Ng S C, Ching J Y L, Chan V C W, Wong M C S, Tang R, Wong S, Luk A K C, Lam T Y T, Gao Q, Chan A W H, Wu J C Y, Chan F K L, Lau J Y W, Sung J J Y
Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, State Key Laboratory of Digestive Diseases, Chinese University of Hong Kong, Shatin, Hong Kong, China.
Aliment Pharmacol Ther. 2015 Jan;41(1):108-15. doi: 10.1111/apt.13003. Epub 2014 Oct 22.
Serrated polyps of the colorectum have distinct histological features and malignant potential.
To assess the association between the presence of serrated polyps and synchronous advanced colorectal neoplasia.
Among 4989 asymptomatic Chinese individuals aged 50-70 years who underwent screening colonoscopy, 281 cases with advanced neoplasia (adenoma ≥1 cm, with tubulovillous/villous histology, with high-grade dysplasia, or invasive adenocarcinoma) were compared with 4708 controls without advanced neoplasia for age, sex, smoking history, body mass index, family history of colorectal cancer and the presence of serrated polyps. Independent predictors of advanced neoplasia were determined by multivariate logistic regression analysis.
The prevalence of advanced neoplasia and serrated polyps (excluding small distal hyperplastic polyps) was 5.7% and 5.6%, respectively. 3.7% and 0.4% subjects had proximal and large (≥10 mm) serrated polyps, respectively. Independent predictors of synchronous advanced colorectal neoplasia were the presence of sessile serrated adenomas (OR: 4.52; 95% CI: 2.40-8.49), proximal serrated polyps (OR: 2.23, 95% CI: 1.38-3.60), large serrated polyps (OR: 59.25; 95% CI: 18.85-186.21), hyperplastic polyps (OR: 1.66; 95% CI: 1.03-2.67), three or more serrated polyps (OR: 4.86; 95% CI: 1.24-19.15) and one or more non-advanced tubular adenomas (OR: 3.58, 95% CI: 2.59-4.96).
Detection of proximal, sessile and/or large serrated polyps at screening colonoscopy is independently associated with an increased risk for synchronous advanced neoplasia.
结直肠锯齿状息肉具有独特的组织学特征和恶性潜能。
评估锯齿状息肉的存在与同步性晚期结直肠肿瘤之间的关联。
在4989名年龄在50 - 70岁接受筛查结肠镜检查的无症状中国个体中，将281例患有晚期肿瘤（腺瘤≥1厘米，具有管状绒毛状/绒毛状组织学，具有高级别异型增生或浸润性腺癌）的患者与4708例无晚期肿瘤的对照者进行年龄、性别、吸烟史、体重指数、结直肠癌家族史以及锯齿状息肉存在情况的比较。通过多因素逻辑回归分析确定晚期肿瘤的独立预测因素。
晚期肿瘤和锯齿状息肉（不包括小的远端增生性息肉）的患病率分别为5.7%和5.6%。分别有3.7%和0.4%的受试者患有近端和大的（≥10毫米）锯齿状息肉。同步性晚期结直肠肿瘤的独立预测因素为无蒂锯齿状腺瘤的存在（比值比：4.52；95%置信区间：2.40 - 8.49）、近端锯齿状息肉（比值比：2.23，95%置信区间：1.38 - 3.60）、大的锯齿状息肉（比值比：59.25；95%置信区间：18.85 - 186.21）、增生性息肉（比值比：1.66；95%置信区间：1.03 - 2.67）、三个或更多锯齿状息肉（比值比：4.86；95%置信区间：1.24 - 19.15）以及一个或更多非晚期管状腺瘤（比值比：3.58，95%置信区间：2.59 - 4.96）。
在筛查结肠镜检查中检测到近端、无蒂和/或大的锯齿状息肉与同步性晚期肿瘤风险增加独立相关。
