LONG-TERM RISK OF COLORECTAL-CANCER AFTER EXCISION OF RECTOSIGMOID ADENOMAS
LONG-TERM RISK OF COLORECTAL-CANCER AFTER EXCISION OF RECTOSIGMOID ADENOMAS
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DOI：
10.1056/nejm199203053261002
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发表时间：
1992-03-05
影响因子：
158.5
通讯作者：
CUZICK, J
中科院分区：
文献类型：
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作者：
ATKIN, WS;MORSON, BC;CUZICK, J
背景和方法。 目前建议对结直肠腺瘤患者进行重复结肠镜检查。我们评估了1618例未接受监测的直肠乙状结肠腺瘤（直肠或乙状结肠远端肿瘤）患者接受硬性器械乙状结肠镜检查和息肉切除术后结直肠癌的长期风险。共累积了22，462人-年的观察（平均每例患者14年）。 这些患者随后直肠癌的发病率与一般人群相似（标准化发病率比为1.2; 95%可信区间为0.7 ~ 2.1）。大多数直肠癌发生于腺瘤未充分切除的患者，完全切除后发生结肠癌的风险很低，而发生结肠癌的风险取决于直肠乙状结肠腺瘤的组织学类型、大小和数量。在842例管状绒毛状、绒毛状或较大（大于或等于1 cm）的直肠乙状结肠腺瘤患者中，31例患者发生结肠癌。标准化发病率为3.6（95%置信区间，2.4 ~ 5.0），如果有多发性直肠乙状结肠腺瘤，则为6.6（95%置信区间，3.3 ~ 11.8）。在剩下的776例只有小的管状腺瘤（无论是单个还是多个）的患者中，只有4例患者发生结肠癌。该组的标准化发病率比为0.5（95%置信区间为0.1 ~ 1.3）。 对于直肠乙状结肠管状绒毛状、绒毛状或大腺瘤的患者，尤其是多发性腺瘤的患者，随访结肠镜检查是必要的。然而，在只有一个单一的，小管状腺瘤，只是轻度或中度异型增生的患者（我们的系列的43%），监测可能没有价值，因为癌症的风险是如此之低。
Background and Methods. Surveillance by repeated colonoscopy is currently recommended for patients with colorectal adenomas. We assessed the long-term risk of colorectal cancer after rigid-instrument sigmoidoscopy and polypectomy in 1618 patients with rectosigmoid adenomas (tumors of the rectum or distal sigmoid colon) who did not undergo surveillance. A total of 22,462 person-years of observation were accrued (mean, 14 years per patient).Results. The incidence of subsequent rectal cancer in these patients was similar to that in the general population (standardized incidence ratio, 1.2; 95 percent confidence interval, 0.7 to 2.1). Most rectal cancers developed in patients whose adenomas had been inadequately removed; the risk was very low after complete removal.The risk of subsequent colon cancer depended on the histologic type, size, and number of adenomas in the rectosigmoid. Among 842 patients with a rectosigmoid adenoma that was tubulovillous, villous, or large (greater-than-or-equal-to 1 cm), colon cancer developed in 31 patients. The standardized incidence ratio was 3.6 overall (95 percent confidence interval, 2.4 to 5.0) and 6.6 (95 percent confidence interval, 3.3 to 11.8) if there were multiple rectosigmoid adenomas. Among the remaining 776 patients with only small, tubular adenomas (whether single or multiple), colon cancer developed in only 4 patients. The standardized incidence ratio in this group was 0.5 (95 percent confidence interval, 0.1 to 1.3).Conclusions. Follow-up colonoscopic examinations may be warranted in patients with tubulovillous, villous, or large adenomas in the rectosigmoid, particularly if the adenomas are also multiple. In patients with only a single, small tubular adenoma that is only mildly or moderately dysplastic (43 percent of our series), however, surveillance may not be of value because the risk of cancer is so low.