Emilsson Louise, Løberg Magnus, Bretthauer Michael, Holme Øyvind, Fall Katja, Jodal Henriette C, Adami Hans-Olov, Kalager Mette
a Institute of Health and Society , University of Oslo , Oslo , Norway.
b Vårdcentralen Värmlands Nysäter and Centre for Clinical Research , County Council of Värmland , Värmland , Sweden.
Scand J Gastroenterol. 2017 Dec;52(12):1377-1384. doi: 10.1080/00365521.2017.1377763. Epub 2017 Sep 14.
Improved understanding of the subsequent risk death from colorectal cancer (CRC) among individuals who had adenomas removed is needed. We aimed to quantify this risk using prospectively collected data from population-based cohorts.
Using Norwegian and Swedish registries, a cohort of 90,864 individuals with colorectal adenomas removed between 1980 and 2013 was identified. Surveillance was only recommended for high-risk adenomas. The validity of the registry data did not allow classification into low- and high-risk adenomas. Virtually complete follow-up was achieved through linkage to nationwide registers. We calculated incidence-based standardised mortality ratios (SMRs) with 95% confidence intervals (CI).
The median follow-up was 7.2 years; 48,058 individuals were followed for more than 10 years. We observed 819 deaths (0.9%) from CRC and expected 731 CRC deaths (0.8%), corresponding to an absolute excess risk of 88 cases (0.1%) and a relative risk of 12% (SMR 1.12; 95%CI 1.05-1.20). The relative risk of CRC death following adenoma removal was slightly higher in Sweden (SMR 1.22; 95%CI 1.11-1.34) than in Norway (SMR 1.03; 95%CI 0.93-1.14), and higher in women (SMR 1.24; 95%CI 1.12-1.36) than in men (SMR 1.02; 95%CI 0.93-1.13). Among individuals with more than 10 years of follow-up, the estimates were similar to the overall cohort, absolute excess risk 0.1% (SMR 1.15; 95%CI 1.06-1.24).
The excess risk of CRC death following adenoma removal is small. Optimal surveillance recommendations should be tested in randomised trials.
需要更好地了解切除腺瘤的个体随后患结直肠癌（CRC）死亡的风险。我们旨在使用基于人群队列的前瞻性收集数据来量化这种风险。
利用挪威和瑞典的登记处，确定了一组在1980年至2013年间切除大肠腺瘤的90864名个体。仅建议对高危腺瘤进行监测。登记数据的有效性不允许将其分类为低危和高危腺瘤。通过与全国性登记处的关联实现了几乎完全的随访。我们计算了基于发病率的标准化死亡比（SMR）及其95%置信区间（CI）。
中位随访时间为7.2年；48058名个体的随访时间超过10年。我们观察到819例CRC死亡（0.9%），预期CRC死亡731例（0.8%），绝对超额风险为88例（0.1%），相对风险为12%（SMR 1.12；95%CI 1.05 - 1.20）。腺瘤切除后CRC死亡的相对风险在瑞典（SMR 1.22；95%CI 1.11 - 1.34）略高于挪威（SMR 1.03；95%CI 0.93 - 1.14），在女性中（SMR 1.24；95%CI 1.12 - 1.36）高于男性（SMR 1.02；95%CI 0.93 - 1.13）。在随访超过10年的个体中，估计结果与整个队列相似，绝对超额风险为0.1%（SMR 1.15；95%CI 1.06 - 1.24）。
腺瘤切除后CRC死亡的超额风险较小。最佳监测建议应在随机试验中进行检验。
