Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
J Gen Intern Med. 2012 Mar;27(3):361-70. doi: 10.1007/s11606-011-1919-y. Epub 2011 Nov 8.
To investigate the association between proximal colonic neoplasia and distal lesions as a function of the lesion type. The extent to which health, demographic, and study characteristics moderate this association was also examined.
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Studies allowing the calculation of OR of proximal neoplasia (PN) and proximal advanced neoplasia (PAN) for distal hyperplastic polyps (HP), nonadvanced adenomas (NAA), adenomas (AD), and advanced neoplasia (AN); also, studies for which the proportions of subjects with isolated (i.e., not accompanied by distal lesions) PN (IPN) and PAN (IPAN) over the total number of subjects with PN or PAN could be calculated.
Thirty-two studies were included for calculating OR between proximal neoplasia and distal lesions and 40 studies for proportions of IPN and IPAN. Subgroup analyses were conducted for presence of symptoms, prevalence of PN and PAN, age, proportion of males, geographic region, study design, and demarcation point.
The association between distal lesions and proximal neoplasia increased with the severity of the distal lesions. Odds of PN were higher in subjects with HP compared to subjects with a normal distal colon. Odds of PN and PAN were higher in subjects with NAA, AD, and AN than in subjects with a normal distal colon. PAN were more strongly associated with distal lesions in asymptomatic populations, in young populations, and in populations with a low prevalence of PAN. In approximately 60% of the subjects with PN and PAN, these neoplasia were isolated.
The present results may be affected by publication bias and dichotomization in the subgroup analyses. Limitations related to the individual studies include self-selection, lesion misclassification and misses, and technological advances leading to changes in the detection of lesions during the time span of the included studies.
All types of distal lesions are predictive of PN. All types of distal neoplasia are predictive of PAN. The association between distal lesions and proximal neoplasia increases with the severity of the distal lesion. The association between distal lesions and proximal advanced neoplasia is stronger in low-risk groups as compared to high-risk groups.
研究近端结直肠肿瘤与远端病变之间的相关性，这种相关性与病变类型有关。本研究还考察了健康、人口统计学和研究特征在多大程度上调节了这种相关性。
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允许计算近端腺瘤（PN）和近端高级别腺瘤（PAN）与远端增生性息肉（HP）、非高级别腺瘤（NAA）、腺瘤（AD）和高级别腺瘤（AN）之间比值比（OR）的研究；还包括可以计算出近端腺瘤（PN）和高级别腺瘤（PAN）中孤立病变（即不伴有远端病变）的比例（IPN 和 IPAN）的研究。
共纳入 32 项研究以计算近端肿瘤与远端病变之间的 OR，纳入 40 项研究以计算 IPN 和 IPAN 的比例。对于症状的存在、PN 和 PAN 的患病率、年龄、男性比例、地理位置、研究设计和界限点进行了亚组分析。
远端病变与近端肿瘤的相关性随着远端病变的严重程度而增加。与远端结肠正常的患者相比，HP 患者发生 PN 的几率更高。与远端结肠正常的患者相比，NAA、AD 和 AN 患者发生 PN 和 PAN 的几率更高。在无症状人群、年轻人群和 PAN 患病率较低的人群中，PAN 与远端病变的相关性更强。在大约 60%的 PN 和 PAN 患者中，这些肿瘤是孤立的。
本研究结果可能受到发表偏倚和亚组分析中二分法的影响。与个别研究相关的局限性包括自我选择、病变分类错误和遗漏以及技术进步，这些进步导致在纳入研究的时间跨度内病变的检测发生变化。
所有类型的远端病变均能预测 PN。所有类型的远端肿瘤均能预测 PAN。远端病变与近端肿瘤的相关性随着远端病变的严重程度而增加。与高危人群相比，低危人群中远端病变与近端高级别肿瘤的相关性更强。
