Gao Qinyan, Tsoi Kelvin K F, Hirai Hoyee W, Wong Martin C S, Chan Francis K L, Wu Justin C Y, Lau James Y W, Sung Joseph J Y, Ng Siew C
1] Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] Division of Gastroenterology and Hepatology, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China.
1] Institute of Digestive Disease, Department of Medicine and Therapeutics, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Shatin, Hong Kong, China [2] School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, China.
Am J Gastroenterol. 2015 Apr;110(4):501-9; quiz 510. doi: 10.1038/ajg.2015.49. Epub 2015 Mar 10.
Serrated polyps of the colon comprise a heterogeneous group of lesions with distinct histological and malignant features. The presence of serrated polyps has been associated with synchronous advanced neoplasia, although the magnitude of this relationship is unclear.
Using studies identified from systematic literature search up to February 2014, we performed a systematic review and meta-analysis to estimate the pooled prevalence of serrated polyps and their association with synchronous advanced neoplasia. Random-effects models were used to combine estimates from heterogeneous studies, and odds ratios (ORs) with 95% confidence intervals (CIs) were presented.
Nine studies with 34,084 participants were included. The mean age of subjects was 59.9±6.6 years and 52.5% of the subjects were male. Pooled prevalence of serrated polyps was 15.6% (95% CI, 10.3-22.9%). The pooled OR of advanced neoplasia in individuals with serrated polyps was 2.05 (95% CI, 1.38-3.04). Pooled analysis showed that the presence of proximal serrated polyps (OR=2.77, 95% CI, 1.71-4.46) and large serrated polyps (OR=4.10, 95% CI, 2.69-6.26) was associated with an increased risk of synchronous advanced neoplasia. The pooled OR for advanced neoplasia in individuals with proximal and large serrated polyps was 3.35 (95% CI, 2.51-4.46). Considerable heterogeneity was observed in most analyses.
Our meta-analysis showed that serrated polyps are associated with a more than twofold increased risk of detection of synchronous advanced neoplasia. Individuals with proximal and large serrated polyps have the highest risk. These individuals deserve surveillance colonoscopy.
结肠锯齿状息肉是一组具有不同组织学和恶性特征的异质性病变。锯齿状息肉的存在与同步性进展期肿瘤相关，尽管这种关系的程度尚不清楚。
利用截至2014年2月系统文献检索确定的研究，我们进行了一项系统评价和荟萃分析，以估计锯齿状息肉的合并患病率及其与同步性进展期肿瘤的关联。采用随机效应模型合并来自异质性研究的估计值，并给出比值比（OR）及其95%置信区间（CI）。
纳入9项研究，共34084名参与者。受试者的平均年龄为59.9±6.6岁，52.5%为男性。锯齿状息肉的合并患病率为15.6%（95%CI，10.3 - 22.9%）。有锯齿状息肉个体发生进展期肿瘤的合并OR为2.05（95%CI，1.38 - 3.04）。汇总分析表明，近端锯齿状息肉（OR = 2.77，95%CI，1.71 - 4.46）和大锯齿状息肉（OR = 4.10，95%CI，2.69 - 6.26）的存在与同步性进展期肿瘤风险增加相关。有近端和大锯齿状息肉个体发生进展期肿瘤的合并OR为3.35（95%CI，2.51 - 4.46）。在大多数分析中观察到相当大的异质性。
我们的荟萃分析表明，锯齿状息肉与同步性进展期肿瘤检出风险增加两倍以上相关。有近端和大锯齿状息肉的个体风险最高。这些个体值得接受监测结肠镜检查。
