Department of Medicine, Sørlandet Hospital, Kristiansand, Norway Institute of Health and Society, University of Oslo, Oslo, Norway.
Department of Medicine, Sørlandet Hospital, Kristiansand, Norway Institute of Health and Society, University of Oslo, Oslo, Norway Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Gut. 2015 Jun;64(6):929-36. doi: 10.1136/gutjnl-2014-307793. Epub 2014 Nov 16.
Although serrated polyps may be precursors of colorectal cancer (CRC), prospective data on the long-term CRC risk in individuals with serrated polyps are lacking.
In a population-based randomised trial, 12,955 individuals aged 50-64 years were screened with flexible sigmoidoscopy, while 78 220 individuals comprised the control arm. We used Cox models to estimate HRs with 95% CIs for CRC among individuals with ≥1 large serrated polyp (≥10 mm in diameter), compared with individuals with adenomas at screening, and to population controls, and multivariate logistic regression to assess polyp risk factors for CRC.
A total of 103 individuals had large serrated polyps, of which 81 were included in the analyses. Non-advanced adenomas were found in 1488 individuals, advanced adenomas in 701. Median follow-up was 10.9 years. Compared with the control arm, the HR for CRC was 2.5 (95% CI 0.8 to 7.8) in individuals with large serrated polyps, 2.0 (95% CI 1.3 to 2.9) in individuals with advanced adenomas and 0.6 (95% CI 0.4 to 1.1) in individuals with non-advanced adenomas. A large serrated polyp was an independent risk factor for CRC, adjusted for histology, size and multiplicity of concomitant adenomas (OR 3.3; 95% CI 1.3 to 8.6). Twenty-three large serrated polyps found at screening were left in situ for a median of 11.0 years. None developed into a malignant tumour.
Individuals with large serrated polyps have an increased risk of CRC, comparable with individuals with advanced adenomas. However, this risk may not be related to malignant growth of the serrated polyp.
The Norwegian Colorectal Cancer Screening trial is registered at clinicaltrials.gov (NCT00119912).
尽管锯齿状息肉可能是结直肠癌（CRC）的前体，但缺乏锯齿状息肉患者长期 CRC 风险的前瞻性数据。
在一项基于人群的随机试验中，对 12955 名 50-64 岁的个体进行了乙状结肠镜筛查，而 78220 名个体构成对照组。我们使用 Cox 模型估计了在筛查时具有≥1 个大锯齿状息肉（直径≥10mm）的个体与具有腺瘤的个体以及与人群对照组相比 CRC 的 HR，并使用多变量逻辑回归评估了 CRC 的息肉危险因素。
共有 103 名个体患有大锯齿状息肉，其中 81 名个体纳入分析。在 1488 名个体中发现非高级别腺瘤，在 701 名个体中发现高级别腺瘤。中位随访时间为 10.9 年。与对照组相比，具有大锯齿状息肉的个体 CRC 的 HR 为 2.5（95%CI 0.8 至 7.8），具有高级别腺瘤的个体为 2.0（95%CI 1.3 至 2.9），具有非高级别腺瘤的个体为 0.6（95%CI 0.4 至 1.1）。大锯齿状息肉是 CRC 的独立危险因素，调整了组织学、大小和同时存在的腺瘤数量（OR 3.3；95%CI 1.3 至 8.6）。筛查时发现的 23 个大锯齿状息肉原位保留中位时间为 11.0 年。没有一个发展成恶性肿瘤。
具有大锯齿状息肉的个体 CRC 的风险增加，与具有高级别腺瘤的个体相当。然而，这种风险可能与锯齿状息肉的恶性生长无关。
挪威结直肠癌筛查试验在 clinicaltrials.gov 注册（NCT00119912）。
