The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.
The National Polyp Study. Patient and polyp characteristics associated with high-grade dysplasia in colorectal adenomas.
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DOI：
10.5555/uri:pii:001650859090827n
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发表时间：
1990-02
期刊：
影响因子：
29.4
通讯作者：
M. O'brien;S. Winawer;A. Zauber;L. Gottlieb;S. Sternberg;B. Diaz;G. Dickersin;Stephen Ewing;Stephen Geller;D. Kasimian;R. Komorowski;A. Szporn
中科院分区：
文献类型：
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作者：
M. O'brien;S. Winawer;A. Zauber;L. Gottlieb;S. Sternberg;B. Diaz;G. Dickersin;Stephen Ewing;Stephen Geller;D. Kasimian;R. Komorowski;A. Szporn
国家息肉研究（National Polyps Study，简称NPA）是一项随机临床试验，旨在评估对发现患有一个或多个结直肠腺瘤的患者的有效监测，该研究是该统计分析的框架，使用多逻辑模型评估与腺瘤高度异型增生相关的患者和息肉特征的独立风险因素。该数据库包括来自1867名患者的3371个腺瘤。腺瘤大小和绒毛成分的范围被认为是与高度异型增生相关的主要独立息肉风险因素（p <0.0001）。与小腺瘤相比，中等大小腺瘤的校正比值比为3.3，大腺瘤为7.7，绒毛状A腺瘤为2.7，绒毛状B腺瘤为3.4，绒毛状C和D腺瘤为8.1。位于脾曲远端的腺瘤中高度异型增生的频率增加主要归因于大小和绒毛成分的增加，而不是位置本身。左侧位置的调整优势比为1.4（p <0.11）。腺瘤的多发性影响患者高度异型增生的风险，但取决于腺瘤的大小和绒毛成分，而不是一个独立的因素。多重性的调整优势比为1.3（p <0.17）。年龄的增加与患者高度异型增生的风险相关，这种影响与腺瘤大小和组织学类型的影响无关。年龄大于或等于60岁的调整优势比为1.8（p <0.0016）。性别与高度异型增生无关。男性的调整优势比为1.0（p <0.95）。患者系列的规模、数据收集的前瞻性、所有患者信息的完整性、对整个结肠的完整检查和所有病变的病理检查的要求以及排除既往诊断为腺瘤的患者是本研究的独特特征。分析提供的详细模型整合了与结直肠腺瘤高度异型增生相关的多种患者和腺瘤因素。
The National Polyp Study (NPS), a randomized clinical trial to evaluate effective surveillance of patients discovered to have one or more colorectal adenomas, was the framework for this statistical analysis which used a multiple logistic model to assess the independent risk factors of patient and polyp characteristics associated with high-grade dysplasia in adenomas. The database included 3371 adenomas from 1867 patients. Adenoma size and the extent of the villous component were found to be the major independent polyp risk factors associated with high-grade dysplasia (p less than 0.0001). The adjusted odds ratios were 3.3 for medium-sized adenomas and 7.7 for large adenomas relative to small adenomas and 2.7 for villous A adenomas, 3.4 for villous B adenomas, and 8.1 for villous C and D adenomas relative to tubular adenomas. Increased frequency of high-grade dysplasia in adenomas located distal to the splenic flexure was attributable mainly to increased size and villous component rather than to location per se. The adjusted odds ratio was 1.4 (p less than 0.11) for left-sided location. Multiplicity of adenomas affected the risk for high-grade dysplasia in patients but was dependent on adenoma size and villous component and was not an independent factor. The adjusted odds ratio was 1.3 (p less than 0.17) for multiplicity. Increasing age was associated with risk for high-grade dysplasia in patients, and this effect was independent of the effect of adenoma size and histological type. The adjusted odds ratio was 1.8 (p less than 0.0016) for age greater than or equal to 60 yr. Gender was not associated with high-grade dysplasia. The adjusted odds ratio was 1.0 (p less than 0.95) for men. The size of the patient series, the prospective nature of the data collection, the completeness of information on all patients, the requirements of complete examination of the entire colon and pathological examination of all lesions encountered, and the exclusion of patients with previously diagnosed adenomas are, collectively, features unique to this study. The detailed model provided by the analysis integrates multiple patient and adenoma factors associated with high-grade dysplasia in colorectal adenomas.