Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Azienda Ospedaliera University of Padova, Padova, Italy.
Surg Endosc. 2013 Jan;27(1):207-13. doi: 10.1007/s00464-012-2421-2. Epub 2012 Jul 7.
Currently, no guidelines exist for the treatment of patients with multiple colorectal adenomas (MCRAs) (>10 but <100 synchronous nondiminutive polyps of the large bowel). This retrospective study aimed to investigate the clinical and molecular factors related to different treatments for MCRAs.
Patients with MCRAs were consecutively enrolled from January 2003 to June 2011. Sequencing of their APC and MutYH genes was performed. The clinical, molecular, and family histories of the patients were collected using the Progeny database. The patient treatments were divided into three groups of increasing clinical weight: endoscopic polypectomy, segmental resection, and total colectomy. A logistic regression analysis of clinicomolecular factors related to different treatment options was performed.
The study comprised 80 patients (32 women, 40%) with a median age of 53 years (range 13-74 years). The median number of polyps was 33 (range 10-90).The cases included 62 diffuse polyposis, 18 segmental polyposis coli and synchronous colorectal carcinomas (CRC; 34 cases, 43%). The pathogenetic mutations were biallelic MutYH (n = 19, 24%) and APC (n = 4, 5%). The mean follow-up period was 74 months (median 43 months, range 1-468 months). Endoscopic polypectomy was performed in 25 cases (31%), segmental resection in 16 cases (20%), and total colectomy in 39 cases (49%). The logistics regression analysis, considering all the patients, showed that the number of polyps, the presence of CRC, and mutation were correlated with more intensive treatment. For the patients without CRC, only the number of polyps was correlated with the severity of the treatment (p > 0.0166). "On the ROC (receiver operating characteristic) curve, 25 was the number of polyps that best discriminated between surgical and endoscopic therapy.
The majority of patients with MCRAs undergo surgery. For patients without CRC, only the number of polyps, and not the presence of a disease-causing mutation, is correlated with increased heaviness of treatment. Patients with more than 25 polyps are more likely to undergo a surgical resection.
目前，尚无针对多发性大肠腺瘤（MCRAs）（>10 但<100 个大肠非小息肉）患者的治疗指南。本回顾性研究旨在探讨与 MCRAs 不同治疗方法相关的临床和分子因素。
2003 年 1 月至 2011 年 6 月连续入组 MCRAs 患者。对其 APC 和 MutYH 基因进行测序。使用 Progeny 数据库收集患者的临床、分子和家族史。将患者的治疗分为三组：内镜息肉切除术、节段切除术和全结肠切除术。对与不同治疗选择相关的临床分子因素进行逻辑回归分析。
研究共纳入 80 例患者（32 例女性，40%），中位年龄为 53 岁（范围 13-74 岁）。中位息肉数为 33 个（范围 10-90 个）。病例包括 62 例弥漫性息肉病、18 例节段性结肠息肉和同步结直肠癌（CRC；34 例，43%）。致病突变均为双等位基因 MutYH（n=19，24%）和 APC（n=4，5%）。中位随访时间为 74 个月（中位数 43 个月，范围 1-468 个月）。25 例（31%）行内镜息肉切除术，16 例（20%）行节段切除术，39 例（49%）行全结肠切除术。考虑所有患者的逻辑回归分析显示，息肉数量、CRC 存在和突变与更强化的治疗相关。对于无 CRC 的患者，只有息肉数量与治疗的严重程度相关（p>0.0166）。在 ROC（接受者操作特征）曲线上，25 个息肉是区分手术和内镜治疗的最佳数量。
大多数 MCRAs 患者需要手术治疗。对于无 CRC 的患者，只有息肉数量，而不是致病突变的存在，与治疗加重相关。息肉数超过 25 个的患者更有可能接受手术切除。
