非洲裔美国人结直肠肿瘤发病差异与无蒂锯齿状息肉的发生部位和速率有关吗？
Can the rate and location of sessile serrated polyps be part of colorectal Cancer disparity in African Americans?
机构信息
University of Pittsburg, Medical center, Pittsburg, PA, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, USA.
出版信息
BMC Gastroenterol. 2019 May 24;19(1):77. doi: 10.1186/s12876-019-0996-y.
BACKGROUND
Up to 30% of colorectal cancers develop through the serrated pathway. African Americans (AAs) suffer a disproportionate burden of colorectal cancer. The aim of this study was to evaluate clinicopathological features of AA patients diagnosed with sessile serrated polyps (SSPs).
METHODS
We conducted a retrospective study of all colonoscopies (n = 12,085) performed at Howard University Hospital, from January 1st, 2010 to December 31st, 2015, of which 83% were in AA patients, (n = 10,027). Among AAs, pathology reports confirmed 4070 patients with polyps including 252 with SSPs. Demographic and clinical variables (i.e. sex, age, BMI, anatomic location, clinical symptoms, polyp size, and clinical indications were collected at colonoscopy.
RESULTS
In the AA population, the median age was 56 with interquartile range (IQR) of 51 to 62 years, 54% were female, and 48% had a BMI > 30. The most common reason for colonoscopy was screening (53%), whereas the prevalent reasons for diagnostic colonoscopies were changes in bowel habits (18%) and gastrointestinal bleeding (17%). The total number of SSPs among the 252 AA (diagnosed with SSPs) was 338. Of these, 9% (n = 29/338) had some degree of cytological dysplasia, primarily in the ascending colon (n = 6/42, 14%), Transverse colon (n = 2/16, 13%) and rectosigmoid (n = 19/233, 8%). About 24% of patients had more than 2 polyps. Most patients (76%) had distal SSPs (rectal and rectosigmoid), in comparison to 14% of proximal polyps and 10% of bilateral locations. Median SSA/P size for all locations was 0.6 cm.
CONCLUSION
The prevalence of SSPs accounts for 6% of all polyps in AA patients and was diagnosed in 2.5% of all colonoscopies (n = 252/10,027), which is higher than Caucasians in the US. SSPs were predominantly located in the left side, as compared to published literature showing the predominance in the right side of the colon. Screening of CRC will have the chance to detect high risk SSA/P in this population.
背景
多达 30%的结直肠癌是通过锯齿状途径发展的。非裔美国人（AA）患结直肠癌的负担不成比例。本研究的目的是评估诊断为无蒂锯齿状息肉（SSP）的 AA 患者的临床病理特征。
方法
我们对 2010 年 1 月 1 日至 2015 年 12 月 31 日期间在霍华德大学医院进行的所有结肠镜检查（n=12085）进行了回顾性研究，其中 83%为 AA 患者（n=10027）。在 AA 中，病理报告证实 4070 例患者有息肉，其中 252 例为 SSP。收集了结肠镜检查时的人口统计学和临床变量（即性别、年龄、BMI、解剖部位、临床症状、息肉大小和临床指征）。
结果
在 AA 人群中，中位年龄为 56 岁，四分位距（IQR）为 51 至 62 岁，54%为女性，48%的 BMI>30。结肠镜检查的最常见原因是筛查（53%），而诊断性结肠镜检查的常见原因是排便习惯改变（18%）和胃肠道出血（17%）。在 252 例 AA（诊断为 SSP）中，SSP 的总数为 338 个。其中，9%（n=29/338）有一定程度的细胞学异型增生，主要位于升结肠（n=6/42，14%）、横结肠（n=2/16，13%）和直肠乙状结肠（n=19/233，8%）。约 24%的患者有超过 2 个息肉。大多数患者（76%）有远端 SSP（直肠和直肠乙状结肠），而近端息肉占 14%，双侧息肉占 10%。所有部位的 SSA/P 大小中位数为 0.6cm。
结论
SSP 占 AA 患者所有息肉的 6%，在所有结肠镜检查（n=252/10027）中诊断为 2.5%，高于美国白人。SSP 主要位于左侧，而发表的文献显示其在结肠右侧更为常见。CRC 的筛查将有机会在该人群中检测到高危 SSA/P。
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