Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Dig Liver Dis. 2018 Jun;50(6):568-572. doi: 10.1016/j.dld.2018.03.001. Epub 2018 Mar 12.
BACKGROUND/AIMS: Although the patients with multiple advanced adenomas (AA) in index colonoscopy may have an increased risk for subsequent advanced colorectal neoplasia (CRN), the current guidelines do not consider this factor. We aimed to compare the risk of metachronous advanced CRN according to the number of AAs.
A total of 2250 patients with ≥1 adenoma at index colonoscopy were included. The patients were divided according to the number of AAs (1, 2 and ≥3 AAs). The relative and 3-year absolute risk of metachronous advanced CRN was compared between the AA groups.
The relative risk of metachronous advanced CRN was higher in the patients with ≥3 AAs than in the patients with one AA (16.7% vs. 6.8%, p = 0.004). The 3-year absolute risk of metachronous advanced CRN was higher in the patients with ≥3 AAs than in the patients with 1-2 AA (19.4% vs. 6.9%, p = 0.04). Having ≥3 AAs (odds ratio, 5.42; 95% confidence interval 1.75-16.83) was a significant risk factor for developing advanced CRN.
The risk of metachronous advanced CRN in the patients with ≥3 AAs was higher than that in the patients with one or two AAs. More intensive surveillances might be needed for these patient groups.
背景/目的：尽管在首次结肠镜检查中发现多个进展性腺瘤（AA）的患者可能存在随后发生高级结直肠肿瘤（CRN）的风险增加，但目前的指南并未考虑这一因素。我们旨在根据 AA 的数量比较发生异时性高级 CRN 的风险。
共纳入 2250 名在首次结肠镜检查中至少有 1 个腺瘤的患者。根据 AA 的数量（1、2 和≥3 个 AA）将患者进行分组。比较了 AA 组之间异时性高级 CRN 的相对风险和 3 年绝对风险。
与 1 个 AA 的患者相比，≥3 个 AA 的患者发生异时性高级 CRN 的相对风险更高（16.7%比 6.8%，p=0.004）。与 1-2 个 AA 的患者相比，≥3 个 AA 的患者发生异时性高级 CRN 的 3 年绝对风险更高（19.4%比 6.9%，p=0.04）。存在≥3 个 AA（比值比，5.42；95%置信区间 1.75-16.83）是发生高级 CRN 的显著危险因素。
≥3 个 AA 的患者发生异时性高级 CRN 的风险高于 1 个或 2 个 AA 的患者。这些患者群体可能需要更密集的监测。
