Colorectal endoscopy, advanced adenomas, and sessile serrated polyps: implications for proximal colon cancer.
Colorectal endoscopy, advanced adenomas, and sessile serrated polyps: implications for proximal colon cancer.
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DOI：
10.1038/ajg.2012.167
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发表时间：
2012-08
影响因子：
9.8
通讯作者：
Potter, John D.
中科院分区：
文献类型：
--
作者：
Burnett-Hartman, Andrea N.;Newcomb, Polly A.;Phipps, Amanda I.;Passarelli, Michael N.;Grady, William M.;Upton, Melissa P.;Zhu, Lee-Ching;Potter, John D.
结肠镜检查与降低结直肠癌风险相关，但在降低远端恶性肿瘤风险方面可能比近端恶性肿瘤更有效。为了深入了解近端和远端结肠内镜表现的差异，我们对晚期腺瘤（结直肠内镜筛查的主要目标）和新发现的最常发生在近端结肠的结直肠癌亚群的前体病变——无柄锯齿状息肉（ssp）进行了病例对照研究。以健康为基础的研究人群包括：213例晚期腺瘤病例，172例SSP病例和1,704例50-79岁的对照，他们在1998-2007年间接受了指数结肠镜检查。所有参与者都完成了一份包含内窥镜病史的结构化问卷。息肉患者接受标准病理检查以确认诊断并将一个亚群重新分类为晚期腺瘤或ssp。进行Logistic回归分析，分别估计内窥镜检查与晚期腺瘤和ssp之间的校正优势比（OR）和95%置信区间（CI）；完成了特定地点的分析。既往内镜检查与直肠/远端结肠（OR=0.38; 95%CI: 0.26-0.56）和近端结肠（OR=0.31; 95%CI: 0.19-0.52）发生晚期腺瘤的风险降低相关，但既往内镜检查与ssp之间无统计学意义相关性（OR=0.80; 95%CI: 0.56-1.13）。我们的结果支持内窥镜检查在晚期腺瘤和ssp之间的效果不同的假设。这可能对近端结肠癌的预防有影响，这是由于内窥镜检查无法检测/去除ssp，或者假设的ssp的快速发展。
Colonoscopy is associated with a decreased risk of colorectal cancer but may be more effective in reducing the risk of distal than proximal malignancies. To gain insight into the differences between proximal and distal colon endoscopic performance, we conducted a case-control study of advanced adenomas, the primary targets of colorectal endoscopy screening, and sessile serrated polyps (SSPs), newly recognized precursor lesions for a colorectal cancer subset that occurs most often in the proximal colon. The Group Health-based study population included: 213 advanced adenoma cases, 172 SSP cases, and 1,704 controls ages 50–79, who received an index colonoscopy from 1998–2007. All participants completed a structured questionnaire covering endoscopy history. Participants with polyps underwent a standard pathology review to confirm the diagnosis and reclassify a subset as advanced adenomas or SSPs. Logistic regression analyses were conducted to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between endoscopy and advanced adenomas and SSPs separately; site-specific analyses were completed. Previous endoscopy was associated with decreased risk of advanced adenomas in both the rectum/distal colon (OR=0.38; 95% CI: 0.26–0.56) and proximal colon (OR=0.31; 95% CI: 0.19–0.52), but there was no statistically significant association between prior endoscopy and SSPs (OR=0.80; 95%CI: 0.56–1.13). Our results support the hypothesis that the effect of endoscopy differs between advanced adenomas and SSPs. This may have implications for proximal colon cancer prevention and be due to the failure of endoscopy to detect/remove SSPs, or the hypothesized rapid development of SSPs.
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