Urman Jesús, Gomez Marta, Basterra Marta, Mercado María Del Rosario, Montes Marta, Gómez Dorronsoro Marisa, Garaigorta Maitane, Fraile María, Rubio Eva, Aisa Gregorio, Galbete Arkaitz
Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España.
Servicio de Aparato Digestivo, Complejo Hospitalario de Navarra, Pamplona, España.
Gastroenterol Hepatol. 2016 Nov;39(9):574-583. doi: 10.1016/j.gastrohep.2015.12.010. Epub 2016 Mar 10.
Large serrated polyps (SP), proximal SP, SP with dysplasia and the presence of multiple sessile serrated adenomas/polyps (SSA/P), which we refer to as SP with increased risk of metachronous lesions (SPIRML), have been associated with an increased risk of advanced colon lesions on follow-up. It is unclear, however, whether SPIRML are also associated with an increased risk of synchronous advanced colorectal neoplasia (ACN).
The aim of this study was to estimate the prevalence of SPIRML and to evaluate the association between SPIRML and synchronous ACN.
A cross-sectional population-based study in all patients (1,538) with histological diagnosis of SP obtained from colonoscopies, sigmoidoscopies and colonic surgery performed in Navarra Health Service hospitals (Spain) in 2011. Demographic parameters and synchronous colonic lesions (adenomas, advanced adenomas [AA] and ACN) were analyzed.
One fourth of the sample (384 patients) presented SPIRML. These were older patients, with a slight predominance of women, and with no differences in body mass index (BMI) compared to patients without SPIRML. In the univariate analysis, patients with SPIRML showed an increased risk of adenoma, AA and ACN. In the multivariate analysis, the SPIRML group had a higher risk of synchronous AA and ACN (odds ratio [OR]: 2.38 [1.77-3.21] and OR: 2.29 [1.72-3.05], respectively); in the case of ACN, this risk was statistically significant in both locations (proximal or distal), with OR slightly higher for the proximal location. Different subtypes of SPIRML had a higher risk of AA and synchronous NA.
SPIRML were common in patients with SP, and their presence was associated with an increased risk of synchronous ACN.
大的锯齿状息肉（SP）、近端SP、伴有发育异常的SP以及多个无蒂锯齿状腺瘤/息肉（SSA/P）的存在，我们将其称为具有异时性病变风险增加的SP（SPIRML），与随访时晚期结肠病变风险增加相关。然而，尚不清楚SPIRML是否也与同步性晚期结直肠肿瘤（ACN）风险增加相关。
本研究旨在估计SPIRML的患病率，并评估SPIRML与同步性ACN之间的关联。
对2011年在西班牙纳瓦拉卫生服务医院进行结肠镜检查、乙状结肠镜检查和结肠手术且组织学诊断为SP的所有患者（1538例）进行基于人群的横断面研究。分析人口统计学参数和同步性结肠病变（腺瘤、高级别腺瘤[AA]和ACN）。
四分之一的样本（384例患者）存在SPIRML。这些患者年龄较大，女性略占优势，与无SPIRML的患者相比，体重指数（BMI）无差异。在单因素分析中，SPIRML患者发生腺瘤、AA和ACN的风险增加。在多因素分析中，SPIRML组发生同步性AA和ACN的风险更高（优势比[OR]分别为2.38[1.77 - 3.21]和OR为2.29[1.72 - 3.05]）；就ACN而言，在两个部位（近端或远端）该风险均具有统计学意义，近端部位的OR略高。不同亚型的SPIRML发生AA和同步性结直肠肿瘤（NA）的风险更高。
SPIRML在SP患者中很常见，其存在与同步性ACN风险增加相关。
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