区间低，高1.4，12.9)，大小大于10 mm(高5.2倍，95%可信区间低，高1.8，15.1)，高度不典型增生(13.2倍风险，95%可信区间低，高2.8，62.1)，或绒毛特征(风险高7.4倍，低可信区间95%，高2.8，62.1)，高2.5，21.5)。这些属性加在一起，使正确预测CRC的概率增加了22.8%。从2005年到2011年，与筛查相比，监测利用增加了三倍。监测的不良反应(34.1%)是筛查(23.1%)的1.5倍。结论：这些结果强调了对临床指南中建议的具有高危属性的基线腺瘤患者进行及时的监测结肠镜检查以减少过度风险的必要性。
OBJECTIVES: The decision tree underlying current practice guidelines for post polypectomy surveillance relies on risk stratification based on predictive attributes gleaned from adenomas removed on screening colonoscopy examination. Our primary aim was to estimate the magnitude of association between baseline adenoma attributes and the risk of adenoma recurrence and invasive colorectal adenocarcinoma (CRC). Our secondary aims were to estimate the adenoma detection rate (ADR) of surveillance compared with screening colonoscopies and describe time trends in preventive colonoscopy utilization.METHODS: We used prospective analyses of retrospectively collected clinical data from electronic health records. A cohort of primary care patients eligible for colorectal cancer screening was assembled encompassing 110,452 subjects, of which 3,300 had adenomas removed on screening examination. Of those patients who had a follow-up surveillance colonoscopy (defined as a patient with a documented adenoma on prior colonoscopy) recorded during the study period, 537 had a recurrent adenoma.RESULTS: Of those recurrent adenomas, 354 had a high-risk attributes. High-risk attributes were described at>3 adenomas, at least one adenoma >10 mm in size, high-grade dysplasia, or villous features. The risk of developing invasive CRC among post polypectomy patients was significantly higher if the baseline adenomas displayed any of the following attributes: more numerous than 3 (4.3-fold higher risk, 95% confidence interval (CI) low, high 1.4, 12.9), larger than 10 mm in size (5.2-fold higher risk, 95% CI low, high 1.8, 15.1), high-grade dysplasia (13.2-fold risk, 95% CI low, high 2.8, 62.1), or villous features (7.4-fold higher risk, 95% CI low, high 2.5, 21.5). These attributes combined added a net value of 22.8% to the probability of correctly predicting CRC. There was a threefold increase in surveillance utilization relative to screening from 2005 to 2011. The ADR of surveillance (34.1%) was 1.5-fold higher than that of screening (23.1%).CONCLUSIONS: These results emphasize the need to mitigate excessive risk by performing timely surveillance colonoscopies in patients with baseline adenomas displaying high-risk attributes as recommended in practice guidelines.