锯齿状息肉亚型患者的大肠癌管理需分层
创作:章台柳 审核:章台柳 09月06日
  • 纳入317178名接受结肠镜检查的受试,确诊695例结直肠癌(CRC)和3475例无结直肠癌对照;
  • 将锯齿状息肉(SP)分类为无柄锯齿状病变(SSL)、增生性息肉(HP)和传统锯齿状腺瘤;
  • 与无息肉个体相比,SSL或SSL合并腺瘤增加CRC患病风险,其aOR分别为2.9和4.4;
  • 伴有异型增生的SSL、大近端SSL、小近端SSL和近端未指明的SP均增加CRC风险,aOR分别为10.3、12.8、1.9和5.8,而HP则无关;
  • 患SSL的女性患CRC的风险高于男性(aOR,4.4 vs 1.7)。
主编推荐语
章台柳
Gut近期发表的文章,通过对锯齿状息肉与结直肠癌发生风险之间关系的分析,发现无柄锯齿状病变(SSL)患者(尤其是近端较大的SSL患者或异型增生患者)发生CRC的风险增加,需要密切的内镜监测。近端未指定SP也与CRC风险增加相关,应作为SSL进行管理。
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Gut [IF:23.059]

Risk stratification for colorectal cancer in individuals with subtypes of serrated polyps

锯齿状息肉亚型患者结直肠癌的危险分层

10.1136/gutjnl-2021-324301

08-11, Article

Abstract & Authors:展开

Abstract:收起
OBJECTIVE: The longitudinal risk of colorectal cancer (CRC) associated with subtypes of serrated polyps (SPs) remains incompletely understood.
DESIGN: This community-based, case-control study included 317 178 Kaiser Permanente Northern California members who underwent their first colonoscopy during 2006-2016. Nested within this population, we identified 695 cases of CRC and 3475 CRC-free controls (matched 5:1 to cases for age, sex and year of colonoscopy). Two expert pathologists reviewed the tissue slides of all SPs identified on the first colonoscopy and reclassified them to sessile serrated lesions (SSLs), hyperplastic polyps (HPs) and traditional serrated adenomas. SPs with borderline characteristics of SSLs but insufficient to make a definitive diagnosis were categorised as unspecified SPs. The association with development of CRC was assessed using multivariable logistic regression.
RESULTS: Compared with individuals with no polyp, the adjusted ORs (aORs) for SSL alone or with synchronous adenoma were 2.9 (95% CI: 1.8 to 4.8) and 4.4 (95% CI: 2.7 to 7.2), respectively. The aORs for SSL with dysplasia, large proximal SSL,and small proximal SSL were 10.3 (95% CI: 2.1 to 50.3), 12.8 (95% CI: 3.5 to 46.9) and 1.9 (95% CI: 0.8 to 4.7), respectively. Proximal unspecified SP also conferred an increased risk (aOR: 5.8, 95% CI: 2.2 to 15.2). Women with SSL were associated with higher risk (aOR: 4.4; 95% CI: 2.3 to 8.2) than men (aOR: 1.7; 95% CI: 0.8 to 3.8).
CONCLUSION: Increased risk of CRC was observed in individuals with SSLs, particularly large proximal ones or with dysplasia, supporting close endoscopic surveillance. Proximal unspecified SPs were also associated with increased risk of CRC and should be managed as SSLs.

First Authors:
Dan Li

Correspondence Authors:
Dan Li

All Authors:
Dan Li,Amanda R Doherty,Menaka Raju,Liyan Liu,Nan Ye Lei,Laura B Amsden,Jeffrey K Lee,Theodore R Levin,Douglas A Corley,Lisa J Herrinton

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