Can the Sum of Adenoma Diameters (Adenoma Bulk) on Index Examination Predict Risk of Metachronous Advanced Neoplasia?
Can the Sum of Adenoma Diameters (Adenoma Bulk) on Index Examination Predict Risk of Metachronous Advanced Neoplasia?
复制标题
DOI：
10.1097/mcg.0000000000000899
复制
发表时间：
2018-08
影响因子：
2.9
通讯作者：
Baron JA
中科院分区：
文献类型：
--
作者：
Anderson JC;Morris CB;Robertson DJ;Barry ELR;Figueiredo JC;Cruz-Correa M;Bostick RM;Ahnen DJ;Baron JA
最近的数据表明，腺瘤的大小和数量比高级组织学更能预测异时性大肠肿瘤的发生。此外，在诊断晚期组织学、高度不典型增生(HGD)和绒毛组织学方面重复性较差。因此，我们开发了一种新的衡量标准，腺瘤体积，即所有基线腺瘤的直径之和，而不考虑高级特征。比较腺瘤肿块的异时性晚期瘤变与传统范式的预测价值。数据是在一项多中心腺瘤化学预防试验(2004-13)中前瞻性收集的。对于传统的范例，高危基线发现被定义为腺瘤、大腺瘤(≥1 cm)或有绒毛成分的腺瘤或HGD。腺瘤肿块的检查跨越四分位数，并作为一个连续变量。使用常规标准和腺瘤体积计算异时性晚期肿瘤的预测特征(敏感度、特异度、c统计量)。用Logistic回归计算ROC曲线。1,948名成人接受了指数结肠镜检查和随访(平均随访45.2个月)。腺瘤体积≥为10 mm(第4个四分位数)的患者异时性晚期肿瘤形成的风险较高(14.4%对6.9%-8.2%；p=0.0002)。腺瘤肿块模型和常规模型的c统计量和敏感性分别为0.587和0.563(p=0.17)和0.396和0.390。根据腺瘤体积VS≥10 mm将散发性腺瘤患者归类为异时性晚期肿瘤的高风险与低风险，可能与传统范例具有相似的预测性，并通过消除对切除的息肉中绒毛成分的范围或不典型程度的额外组织学的需要而简化风险分层。腺瘤体积指标，特别是10 mm的截止值，必须在其他人群中得到验证，才能用于临床实践。
Recent data suggest that adenoma size and number are more important predictors of metachronous colorectal neoplasia than advanced histology. Furthermore, there is poor reproducibility in diagnosing advanced histology; high-grade dysplasia (HGD) and villous histology. Therefore we developed a new metric, adenoma bulk, the sum of diameters of all baseline adenomas, regardless of advanced features. Compare the predictive value for metachronous advanced neoplasia of adenoma bulk to conventional paradigm. Data were collected prospectively in a multi-center adenoma-chemoprevention trial (2004–13). For the conventional paradigm, high-risk baseline findings were defined as >/=3 adenomas, large adenomas (≥1cm) or adenomas with villous components or HGD. Adenoma bulk was examined across quartiles and as a continuous variable. Predictive characteristics (sensitivities, specificities, c-statistics) for metachronous advanced neoplasia using conventional criteria and adenoma bulk were calculated. ROC curves were computed using logistic regression. 1,948 adults had index and follow-up colonoscopies (mean follow-up 45.2 months). Those with an adenoma bulk ≥10 mm (4th quartile) had a higher metachronous advanced neoplasia risk (14.4% vs. 6.9%–8.2% in lower 3 quartiles; p=0.0002). The c-statistics and sensitivities (specificity fixed at 0.73) for the adenoma bulk and conventional models were 0.587 and 0.563 (p=0.17) and 0.396 and 0.390, respectively. Categorizing sporadic adenoma patients as high vs. low-risk for metachronous advanced neoplasia by adenoma bulk of < vs ≥10 mm may be comparably predictive as conventional paradigm and simplifies risk stratification by obviating need for additional histology regarding extent of villous component or degree of dysplasia in resected polyps. The adenoma bulk metric and the 10 mm cutoff in particular would have to be validated in other populations before it can be used in clinical practice.