Gastroenterology:腺瘤及息肉切除后长期结直肠癌风险研究

2020-03-17 MedSci原创 MedSci原创

研究支持,晚期腺瘤和大锯齿状息肉患者在3年内进行内镜复查,而非晚期腺瘤或小锯齿状息肉的患者无需过度筛查

内镜检查可发现常规腺瘤或锯齿状息肉,通过对前体病变的及时切除以降低结直肠癌(CRC)的发病率和死亡率,但对于前体病变切除后的复查间隔目前尚无定律。

研究人员通过考察护士健康研究1(1990-2012年)、护士健康研究2(1989-2013年)和健康专业人员随访研究(1990-2012年)数据,总计122899名参与者接受乙状结肠镜或结肠镜检查,内镜检查结果分为无息肉、常规腺瘤或锯齿状息肉(增生性息肉、传统锯齿状腺瘤或无梗锯齿状腺瘤,有或无细胞学发育异常)。传统的腺瘤分为晚期型(≥10毫米,高级发育不良,或管状或绒毛组织学)和非晚期型,锯齿状息肉分为大型(≥10mm)或小型(<10mm)。在对危险因素进行调整后,研究人员采用Cox比例危险回归模型计算了CRC发病率的危险比(HRs)。

经过10年的中位随访,总计记录了491例CRC病例,其中6161名常规腺瘤患者中51例,5918名锯齿状息肉患者中24例,112107名无息肉患者中427例。与初次内镜检查未发现息肉的参与者相比,晚期腺瘤患者的CRC风险为4.07,大锯齿息肉患者发生癌变风险为3.35。相比之下,非晚期腺瘤(HR:1.21)或小锯齿息肉(HR:1.25)患者的CRC风险没有显著增加。

研究支持,晚期腺瘤和大锯齿状息肉患者在3年内进行内镜复查,而非晚期腺瘤或小锯齿状息肉的患者无需过度筛查。

原始出处:

Xiaosheng He et al. Long-term Risk of Colorectal Cancer After Removal of Conventional Adenomas and Serrated Polyps. Gastroenterology. March 2020.

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    2020-05-24 许安
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