Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study.
Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study.
复制标题
传统锯齿状腺瘤的基线特征和纵向结果：一项队列研究。
DOI：
10.1016/j.cgh.2022.09.030
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Gupta,Samir
中科院分区：
文献类型：
--
作者：
Trivedi,Mehul;Godil,Suha;Demb,Joshua;Earles,Ashley;Bustamante,Ranier;Patterson,OlgaV;Gawron,AndrewJ;Kaltenbach,Tonya;Mahata,Sumana;Liu,Lin;Gupta,Samir
背景和目标传统锯齿状腺瘤 (TSA) 可能会增加结直肠癌 (CRC) 的风险。我们这项研究的目的是检查与 TSA 诊断相关的临床特征和长期结果。方法我们对 1999 年至 2018 年间年龄≥18 岁且 TSA ≥1 的美国退伍军人进行了回顾性队列研究。提取了基线特征、结肠镜检查结果以及偶发和致死性 CRC 的诊断。晚期肿瘤的定义是结直肠癌或具有高度不典型增生、绒毛组织学或大小≥1 cm的腺瘤。随访时间为 CRC 诊断、死亡或研究结束（2018 年 12 月 31 日）。结果 总共确定了 853 名具有基线 TSA 的退伍军人； 74% 年龄≥60 岁，96% 为男性，14% 为黑人，73% 为非西班牙裔白人。大约 64% 是当前或以前的吸烟者。在超过 2044 人年的随访中，有 11 例 CRC 病例和 1 例 CRC 死亡。累积 CRC 发病率为 1.34%（95% 置信区间 [CI]，0.67%–2.68%），累积 CRC 死亡率为 0.12%（95% CI，0.00%–0.35%）。在 378 名接受≥1 次结肠镜监测的 TSA 患者中，65.1% 的患者在随访时患有高危肿瘤。 TSA 患者的 CRC 发病率显着高于基线时结肠镜检查正常的患者比较队列（风险比，3.70；95% CI，1.63–8.41），与基线常规晚期腺瘤的比较队列相似（风险比，0.86；95% CI，0.45–1.64）。 结论 根据累积 CRC，TSA 患者患 CRC 的风险很大发病率，以及在随访监测结肠镜检查中发生其他高危肿瘤的显着风险。这些数据强调了当前建议在 TSA 诊断后进行密切结肠镜检查的重要性。
Background and AimsTraditional serrated adenomas (TSAs) may confer increased risk for colorectal cancer (CRC). Our objective with this study was to examine clinical characteristics and long-term outcomes associated with TSA diagnosis.MethodsWe conducted a retrospective cohort study of U.S. Veterans ≥18 years of age with ≥1 TSA between 1999 and 2018. Baseline characteristics, colonoscopy findings, and diagnosis of incident and fatal CRC were abstracted. Advanced neoplasia was defined by CRC or adenoma with high-grade dysplasia, villous histology, or size ≥1 cm. Follow-up was through CRC diagnosis, death, or end of study (December 31, 2018).ResultsA total of 853 Veterans with a baseline TSA were identified; 74% were ≥60 years of age, 96% were men, 14% were Black, and 73% were non-Hispanic White. About 64% were current or former smokers. Over 2044 total person-years at follow-up, there were 11 incident CRC cases and 1 CRC death. Cumulative CRC incidence was 1.34% (95% confidence interval [CI], 0.67%–2.68%), and cumulative CRC death was 0.12% (95% CI, 0.00%–0.35%). Among the subset of 378 TSA patients with ≥1 surveillance colonoscopy, 65.1% had high-risk neoplasia on follow-up. CRC incidence among TSA patients was significantly higher than in a comparison cohort of patients with normal baseline colonoscopy at baseline (hazard ratio, 3.70; 95% CI, 1.63–8.41) and similar to a comparison cohort with baseline conventional advanced adenoma (hazard ratio, 0.86; 95% CI, 0.45–1.64).ConclusionIndividuals with TSA have substantial risk for CRC based on their cumulative CRC incidence, as well as significant risk of developing other high-risk neoplasia at follow-up surveillance colonoscopy. These data underscore importance of current recommendations for close colonoscopy surveillance after TSA diagnosis.