Pohl Heiko, Robertson Douglas J, Mott Leila A, Ahnen Dennis J, Burke Carol A, Barry Elizabeth L, Bresalier Robert S, Figueiredo Jane C, Shaukat Aasma, Sandler Robert S, Baron John A
Department of Gastroenterology, VA Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Gastrointest Endosc. 2016 Oct;84(4):709-16. doi: 10.1016/j.gie.2016.02.048. Epub 2016 Mar 11.
The biological environment varies across the colorectum and may therefore affect neoplastic growth differently in the proximal and distal colon. The aim of the study was to evaluate the risk for recurrent adenomas and their anatomic location based on adenoma location at baseline colonoscopy.
Data were extracted from 3 adenoma prevention trials (n = 2430). Participants had at least 1 adenoma at baseline colonoscopy and underwent subsequent surveillance colonoscopy, at which time metachronous adenomas could be detected. We calculated the risk ratio (RR) and the 95% confidence interval (CI) for metachronous adenomas by location of the baseline lesion and considered the impact of advanced neoplasia and multiplicity.
At baseline, 522 patients (21.5%) had adenomas only in the proximal colon, 1266 patients (52.1%) had adenomas only in the distal colorectum, and 642 (26.4%) had adenomas in both regions. Overall, 877 patients (36.5%) had metachronous adenomas during the follow-up period. Those with only proximal adenomas at baseline had a higher risk of metachronous adenomas compared with patients with only distal adenomas (RR, 1.17; 95% CI, 1.01-1.35). A greater proximal risk was found after restricting the analysis to patients with multiple proximal adenomas versus multiple distal adenomas (RR, 1.35; 95% CI, 1.10-1.67). The risk of recurrent adenomas on the same side was 48% higher for patients with only proximal adenomas at baseline compared with those with only distal adenomas at baseline (RR, 1.48; 95% CI, 1.22-1.80).
Patients with proximal adenomas only have a modestly greater risk of adenoma recurrence than patients with adenomas limited to the distal colon, and have a greater likelihood of adenoma recurrence on the same side compared with patients with distal adenomas. This observation suggests that biological factors may differentially affect neoplasia growth across the colon.
整个结肠的生物学环境各不相同，因此可能对近端和远端结肠的肿瘤生长产生不同影响。本研究的目的是根据基线结肠镜检查时腺瘤的位置，评估复发性腺瘤的风险及其解剖位置。
数据来自3项腺瘤预防试验（n = 2430）。参与者在基线结肠镜检查时至少有1个腺瘤，并接受了后续的监测结肠镜检查，此时可检测到异时性腺瘤。我们根据基线病变的位置计算了异时性腺瘤的风险比（RR）和95%置信区间（CI），并考虑了高级别肿瘤和多发性的影响。
在基线时，522例患者（21.5%）仅在近端结肠有腺瘤，1266例患者（52.1%）仅在远端结肠有腺瘤，642例（26.4%）在两个区域均有腺瘤。总体而言，877例患者（36.5%）在随访期间出现了异时性腺瘤。与仅在远端有腺瘤的患者相比，基线时仅在近端有腺瘤的患者发生异时性腺瘤的风险更高（RR，1.17；95%CI，1.01 - 1.35）。将分析限制在有多发性近端腺瘤与多发性远端腺瘤的患者中时，发现近端风险更高（RR，1.35；95%CI，1.10 - 1.67）。与基线时仅在远端有腺瘤的患者相比，基线时仅在近端有腺瘤的患者同侧复发性腺瘤的风险高48%（RR，1.48；95%CI，1.22 - 1.80）。
仅患有近端腺瘤的患者比腺瘤局限于远端结肠的患者发生腺瘤复发的风险略高，并且与远端腺瘤患者相比，同侧腺瘤复发的可能性更大。这一观察结果表明，生物学因素可能对整个结肠的肿瘤生长产生不同影响。
