Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden.
Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden.
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DOI：
10.1136/bmj.n877
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发表时间：
2021-05-04
期刊：
影响因子：
--
通讯作者：
Ludvigsson JF
中科院分区：
文献类型：
--
作者：
Song M;Emilsson L;Roelstraete B;Ludvigsson JF
评估结直肠癌（CRC）前病变（息肉）患者的一级亲属（父母和全同胞）患CRC的风险。病例对照研究。与瑞典多代登记和胃肠道ESSERO（瑞典组织病理学报告加强的流行病学）组织病理学队列的关联。68060例结直肠癌患者和333753例对照组。根据结直肠息肉一级亲属的数量、息肉的组织学和一级亲属诊断时的年龄，多变量校正的CRC比值比。根据结直肠癌诊断时的年龄进行亚组分析，并评估结直肠息肉家族史和结直肠癌家族史的联合相关性。在校正了CRC家族史和其他协变量后，结直肠息肉的一级亲属（病例组8.4%（5742/68 060），对照组5.7%（18 860/333 753））与CRC的高风险相关（比值比1.40，95%置信区间1.35至1.45）。比值比从增生性息肉的1.23到管状绒毛状腺瘤的1.44不等。为了更好地看待这种风险，根据2018年瑞典全国CRC发病率，根据息肉家族史估计了结肠癌和直肠癌的年龄特异性绝对风险。例如，60-64岁有和无结肠直肠息肉家族史的个体中结肠癌的绝对风险分别为男性每10万人94.3和67.9，女性每10万人89.1和64.1。息肉家族史与结直肠癌风险之间的相关性随着息肉一级亲属数量的增加而加强（≥2个一级亲属：1.70，1.52至1.90，趋势P<0.001）和息肉诊断年龄的降低（<50岁：1.77，1.57至1.99，趋势P<0.001）。在50岁之前诊断的早发性CRC中发现了特别强的相关性（≥2个一级亲属：3.34，2.05至5.43，P=0.002，根据CRC诊断年龄的异质性）。在联合分析中，有两个或两个以上一级亲属患有息肉但没有结直肠癌的个体患结直肠癌的优势比为1.79（1.52 ~ 2.10），与大肠癌有一级亲属关系但无息肉者为1.70（1.65 ~ 1.76），有2个或2个以上一级亲属同时患有息肉和结直肠癌的患者的平均患病率为5.00（3.77 ~ 6.63）（交互作用P<0.001）。在调整CRC家族史后，结直肠息肉患者的兄弟姐妹和子女仍然有较高的CRC风险，特别是早发性CRC。对于息肉患者的一级亲属，可考虑进行CRC的早期筛查。
To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC. Case-control study. Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden. 68 060 patients with CRC and 333 753 matched controls. Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC. After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4% (5742/68 060) in cases and 5.7% (18 860/333 753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (≥2 first degree relatives: 1.70, 1.52 to 1.90, P<0.001 for trend) and decreasing age at polyp diagnosis (<50 years: 1.77, 1.57 to 1.99, P<0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years (≥2 first degree relatives: 3.34, 2.05 to 5.43, P=0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P<0.001 for interaction). After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.
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DOI：
10.1056/nejmoa1301969
发表时间：
2013-09-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Nishihara R;Wu K;Lochhead P;Morikawa T;Liao X;Qian ZR;Inamura K;Kim SA;Kuchiba A;Yamauchi M;Imamura Y;Willett WC;Rosner BA;Fuchs CS;Giovannucci E;Ogino S;Chan AT
通讯作者：
Chan AT
影响因子：
9.8
作者：
Rex, Douglas K.;Ahnen, Dennis J.;Baron, John A.;Batts, Kenneth P.;Burke, Carol A.;Burt, Randall W.;Goldblum, John R.;Guillem, Jose G.;Kahi, Charles J.;Kalady, Matthew F.;O'Brien, Michael J.;Odze, Robert D.;Ogino, Shuji;Parry, Susan;Snover, Dale C.;Torlakovic, Emina Emilia;Wise, Paul E.;Young, Joanne;Church, James
通讯作者：
Church, James
影响因子：
29.4
作者：
Meester RGS;van Herk MMAGC;Lansdorp-Vogelaar I;Ladabaum U
通讯作者：
Ladabaum U
影响因子：
7.7
作者：
Rex, Douglas K.;Boland, C. Richard;Robertson, Douglas J.
通讯作者：
Robertson, Douglas J.
影响因子：
3.9
作者：
Ludvigsson, Jonas F.;Lashkariani, Mariam
通讯作者：
Lashkariani, Mariam