Division of Gastroenterology, University of Washington School of Medicine, 1959 NE Pacific St., Box 356424, Seattle, WA, 98195-6424, USA.
Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, 1100 Ninth Ave., C3-GAS, Mailstop H7-ID, Seattle, WA, 98101, USA.
Dig Dis Sci. 2019 Aug;64(8):2107-2112. doi: 10.1007/s10620-019-05521-w. Epub 2019 Feb 20.
The national incidence of colorectal cancer is increasing in people younger than 50 years old. Although diagnostic colonoscopy is detecting more sporadic adenomas in young adults, there are no guidelines for post-polypectomy surveillance. The aim of this review was to survey the medical literature on the prevalence of sporadic adenomas in young adults, subsequent risk of metachronous neoplasia, and lastly to provide several concluding recommendations for clinical practice. We found that the prevalence of sporadic adenomas in young adults is greater than initially estimated and dependent upon factors such as colonoscopy indication and age. The incidence of metachronous colorectal neoplasia following polypectomy is unclear but does not appear to be greater than that of older adults. Risk factors for metachronous neoplasia include findings on index colonoscopy, male gender, smoking status, and certain medical comorbidities. Upon finding a colorectal adenoma in a young person, we suggest that a detailed family history be obtained to confirm that it is truly sporadic. Testing adenomas for evidence of Lynch syndrome is low yield. Strategies to inform surveillance intervals may include an assessment of risk factors for metachronous neoplasia, although surveillance intervals shorter than those recommended in current guidelines are not warranted. Future research should focus on obtaining long-term, prospective data on the incidence of metachronous neoplasia in diverse patient populations.
50 岁以下人群的结直肠癌发病率正在上升。虽然诊断性结肠镜检查能在年轻人中发现更多的散发性腺瘤，但目前还没有针对息肉切除术后监测的指南。本综述旨在调查有关年轻人散发性腺瘤的流行率、随后发生的同时性肿瘤的风险的医学文献，最后为临床实践提供一些结论性建议。我们发现，年轻人散发性腺瘤的流行率高于最初估计，且取决于结肠镜检查的适应证和年龄等因素。息肉切除术后发生同时性结直肠肿瘤的发生率尚不清楚，但似乎并不高于老年人。同时性肿瘤的危险因素包括指数结肠镜检查的结果、男性、吸烟状况和某些合并症。在年轻人中发现结直肠腺瘤时，我们建议详细了解家族史，以确认其确实为散发性腺瘤。对腺瘤进行林奇综合征检测的收益较低。告知监测间隔的策略可能包括评估同时性肿瘤的危险因素，但没有理由将监测间隔缩短至现行指南建议的时间以下。未来的研究应侧重于在不同的患者人群中获得关于同时性肿瘤发生率的长期、前瞻性数据。
