Belderbos Tim Dg, Pullens Hendrikus Jm, Leenders Max, Schipper Marguerite Ei, Siersema Peter D, van Oijen Martijn Gh
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands.
United European Gastroenterol J. 2017 Apr;5(3):440-447. doi: 10.1177/2050640616662428. Epub 2016 Aug 5.
Most post-colonoscopy colorectal cancers (PC-CRCs) are thought to develop from missed or incompletely resected adenomas.
We aimed to assess the incidence rate of PC-CRC overall and per colorectal segment, as a proxy for PC-CRC due to incomplete adenoma resection, and to identify adenoma characteristics associated with these PC-CRCs.
We performed a nationwide, population-based cohort study, including all patients with a first colorectal adenoma between 2000-2010 in the Dutch Pathology Registry (PALGA). Outcomes were the incidence rate of PC-CRC overall and of PC-CRC in the same colorectal segment, occurring between six months and five years after adenoma resection. A multivariable Cox proportional hazard analysis was performed to identify factors associated with PC-CRCs in the same segment.
We included 107,744 patients (mean age 63.4 years; 53.6% male). PC-CRC was detected in 1031 patients (0.96%) with an incidence rate of 1.88 per 1000 person years. PC-CRC in the same segment was found in 323 of 133,519 adenomas (0.24%) with an incidence rate of 0.56 per 1000 years of follow-up. High-grade dysplasia (hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.99-3.25) and both villous (HR 2.63, 95% CI 1.79-3.87) and tubulovillous histology (HR 1.80, 95% CI 1.43-2.27) were risk factors for PC-CRC in the same segment.
Approximately one-third of PC-CRCs are found in the same colorectal segment after adenoma resection and could therefore be a consequence of incomplete adenoma resection, occurring in one in 400 adenomas. The risk of PC-CRC in the same segment is increased in adenomas with high-grade dysplasia or (tubulo)villous histology.
大多数结肠镜检查后结直肠癌（PC-CRC）被认为是由漏诊或切除不完全的腺瘤发展而来。
我们旨在评估PC-CRC的总体发病率以及按结直肠节段划分的发病率，以此作为因腺瘤切除不完全导致的PC-CRC的替代指标，并确定与这些PC-CRC相关的腺瘤特征。
我们开展了一项基于全国人群的队列研究，纳入了荷兰病理登记系统（PALGA）中2000年至2010年间首次诊断为结直肠腺瘤的所有患者。观察指标为腺瘤切除后6个月至5年内PC-CRC的总体发病率以及同一结直肠节段的PC-CRC发病率。进行多变量Cox比例风险分析以确定与同一节段PC-CRC相关的因素。
我们纳入了107744例患者（平均年龄63.4岁；53.6%为男性）。1031例患者（0.96%）检测到PC-CRC，发病率为每1000人年1.88例。在133519例腺瘤中的323例（0.24%）发现了同一节段的PC-CRC，随访每1000年的发病率为0.56例。高级别异型增生（风险比（HR）2.54，95%置信区间（CI）1.99 - 3.25）以及绒毛状（HR 2.63，95% CI 1.79 - 3.87）和管状绒毛状组织学类型（HR 1.80，95% CI 1.43 - 2.27）是同一节段PC-CRC的危险因素。
大约三分之一的PC-CRC在腺瘤切除后出现在同一结直肠节段，因此可能是腺瘤切除不完全的结果，每400例腺瘤中会出现1例。同一节段PC-CRC的风险在具有高级别异型增生或（管状）绒毛状组织学类型的腺瘤中增加。
