Saurin Jean-Christophe, Gutknecht Christelle, Napoleon Bertrand, Chavaillon Annick, Ecochard René, Scoazec Jean-Yves, Ponchon Thierry, Chayvialle Jean-Alain
Service d'Hepatogastroenterologie, Pavillon I, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437 Lyon cedex 03, France.
J Clin Oncol. 2004 Feb 1;22(3):493-8. doi: 10.1200/JCO.2004.06.028.
The development of high-grade dysplasia (HGD) on duodenal or jejunal adenomas and of late-stage (stage IV) duodenal polyposis are major clinical events for familial adenomatous polyposis (FAP) patients. Our aim was to determine their respective frequency, risk factors, and cumulative risk.
A prospective, optimized, endoscopic surveillance protocol was applied to 58 FAP patients in a university hospital. The number, size, and histology of duodenojejunal polyps were assessed, and the Spigelman's score was calculated at each endoscopy. Cox regression and linear regression analysis were used to determine risk factors for HGD development and the cumulative risk of stage IV duodenal polyposis, respectively.
During a median (+/- standard deviation) follow-up of 47.9 +/- 15.6 months, 35 patients with at least two consecutive examinations had 107 duodenojejunal examinations. The Spigelman's score increased in 21 patients (60.0%), and HGD developed in 12 patients (34.2%). High initial Spigelman's score (> 7 points), but not age or APC mutation site, was a risk factor for HGD development. Estimated cumulative risk of developing stage IV duodenal polyposis was of 42.9% at age 60 (95% CI, 35.7% to 50.0%) and 50.0% at age 70 (95% CI, 42.9% to 57.1%).
This prospective series shows a higher duodenal polyposis progression rate and cumulative risk of late-stage (stage IV) duodenal polyposis in FAP patients compared with previous series. These results suggest that current modalities for surveillance and management of these patients need revision.
十二指肠或空肠腺瘤发生高级别异型增生（HGD）以及晚期（IV期）十二指肠息肉病是家族性腺瘤性息肉病（FAP）患者的主要临床事件。我们的目的是确定它们各自的发生率、危险因素和累积风险。
在一所大学医院，对58例FAP患者应用了一项前瞻性、优化的内镜监测方案。评估十二指肠空肠息肉的数量、大小和组织学情况，并在每次内镜检查时计算Spigelman评分。分别采用Cox回归和线性回归分析来确定HGD发生的危险因素以及IV期十二指肠息肉病的累积风险。
在中位（±标准差）47.9±15.6个月的随访期间，35例至少连续接受两次检查的患者进行了107次十二指肠空肠检查。21例患者（60.0%）的Spigelman评分升高，12例患者（34.2%）发生了HGD。初始Spigelman评分高（>7分）是HGD发生的危险因素，而年龄或APC突变位点不是。60岁时发生IV期十二指肠息肉病的估计累积风险为42.9%（95%CI，35.7%至50.0%），70岁时为50.0%（95%CI，42.9%至57.1%）。
与既往系列研究相比，这个前瞻性系列研究显示FAP患者十二指肠息肉病的进展率更高以及晚期（IV期）十二指肠息肉病的累积风险更高。这些结果提示，目前对这些患者的监测和管理方式需要修订。
