关注结直肠癌,警惕高危腺瘤
创作:Lexi 审核:Lexi 2019年11月11日
  • 2004-2010年,21个医疗中心的64422名参与者接受基线结肠镜检查,女性占比54.3%,平均年龄61.6±7.1岁,中位随访期8.1年;
  • 按检查结果分为无腺瘤、低危腺瘤和高危腺瘤组;
  • 参与者接受随访,直到CRC确诊、死亡、健康计划除名、或到2017年12月31日;
  • 采用Cox回归校正干扰因子,比较高、低危腺瘤组与无腺瘤组的CRC风险及相关死亡;
  • 相比无腺瘤组,高风险腺瘤组患癌风险及相关死亡率更高,低风险腺瘤组患癌风险及相关死亡率无明显增加。
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Lexi
切除腺瘤后结直肠癌(CRC)的长期风险和与CRC相关死亡情况并不确定。目前的腺瘤检测指南对某些息肉类型的随访建议各不相同,因此需要更多研究数据用以提供监测指南。最新发表在Gastroenterology杂志的研究,利用大型社区综合卫生保健机构的数据,通过基线结肠镜检查腺瘤的发现来调查与之相关的CRC风险和相关死亡情况。研究结果表明低危腺瘤与CRC或相关死亡风险的显著增加无关。相比无腺瘤人群,高风险腺瘤患者在腺瘤切除后,患癌风险及相关死亡率显著升高。该结果可以为当前高危和低危腺瘤的监测指南提供参考。
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Gastroenterology [IF:17.373]

Long-term Risk of Colorectal Cancer and Related Death After Adenoma Removal in a Large, Community-based Population

腺瘤切除后,结直肠癌长期风险和相关死亡——基于社区的大规模人群研究

10.1053/j.gastro.2019.09.039

2019-10-04, Article

Abstract & Authors:展开

Abstract:收起
Background & Aims: The long-term risks of colorectal cancer (CRC) and CRC-related death following adenoma removal are uncertain. Data are needed to inform evidence-based surveillance guidelines, which vary in follow-up recommendations for some polyp types. Using data from a large, community-based integrated health care setting, we examined the risks of CRC and related death by baseline colonoscopy adenoma findings.
Methods: Participants at 21 medical centers underwent baseline colonoscopies from 2004 through 2010; findings were categorized as no adenoma, low-risk adenoma, or high-risk adenoma. Participants were followed until the earliest of CRC diagnosis, death, health plan disenrollment, or December 31, 2017. Risks of CRC and related deaths among the high- and low-risk adenoma groups were compared with the no adenoma group using Cox regression adjusting for confounders.
Results: Among 186,046 patients, 64,422 met eligibility criteria (54.3% female; mean age, 61.6±7.1 y; median follow-up time, 8.1 y from the baseline colonoscopy). Compared with the no-adenoma group (45,881 patients), the high-risk adenoma group (7563 patients) had a higher risk of CRC (hazard ratio [HR], 2.61; 95% CI, 1.87–3.63) and related death (HR, 3.94; 95% CI, 1.90–6.56), whereas the low-risk adenoma group (10,978 patients) did not have a significant increase in risk of CRC (HR, 1.29; 95% confidence interval, 0.89–1.88) or related death (HR, 0.65; 95% CI, 0.19–2.18).
Conclusions: With up to 14-years of follow-up, high-risk adenomas were associated with an increased risk of CRC and related death, supporting early colonoscopy surveillance. Low-risk adenomas were not associated with a significantly increased risk of CRC or related deaths. These results can inform current surveillance guidelines for high- and low-risk adenomas.

First Authors:
Jeffrey K Lee

Correspondence Authors:
Jeffrey K Lee

All Authors:
Jeffrey K Lee,Christopher D Jensen,Theodore R Levin,Chyke A Doubeni,Ann G Zauber,Jessica Chubak,Aruna S Kamineni,Joanne E Schottinger,Nirupa R Ghai,Natalia Udaltsova,Wei K Zhao,Bruce H Fireman,Charles P Quesenberry,E John Orav,Celette Sugg Skinner,Ethan A Halm,Douglas A Corley

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