腺瘤切除术后的长期结直肠癌死亡率。

Long-term colorectal-cancer mortality after adenoma removal.

机构信息

From the Department of Health Management and Health Economics, University of Oslo, Oslo (M.L., M.K., G.H., H.-O.A., M.B.), Department of Transplantation Medicine, Oslo University Hospital, Oslo (M.L., M.B.), Cancer Registry of Norway, Oslo (G.H.), Department of Research and Development, Telemark Hospital, Skien (M.K., G.H.), and Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand (Ø.H., M.B.) - all in Norway; the Department of Epidemiology, Harvard School of Public Health, Boston (M.L., M.K., Ø.H., H.-O.A., M.B.); and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (H.-O.A.).

出版信息

N Engl J Med. 2014 Aug 28;371(9):799-807. doi: 10.1056/NEJMoa1315870.

DOI:10.1056/NEJMoa1315870

PMID:25162886

Abstract

BACKGROUND

Although colonoscopic surveillance of patients after removal of adenomas is widely promoted, little is known about colorectal-cancer mortality among these patients.

METHODS

Using the linkage of the Cancer Registry and the Cause of Death Registry of Norway, we estimated colorectal-cancer mortality among patients who had undergone removal of colorectal adenomas during the period from 1993 through 2007. Patients were followed through 2011. We calculated standardized incidence-based mortality ratios (SMRs) using rates for the Norwegian population at large for comparison. Norwegian guidelines recommended colonoscopy after 10 years for patients with high-risk adenomas (adenomas with high-grade dysplasia, a villous component, or a size ≥10 mm) and after 5 years for patients with three or more adenomas; no surveillance was recommended for patients with low-risk adenomas. Polyp size and exact number were not available in the registry. We defined high-risk adenomas as multiple adenomas and adenomas with a villous component or high-grade dysplasia.

RESULTS

We identified 40,826 patients who had had colorectal adenomas removed. During a median follow-up of 7.7 years (maximum, 19.0), 1273 patients were given a diagnosis of colorectal cancer. A total of 398 deaths from colorectal cancer were expected and 383 were observed, for an SMR of 0.96 (95% confidence interval [CI], 0.87 to 1.06) among patients who had had adenomas removed. Colorectal-cancer mortality was increased among patients with high-risk adenomas (expected deaths, 209; observed deaths, 242; SMR, 1.16; 95% CI, 1.02 to 1.31), but it was reduced among patients with low-risk adenomas (expected deaths, 189; observed deaths, 141; SMR, 0.75; 95% CI, 0.63 to 0.88).

CONCLUSIONS

After a median of 7.7 years of follow-up, colorectal-cancer mortality was lower among patients who had had low-risk adenomas removed and moderately higher among those who had had high-risk adenomas removed, as compared with the general population. (Funded by the Norwegian Cancer Society and others.).

摘要

背景

尽管广泛提倡对腺瘤切除后的患者进行结肠镜监测，但对于这些患者的结直肠癌死亡率知之甚少。

方法

利用挪威癌症登记处和死因登记处的关联，我们估算了 1993 年至 2007 年期间接受结直肠腺瘤切除术的患者的结直肠癌死亡率。患者随访至 2011 年。我们使用挪威总人口的发病率标准化死亡率比（SMR）进行比较。挪威指南建议高危腺瘤患者（高级别异型增生、绒毛成分或直径≥10mm 的腺瘤）行结肠镜检查 10 年后，高危腺瘤患者（多发性腺瘤和绒毛成分或高级别异型增生的腺瘤）行结肠镜检查 5 年后；低危腺瘤患者无需进行监测。登记处没有提供息肉大小和确切数量。我们将高危腺瘤定义为多发性腺瘤和有绒毛成分或高级别异型增生的腺瘤。

结果

我们确定了 40826 例有结直肠腺瘤切除的患者。在中位数为 7.7 年（最长为 19.0）的随访期间，1273 例患者被诊断为结直肠癌。共观察到 398 例结直肠癌死亡，预期为 398 例，SMR 为 0.96（95%置信区间[CI]，0.87 至 1.06）。高危腺瘤患者的结直肠癌死亡率增加（预期死亡人数为 209 人；实际死亡人数为 242 人；SMR 为 1.16；95%CI，1.02 至 1.31），但低危腺瘤患者的结直肠癌死亡率降低（预期死亡人数为 189 人；实际死亡人数为 141 人；SMR 为 0.75；95%CI，0.63 至 0.88）。