Zhou Haiping, Shen Zhonglei, Zhao Jianpei, Zhou Zhendong, Xu Yidong
Department of Colorectal Surgery, Ningbo No.2 Hospital, Ningbo 315010, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018 Jun 25;21(6):678-684.
To determine the detection rate and distribution characteristics of colorectal adenomas in Ningbo area of China, and to identify the risk factors for colorectal adenoma, in order to provide reference for colorectal cancer screening.
A cross-sectional study was performed among 8660 subjects undergoing colonoscopy in the Ningbo No.2 Hospital between January and December 2016, using a questionnaire, including demographic data (age, gender, height and weight), history of diseases (diabetes, hypertension, hyperlipidemia, and family history of malignant neoplasm), lifestyle (smoking, alcohol, dietary bias on red meat, dietary bias on fruit and vegetables, dietary frequency of pickled food and physical activities), and intestinal early warning symptoms. All colonoscopically detected polyps were removed for histological examination. Polyps were histologically divided into non-adenomatous (hyperplastic polyps and inflammatory polyps) and adenomatous polyps (tubular, villous, tubulovillous and serrated adenomas). Pathologic features were analyzed according to anatomical site. Multivariate logistic regression analysis was used to identify the risk factors for colorectal adenoma.
A total of 7077 subjects who received colonoscopic examination and completed the questionnaire survey were enrolled in this study. There were 3633 males and 3444 females with a median age of 53 (ranged 17 to 83) years. Adenoma detection rate was 15.6% (1103/7077) in all cases, 21.0%(762/3633) for males, and 9.9%(341/3444) for females(P=0.000). Detection rate of 6.2%(29/469) was recorded in individuals aged less than 30 years, 8.0%(87/1086) in those from 30 to 39 years, 12.1%(148/1222) in those from 40 to 49 years, 16.8%(272/1623) in those from 50 to 59 years, 20.4%(326/1601) in those from 60 to 69 years, and 22.4%(241/1076) in those ≥70 years. The detection rate increased according to age(P=0.000). A total of 1521 adenomas were detected in 1103 cases, including 1455 tubular adenomas, 33 tubulovillous adenomas, 9 villous adenomas and 24 serrated adenomas. Among 1521 adenomas, 44.1%(n=671) located in the right hemicolon, 39.0%(n=593) in the left hemicolon, and 16.9%(n=257) in the rectum. Significantly larger number of serrated adenomas and advanced adenomas (advanced adenoma was defined as any adenoma with high-grade intraepithelial neoplasia, diameter ≥10 mm or with villous component) was observed in the right hemicolon compared to left hemicolon and rectum [serrated adenomas: 2.5%(17/671) vs. 0.8% (5/593) and 0.8% (2/257), P=0.029; advanced adenoma: 9.2% (62/671) vs. 5.2% (31/953) and 6.6% (17/257), P=0.021]. Multivariate analysis showed that malely (P=0.003), elderly (P=0.000), obesity (P=0.014), smoking (P=0.001), alcohol (P=0.032), and family history of malignancy (P=0.000) were independent risk factors of colorectal adenoma.
In view of a higher detection rate of colorectal adenoma in population aged 40 to 49 years especially in male individuals, the starting age of colonoscopy screening may be advanced to 40 years old. People with family history of malignancy, obesity, and habit of smoking or drinking should be regarded as important subjects for colonoscopy screening. During colonoscopy screening, special emphasis should be given to right hemicolon.
确定中国宁波地区结直肠腺瘤的检出率及分布特征，明确结直肠腺瘤的危险因素，为结直肠癌筛查提供参考。
对2016年1月至12月在宁波市第二医院接受结肠镜检查的8660例受试者进行横断面研究，采用问卷调查，内容包括人口统计学数据（年龄、性别、身高和体重）、疾病史（糖尿病、高血压、高脂血症及恶性肿瘤家族史）、生活方式（吸烟、饮酒、红肉饮食偏好、果蔬饮食偏好、腌制食品饮食频率及体育活动情况）以及肠道预警症状。所有经结肠镜检查发现的息肉均切除并进行组织学检查。息肉在组织学上分为非腺瘤性息肉（增生性息肉和炎性息肉）和腺瘤性息肉（管状、绒毛状、管状绒毛状和锯齿状腺瘤）。根据解剖部位分析病理特征。采用多因素logistic回归分析确定结直肠腺瘤的危险因素。
本研究共纳入7077例接受结肠镜检查并完成问卷调查的受试者。其中男性3633例，女性3444例，中位年龄53岁（范围17至83岁）。所有病例的腺瘤检出率为15.6%（1103/7077），男性为21.0%（762/3633），女性为9.9%（341/3444）（P = 0.000）。年龄小于30岁者的检出率为6.2%（29/469），30至39岁者为8.0%（87/1086），40至49岁者为12.1%（148/1222），50至59岁者为16.8%（272/1623），60至69岁者为20.4%（326/1601），≥70岁者为22.4%（241/1076）。腺瘤检出率随年龄增加而升高（P = 0.000）。1103例病例中共检出1521枚腺瘤，其中管状腺瘤1455枚，管状绒毛状腺瘤33枚，绒毛状腺瘤9枚，锯齿状腺瘤24枚。在1521枚腺瘤中，44.1%（n = 671）位于右半结肠，39.0%（n = 593）位于左半结肠，16.9%（n = 257）位于直肠。与左半结肠和直肠相比，右半结肠锯齿状腺瘤和进展性腺瘤（进展性腺瘤定义为任何具有高级别上皮内瘤变、直径≥10 mm或具有绒毛成分的腺瘤）的数量明显更多[锯齿状腺瘤：2.5%（17/671） vs. 0.8%（5/593）和0.8%（2/257），P = 0.029；进展性腺瘤：9.2%（62/671） vs. 5.2%（31/953）和6.6%（17/257），P = 0.021]。多因素分析显示，男性（P = 0.003）、老年人（P = 0.000）、肥胖（P = 0.014）、吸烟（P = 0.001）、饮酒（P = 0.032）及恶性肿瘤家族史（P = 0.000）是结直肠腺瘤的独立危险因素。
鉴于40至49岁人群尤其是男性结直肠腺瘤检出率较高，结肠镜筛查起始年龄可提前至40岁。有恶性肿瘤家族史、肥胖以及吸烟或饮酒习惯的人群应被视为结肠镜筛查的重点对象。在结肠镜筛查过程中，应特别关注右半结肠。
