John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, USA.
Cancer. 2011 Mar 1;117(5):931-7. doi: 10.1002/cncr.25657. Epub 2010 Oct 19.
Colonoscopic screening has increased detection of malignant colonic polyps (MPs). The goal of this study was to analyze trends and patterns in the surgical treatment of MPs and to assess outcomes as measured by lymph node retrieval and patient survival.
The Surveillance, Epidemiology, and End Results (SEER) registry was queried to identify 19,743 patients with MPs from 1988 to 2003.
The majority of MPs were present in the sigmoid and descending colon (54%), and 38% were tubular, 40% were tubulovillous, and 22% were villous. During the study period, the incidence of MPs increased from 29% to 42% and surgical resection (SR) was increasingly used for treatment, from 54% to 70%. Predictors of SR were aged <70 years (odds ratio [OR], 1.3; 95% confidence interval [95% CI], 1.2-1.4), high-grade tumors (OR, 1.5; 95% CI, 1.2-1.9), diagnosis in 1999 through 2003 (OR, 1.7; 95% CI, 1.5-1.9), villous subtype (OR, 2.3; 95% CI, 2.0-2.6), and right colon location (OR, 8.1; 95% CI, 7.0-9.4). In patients undergoing SR, the mean and median number of lymph nodes was only 4 and 1, respectively. A significant percentage of patients (49%) had no lymph nodes retrieved and a worse overall survival at 5 years compared with patients who had at least 1 lymph node examined (64% vs 74%; P <.001).
MPs appear to be increasing in incidence, and there is a trend toward increased use of SR for treatment. However, patients undergoing SR for MPs undergo suboptimal assessment of lymph nodes, with a detrimental impact on survival. Adequate lymphadenectomy and lymph node evaluation are crucial to improve outcomes in patients with these potentially curable lesions. Cancer 2011. © 2010 American Cancer Society.
结肠镜筛查提高了恶性结肠息肉（MPs）的检出率。本研究的目的是分析 MPs 手术治疗的趋势和模式，并评估淋巴结检出和患者生存情况。
通过监测、流行病学和最终结果（SEER）登记处对 1988 年至 2003 年期间 19743 例 MPs 患者进行了调查。
大多数 MPs 位于乙状结肠和降结肠（54%），管状息肉占 38%，管状绒毛状息肉占 40%，绒毛状息肉占 22%。在此研究期间，MPs 的发病率从 29%增加到 42%，手术切除（SR）的应用越来越广泛，从 54%增加到 70%。SR 的预测因素为年龄<70 岁（比值比[OR]，1.3；95%置信区间[95%CI]，1.2-1.4）、高级别肿瘤（OR，1.5；95%CI，1.2-1.9）、1999 年至 2003 年诊断（OR，1.7；95%CI，1.5-1.9）、绒毛状亚型（OR，2.3；95%CI，2.0-2.6）和右半结肠位置（OR，8.1；95%CI，7.0-9.4）。在接受 SR 的患者中，平均和中位数淋巴结数量分别为 4 个和 1 个。相当比例的患者（49%）没有检出淋巴结，5 年总生存率低于至少有 1 个淋巴结检查的患者（64%比 74%；P<0.001）。
MPs 的发病率似乎在增加，并且治疗中 SR 的应用呈上升趋势。然而，接受 MPs SR 的患者淋巴结评估不足，对生存产生不利影响。充分的淋巴结切除术和淋巴结评估对于改善这些潜在可治愈病变患者的预后至关重要。癌症 2011. © 2010 美国癌症协会。
