Cubiella Joaquín, Carballo Fernando, Portillo Isabel, Cruzado Quevedo José, Salas Dolores, Binefa Gemma, Milà Núria, Hernández Cristina, Andreu Montse, Terán Álvaro, Arana-Arri Eunate, Ono Akiko, Valverde María José, Bujanda Luis, Hernández Vicent, Morillas Juan Diego, Jover Rodrigo, Castells Antoni
Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Ourense, Pontevedra and Vigo, Ourense, Spain.
Unidad de Gestión Clínica de Digestivo, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
Endoscopy. 2016 Nov;48(11):995-1002. doi: 10.1055/s-0042-112571. Epub 2016 Aug 2.
The European guidelines for quality assurance in colorectal cancer (CRC) screening have established high-risk (≥ 5 adenomas or an adenoma ≥ 20 mm) and intermediate-risk (3 - 4 adenomas or at least one adenoma 10 - 19 mm in size, or villous histology, or high grade dysplasia) groups with different endoscopic surveillance intervals. The aim of this study was to evaluate the difference in the incidence of advanced neoplasia (advanced adenoma or CRC) between the two risk groups. This retrospective group study included patients meeting high- or intermediate-risk criteria for adenomas detected in CRC screening programs and the COLONPREV study before European guidelines were adopted in Spain (June 2011) with a 3-year surveillance recommendation according to Spanish guidelines. The primary outcome measure was the incidence of advanced neoplasia in patients undergoing surveillance. The secondary outcome measure was the CRC incidence. We used an adjusted proportional hazards regression model to control confounding variables. The study included 5401 patients (3379 intermediate risk, 2022 high risk). Endoscopic surveillance was performed in 65.5 % of the patients (2.8 ± 1 years). The incidence of advanced neoplasia in the high- and intermediate-risk groups was 16.0 % (59.0 cases/1000 patient-years) and 12.3 % (41.2 cases/1000 patient-years), respectively. The CRC incidence was 0.5 % (1.4 cases/1000 patient-years) and 0.4 % (1 case/1000 patient-years), respectively. The advanced neoplasia and CRC attributable risk to the high risk group was of 3.7 % and 0.1 %, respectively. In the proportional hazards analysis, the risk of advanced neoplasia was greater in the high-risk group (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2 - 1.8), with no significant differences in the CRC incidence (HR 1.6, 95 %CI 0.6 - 3.8). Patients meeting high-risk criteria have a higher incidence of advanced neoplasia during endoscopic surveillance. No differences were found in the CRC incidence at a 3-year surveillance recommendation.
欧洲结直肠癌（CRC）筛查质量保证指南确定了高风险（≥5个腺瘤或一个腺瘤≥20mm）和中风险（3 - 4个腺瘤或至少一个大小为10 - 19mm的腺瘤、或绒毛状组织学、或高级别异型增生）组，并规定了不同的内镜监测间隔。本研究的目的是评估这两个风险组之间高级别瘤变（高级别腺瘤或CRC）发生率的差异。这项回顾性分组研究纳入了在CRC筛查项目以及西班牙采用欧洲指南（2011年6月）之前的COLONPREV研究中检测到的符合腺瘤高风险或中风险标准的患者，根据西班牙指南，监测建议为期3年。主要结局指标是接受监测患者的高级别瘤变发生率。次要结局指标是CRC发生率。我们使用调整后的比例风险回归模型来控制混杂变量。该研究纳入了5401例患者（3379例中风险，2022例高风险）。65.5%的患者接受了内镜监测（2.8±1年）。高风险组和中风险组的高级别瘤变发生率分别为16.0%（59.0例/1000患者年）和12.3%（41.2例/1000患者年）。CRC发生率分别为0.5%（1.4例/1000患者年）和0.4%（1例/1000患者年）。高风险组高级别瘤变和CRC的归因风险分别为3.7%和0.1%。在比例风险分析中，高风险组高级别瘤变风险更高（风险比[HR]1.5，95%置信区间[CI]1.2 - 1.8），CRC发生率无显著差异（HR 1.6，95%CI 0.6 - 3.8）。符合高风险标准的患者在内镜监测期间高级别瘤变发生率更高。在3年监测建议下，CRC发生率未发现差异。
