Zhu Hailong, Zhang Guofeng, Yi Xianghua, Zhu Xuyou, Wu Yunjin, Liang Jun, Zhang Suxia, Zeng Yu, Fan Desheng, Yu Xiaoting, He Jian, He Guozhong, Chen Zheng, Duan Shengzhong, Zhang Lanjing
Department of Pathology, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
Department of General Surgery, Tongji Hospital, Tongji University School of Medicine Shanghai, China.
Am J Cancer Res. 2014 Dec 15;5(1):363-74. eCollection 2015.
Sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA) are considered as precursors of colorectal cancer, and are often diagnostic challenges. Their true prevalence is masked by significant inter-observer variations. To investigate the true prevalence and synchronous colorectal carcinoma (sCRC) of colorectal serrated polyps (CSP) and their associated factors, we first retrospectively identified all colorectal polyps collected at our institution between June 1995 and May 2013. After centrally reclassifying all CSP to reduce inter-observer variations, Chi-square tests and logistic regression analyses were used to analyze the potential factors. Among the included 5501 colorectal polyps, 499 CSP of 428 patients were identified and studied, including 353 hyperplastic polyps (HP, 70.7%), 80 SSA (16.0%), 61 TSA (12.2%) and 5 mixed polyp (1.0%). Diagnostic disagreements were found in 68 CSP (13.63% of CSP). SSA and TSA were more often larger than 5 mm and in proximal colon than HP. SSA were also more likely associated with older age (p=0.005), size ≥5 mm (p<0.001) and ≥3 polyps (p=0.004) than HP in distal colon, but only more likely associated with older age (p=0.006) in proximal colon. Multivariate regression analysis demonstrated that CSP with sCRC, compared with CSP without sCRC, were linked to CSP size ≥1 cm (vs <1 cm, odds ratio [OR] 4.412, 95% confidence interval [CI] 1.684-11.556, P=0.003) and a diagnosis of SSA or TSA (vs HP, OR 6.194, 95% CI 1.870-20.513, P=0.003 and OR 6.754, 95% CI 1.981-23.028, P=0.002, respectively), but not age, gender, polyp number and polyp shape. SSA and TSA are similarly often associated with sCRC (P=0.460). In conclusion, histology subtypes and polyp size may serve as markers for sCRC of CSP. SSA and TSA may warrant careful endoscopic examinations and similar follow-up intervals.
无蒂锯齿状腺瘤（SSA）和传统锯齿状腺瘤（TSA）被认为是结直肠癌的癌前病变，且常常在诊断上具有挑战性。它们的真实患病率因观察者之间的显著差异而被掩盖。为了调查结直肠锯齿状息肉（CSP）的真实患病率、同时性结直肠癌（sCRC）及其相关因素，我们首先回顾性地确定了1995年6月至2013年5月间在我们机构收集的所有结直肠息肉。在对所有CSP进行集中重新分类以减少观察者之间的差异后，使用卡方检验和逻辑回归分析来分析潜在因素。在纳入的5501个结直肠息肉中，确定并研究了428例患者的499个CSP，包括353个增生性息肉（HP，70.7%）、80个SSA（16.0%）、61个TSA（12.2%）和5个混合性息肉（1.0%）。在68个CSP（占CSP的13.63%）中发现了诊断分歧。SSA和TSA比HP更常大于5mm且位于近端结肠。与远端结肠的HP相比，SSA也更可能与年龄较大（p = 0.005）、大小≥5mm（p < 0.001）和≥3个息肉（p = 0.004）相关，但在近端结肠仅更可能与年龄较大（p = 0.006）相关。多变量回归分析表明，与无sCRC的CSP相比，患有sCRC的CSP与CSP大小≥1cm（vs <1cm，比值比[OR] 4.412，95%置信区间[CI] 1.684 - 11.556，P = 0.003）以及SSA或TSA的诊断（vs HP，OR分别为6.194，95% CI 1.870 - 20.513，P = 0.003和OR 6.754，95% CI 1.981 - 23.028，P = 0.002）相关，但与年龄、性别、息肉数量和息肉形状无关。SSA和TSA与sCRC的关联同样常见（P = 0.460）。总之，组织学亚型和息肉大小可能作为CSP发生sCRC的标志物。SSA和TSA可能需要仔细的内镜检查和相似的随访间隔。
