Department of Colorectal Surgery, The Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Gastroenterology. 2018 Aug;155(2):355-373.e18. doi: 10.1053/j.gastro.2018.04.019. Epub 2018 Apr 24.
BACKGROUND & AIMS: Serrated polyps (SPs) and conventional adenomas are precursor lesions for colorectal cancer (CRC), but they are believed to arise via distinct pathways. We characterized risk factor profiles for SPs and conventional adenomas in a post hoc analysis of data from 3 large prospective studies.
We collected data from the Nurses' Health Study, the Nurses' Health Study 2, and the Health Professionals Follow-up Study on subjects who developed SPs or conventional adenomas. Our analysis comprised 141,143 participants who had undergone lower gastrointestinal endoscopy, provided updated diet and lifestyle data every 2-4 years, and were followed until diagnosis of a first polyp. We assessed 13 risk factors for CRC in patients with SPs or conventional adenomas and examined the associations according to histopathology features.
We documented 7945 SPs, 9212 conventional adenomas, and 2382 synchronous SPs and conventional adenomas during 18-20 years of follow-up. Smoking, body mass index, alcohol intake, family history of CRC, and height were associated with higher risk of SPs and conventional adenomas, whereas higher intake of vitamin D and marine omega-3 fatty acid were associated with lower risk. The associations tended to be stronger for synchronous SPs and conventional adenomas. Smoking, body mass index, and alcohol intake were more strongly associated with SPs than conventional adenomas (P for heterogeneity <.05), whereas physical activity and intake of total folate and calcium were inversely associated with conventional adenomas but not SPs. For SPs and conventional adenomas, the associations tended to be stronger for polyps in the distal colon and rectum, of 10 mm or larger or with advanced histology.
In an analysis of data from 3 large prospective studies, we found that although SPs and conventional adenomas share many risk factors, some factors are more strongly associated with one type of lesion than the other. These findings provide support for the etiologic heterogeneity of colorectal neoplasia.
锯齿状息肉（SPs）和传统腺瘤是结直肠癌（CRC）的前体病变，但它们被认为是通过不同的途径产生的。我们对 3 项大型前瞻性研究的数据进行了事后分析，以确定 SPs 和传统腺瘤的危险因素特征。
我们从护士健康研究、护士健康研究 2 期和卫生专业人员随访研究中收集了 SPs 或传统腺瘤患者的数据。我们的分析包括 141143 名参与者，他们接受了下消化道内镜检查，每 2-4 年更新一次饮食和生活方式数据，并随访至首次诊断出息肉。我们评估了 SPs 或传统腺瘤患者的 13 个 CRC 危险因素，并根据组织病理学特征检查了这些关联。
我们在 18-20 年的随访中记录了 7945 个 SPs、9212 个传统腺瘤和 2382 个同时存在的 SPs 和传统腺瘤。吸烟、体重指数、酒精摄入量、CRC 家族史和身高与 SPs 和传统腺瘤的风险增加有关，而维生素 D 和海洋 ω-3 脂肪酸的摄入量较高与风险降低有关。同时存在的 SPs 和传统腺瘤的关联往往更强。吸烟、体重指数和酒精摄入量与 SPs 的关联强于传统腺瘤（P 值<0.05），而体力活动以及总叶酸和钙的摄入量与传统腺瘤而非 SPs 呈负相关。对于 SPs 和传统腺瘤，这些关联在远端结肠和直肠的息肉、直径为 10mm 或更大或具有高级别组织学的息肉中更为明显。
在对 3 项大型前瞻性研究的数据进行分析后，我们发现，尽管 SPs 和传统腺瘤有许多共同的危险因素，但有些因素与一种病变的关联比另一种更强。这些发现为结直肠肿瘤发生的病因异质性提供了支持。
