Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas
Risk of Metachronous Advanced Neoplasia in Patients With Multiple Diminutive Adenomas
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DOI：
10.1038/s41395-018-0210-9
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发表时间：
2018-12-01
影响因子：
9.8
通讯作者：
Kim, Young-Ho
中科院分区：
文献类型：
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作者：
Kim, Jung Yoon;Kim, Tae Jun;Kim, Young-Ho
目的：患有晚期腺瘤或三个或更多腺瘤的个体发生异时性晚期肿瘤（AN）的风险较高，建议以较短的时间间隔进行监测性结肠镜检查。然而，患有多个（三个或更多）非晚期小型腺瘤的患者是否应被视为高风险是值得怀疑的。 方法：我们分析了 5482 名在第一次结肠镜筛查期间诊断出患有一个或多个腺瘤并接受后续结肠镜检查的患者。根据基线时的腺瘤特征将患者分为四组：第 1 组，1-2 个非晚期腺瘤；第 1 组，1-2 个非晚期腺瘤；第 2 组，>= 3 个非晚期小型（1 至 5 毫米）腺瘤；第 3 组，≥ 3 个非晚期小（6-9 毫米）腺瘤；第 4 组，晚期腺瘤。 结果：在中位随访 38 个月期间，监测结肠镜检查时异时性 AN 的发生率为 5.6%。第 1 组中 AN 的发生率为 3.9%，第 2 组中为 5.9%，第 3 组中为 10.6%，第 4 组中为 22.1%。第 2 组、第 3 组和第 4 组以及低风险第 1 组之间异时性 AN 的调整后风险比 (HR) [95% 置信区间 (CI)] 为 1.71 (0.99-2.94)，分别为 2.76 (1.72-4.44) 和 5.23 (3.57-7.68)。与第 4 组相比，第 1 组、第 2 组和第 3 组的调整后 HR (95% CI) 分别为 0.19 (0.13-0.28)、0.32 (0.18-0.59) 和 0.52 (0.31-0.89)。 结论：我们发现患有三个或更多非晚期小腺瘤的患者的风险呈临界增加与低风险腺瘤患者相比，异时性 AN 的发生率更高。
OBJECTIVES: Individuals with advanced adenomas or three or more adenomas have a higher risk of metachronous advanced neoplasia (AN) and are recommended to undergo surveillance colonoscopy at shorter intervals. However, it is questionable whether patients with multiple (three or more) non-advanced diminutive adenomas should be considered as high-risk.METHODS: We analyzed 5482 patients diagnosed with one or more adenomas during their first colonoscopy screening and who underwent a follow-up colonoscopy. Patients were categorized into four groups based on adenoma characteristics at baseline: Group 1, 1-2 non-advanced adenomas; Group 2, >= 3 non-advanced, diminutive (1 to 5 mm) adenomas; Group 3, >= 3 non-advanced, small (6-9 mm) adenomas; and Group 4, advanced adenomas.RESULTS: During a median follow-up of 38 months, the incidence of metachronous AN at surveillance colonoscopy was 5.6%. The incidence of AN was 3.9% in group 1, 5.9% in group 2, 10.6% in group 3, and 22.1% in group 4. The adjusted hazard ratios (HRs) [95% confidence intervals (CIs)] for metachronous AN between group 2, group 3, and group 4, and low risk group 1 were 1.71 (0.99-2.94), 2.76 (1.72-4.44), and 5.23 (3.57-7.68), respectively. Compared with group 4, the adjusted HRs (95% CIs) for group 1, group 2, and group 3 were 0.19 (0.13-0.28), 0.32 (0.18-0.59), and 0.52 (0.31-0.89), respectively.CONCLUSIONS: We found that patients with three or more non-advanced diminutive adenomas had a borderline increased risk of metachronous AN compared with patients with low risk adenomas.