Advanced Colorectal Neoplasia Following Polypectomy

描述（申请人提供）：大多数结直肠腺瘤是由腺瘤性息肉引起的，最有效的预防结直肠癌的方法是通过内镜切除这些病变。在接受结肠镜检查的人群中，晚期肿瘤（晚期腺瘤或癌症）的流行病学尚不清楚。由于息肉切除术后晚期肿瘤的发生率较低，因此需要一项具有高随访率的大型前瞻性研究来确定预测这些结果的因素。本研究的目的是通过汇总来自8个已完成的腺瘤研究的个体数据，确定结肠镜息肉切除术后个体发展为晚期肿瘤的高风险或低风险因素。这项工作将导致大约10,000人接受结肠镜切除所有可见息肉的队列，并前瞻性地进行一次或多次结肠镜检查。确定了三个特定目的：1)确定在切除一个或多个组织学证实的腺瘤的个体中晚期肿瘤的发生率；2)在结肠镜监测中识别与晚期结直肠肿瘤发生独立相关的危险因素；3)了解监测期间发现的结直肠癌患者的基线结肠镜检查特点。目前对息肉切除术患者的监测指南是基于稀疏的数据。要完善这些准则，就必须有大量的、可能得到遵循的、特征明确的人口，如本建议的共同努力所产生的人口。这项研究的结果非常及时，可能对国家公共卫生产生重大影响。由于数据是通过进行研究收集的，因此这是评估这一重要研究领域的一种具有成本效益和高效率的方法。

DESCRIPTION (provided by applicant): The majority of colorectal adenomas arise from adenomatous polyps and the most effective method for colorectal cancer prevention is through endoscopic removal of these lesions. The epidemiology of advanced neoplasia (advanced adenomas or cancers) in populations undergoing colonoscopic surveillance is not understood. Since occurrence of advanced neoplasia following polypectomy is low, a large, prospective study with high follow-up rates is needed to identify factors that predict these outcomes. The goal of this research is to identify factors that place individuals at high or low risk for development of advanced neoplasms after colonoscopic polypectomy by pooling individual data from eight completed adenoma studies. This effort will result in a cohort of approximately 10,000 individuals who underwent colonoscopic removal of all visualized polyps and were prospectively followed by undergoing one or more surveillance colonoscopies. Three specific aims were identified: 1) to determine the rate of occurrence of advanced neoplasms among individuals who undergo removal of one or more histologically verified adenoma(s); 2) to identify risk factors independently associated with occurrence of advanced colorectal neoplasms during colonoscopic surveillance; and 3) to identify characteristics of the baseline colonoscopy examination in patients with colorectal cancer discovered during the surveillance period. Current surveillance guidelines for individuals undergoing polypectomy are based on sparse data. Refinement of these guidelines requires a large, prospectively followed, well-characterized population, such as that resulting form the combined efforts of the present proposal. Results of this research are extremely timely and could have a major national public health impact. Given that data were collected through the conduct of the studies, this results in a cost-effective and highly efficient approach for assessing this important research area.