散发性十二指肠腺瘤患者患结肠肿瘤的风险增加。

Increased risk of colonic neoplasia in patients with sporadic duodenal adenoma.

作者信息

Lagarde S, Dauphin M, Delmas C, Vitry F, Bouché O, Thiéfin G, Diebold M D, Cadiot G

机构信息

Service d'hépatogastroentérologie, CHU Robert-Debré, avenue Général-Koenig, 51092 Reims cedex, France.

出版信息

Gastroenterol Clin Biol. 2009 May;33(5):441-5. doi: 10.1016/j.gcb.2008.10.018. Epub 2009 Mar 10.

DOI:10.1016/j.gcb.2008.10.018

PMID:19278801

Abstract

BACKGROUND

Recent studies have shown an increased risk of colorectal neoplasia in patients with duodenal neoplasia. The aim of this retrospective case-control study was to confirm this risk.

PATIENTS AND METHODS

Rate of colorectal neoplasia in 29 patients with one or more duodenal adenomas were compared with controls matched for gender and age, but without duodenal adenomas (one case to two controls). Patients with neoplasia of the ampulla, familial adenomatous polyposis or other known hereditary conditions of the digestive tract were excluded. Indications for upper and lower gastrointestinal endoscopy in controls were abdominal pain or changes in bowel habits. Controls with anemia or digestive bleeding were not included. Neoplastic lesions found at colonoscopy were classified as adenomas, advanced adenomas (size > or =10 mm, villous component, high-grade dysplasia), cancers and advanced neoplasia (cancers and advanced adenomas). Comparison between groups was by Fisher's exact test or Student's t test. Odds-ratios (OR) and 95% confidence intervals were calculated, if the difference was significant.

RESULTS

Mean age of the 29 cases (seven women, 22 men) was 63.2 years and that of the 58 controls (14 women, 44 men) was 62.5 years. First-degree family history of colorectal cancer was present in four cases (13.8%) and eight controls (13.8%) (NS). Colonoscopy showed at least one adenoma in 15 cases (51.7%) and 11 controls (19%) (P=0.0027; OR 1.87, 1.0-3.49), advanced adenomas in four cases (13.8%) and three controls (5.2%) (NS), and colonic adenocarcinoma in three cases (10.3%) and no controls (0%) (P=0.03). Advanced neoplasia was present in seven cases (24.1%) and three controls (5.2%) (P=0.014; OR 2.86, 0.96-8.52). Results were not significantly modified after the exclusion of patients with a family history of colorectal cancer.

CONCLUSION

Although lacking in statistical power, these results confirm that patients with sporadic duodenal adenoma are at high risk of colonic adenoma and advanced neoplasia, warranting systematic colonoscopy.

摘要

背景

近期研究表明，十二指肠肿瘤患者患结直肠肿瘤的风险增加。本回顾性病例对照研究的目的是证实这一风险。

患者与方法

比较29例患有一个或多个十二指肠腺瘤患者的结直肠肿瘤发生率与性别和年龄匹配但无十二指肠腺瘤的对照组（1例患者对应2例对照）。排除壶腹肿瘤、家族性腺瘤性息肉病或其他已知的消化道遗传性疾病患者。对照组进行上消化道和下消化道内镜检查的指征为腹痛或排便习惯改变。不纳入贫血或消化道出血的对照组。结肠镜检查发现的肿瘤性病变分为腺瘤、高级别腺瘤（大小≥10mm、绒毛成分、高级别异型增生）、癌和高级别肿瘤（癌和高级别腺瘤）。组间比较采用Fisher精确检验或Student t检验。若差异有统计学意义，则计算比值比（OR）和95%置信区间。

结果

29例患者（7例女性，22例男性）的平均年龄为63.2岁，58例对照组（14例女性，44例男性）的平均年龄为62.5岁。4例患者（13.8%）和8例对照组（13.8%）有结直肠癌一级家族史（无统计学差异）。结肠镜检查显示，15例患者（51.7%）和11例对照组（19%）至少有一个腺瘤（P = 0.0027；OR 1.87，1.0 - 3.49），4例患者（13.8%）和3例对照组（5.2%）有高级别腺瘤（无统计学差异），3例患者（10.3%）有结肠腺癌而对照组无（0%）（P = 0.03）。7例患者（24.1%）和3例对照组（5.2%）有高级别肿瘤（P = 0.014；OR 2.86，0.96 - 8.52）。排除有结直肠癌家族史的患者后，结果无显著改变。