Morimoto Libby M, Newcomb Polly A, Ulrich Cornelia M, Bostick Roberd M, Lais Cynthia J, Potter John D
Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington 98109-1024, USA.
Cancer Epidemiol Biomarkers Prev. 2002 Oct;11(10 Pt 1):1012-8.
Recent studies have suggested that hyperplastic polyps may be benign precursor lesions for a distinct subset of colorectal tumors. We conducted a clinic-based case-control study to evaluate risk factors for hyperplastic polyps. Cases with hyperplastic polyps (n = 219), adenomas (n = 437), and both types of polyps (n = 138), along with colonoscopy-negative controls (n = 708), were identified at a gastroenterology practice in the Minneapolis area during 1991-1994. A self-administered questionnaire was used to collect risk factor information. Risk factors for hyperplastic and adenomatous polyps were generally similar to those for colorectal cancer. Male sex, smoking, and alcohol consumption were associated with increased risk of all polyp groups; nonsteroidal anti-inflammatory drug use, hormone replacement therapy use, and calcium intake were associated with reduced risk. There was no apparent association between increasing age and hyperplastic polyp risk (P = 0.21) in this analysis, although it was a strong risk factor for adenoma (P < 0.001). The odds ratio (OR) for hyperplastic polyps associated with >25 pack-years of smoking was 4.1 [95% confidence interval (CI), 2.2-7.6], whereas the OR for adenoma alone was 1.3 (95% CI, 0.8-2.3). The OR estimate for individuals diagnosed with both polyp types was 4.2 (95% CI, 1.9-9.3). These results suggest, as one possibility, that the consistent association of adenoma and smoking observed in previous studies may be partially attributable to the inclusion of individuals with both adenomas and hyperplastic polyps in the adenoma case group. To the contrary, individuals with both polyp types may be expressing a phenotype distinct from those who have only adenomas and should be considered separately. Further studies are necessary to establish which polyp phenotypes are related to smoking. Overall, the similarity of the risk profiles of colorectal hyperplastic polyps, adenoma, and cancer provides additional support for the growing body of evidence that some hyperplastic polyps may have neoplastic potential.
近期研究表明，增生性息肉可能是一类独特的结直肠肿瘤的良性前驱病变。我们开展了一项基于临床的病例对照研究，以评估增生性息肉的危险因素。1991年至1994年期间，在明尼阿波利斯地区的一家胃肠病诊所确定了增生性息肉患者（n = 219）、腺瘤患者（n = 437）、同时患有这两种息肉的患者（n = 138）以及结肠镜检查阴性的对照者（n = 708）。通过一份自填式问卷收集危险因素信息。增生性息肉和腺瘤性息肉的危险因素通常与结直肠癌的危险因素相似。男性、吸烟和饮酒与所有息肉组的风险增加相关；使用非甾体类抗炎药、激素替代疗法和摄入钙与风险降低相关。在该分析中，年龄增长与增生性息肉风险之间无明显关联（P = 0.21），尽管年龄是腺瘤的一个强危险因素（P < 0.001）。与吸烟超过25包年相关的增生性息肉的比值比（OR）为4.1 [95%置信区间（CI），2.2 - 7.6]，而单独腺瘤的OR为1.3（95% CI，0.8 - 2.3）。诊断为两种息肉类型的个体的OR估计值为4.2（95% CI，1.9 - 9.3）。这些结果表明，一种可能性是，先前研究中观察到的腺瘤与吸烟之间的一致关联可能部分归因于腺瘤病例组中同时患有腺瘤和增生性息肉的个体。相反，患有两种息肉类型的个体可能表现出与仅患有腺瘤的个体不同的表型，应分别考虑。需要进一步研究以确定哪些息肉表型与吸烟有关。总体而言，结直肠增生性息肉、腺瘤和癌症的风险特征相似，为越来越多的证据提供了额外支持，即一些增生性息肉可能具有肿瘤形成潜能。
