Anderson Joseph C, Robinson Christina M, Butterly Lynn F
Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover New Hampshire, USA.
Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Gastrointest Endosc. 2020 Mar;91(3):669-675. doi: 10.1016/j.gie.2019.11.023. Epub 2019 Nov 21.
Recent increases in colorectal cancer (CRC) incidence in adults younger than 50 years of age have led to more colonoscopies in this age group. As a result, there may be an increasing number of adults <50 years old with polyps detected. There is concern that younger adults may require closer follow-up. Our goal was to use data from the New Hampshire Colonoscopy Registry (NHCR) to examine the risk for metachronous advanced adenomas (AAs) and large (>1 cm) serrated polyps in younger versus older adults who return for a follow-up colonoscopy.
Our cohort consisted of NHCR participants with at least 1 polyp on index examination and a follow-up colonoscopy at least 1 year after the index examination. Outcomes were the risks for metachronous AAs (adenomas ≥1 cm, with villous elements or high-grade dysplasia, or CRC) and large (≥1 cm) serrated polyps. We present absolute risk and adjusted risks from a logistic regression model stratified by age at index colonoscopy (<40, 40-49, 50-59, and 60+ [reference]). Covariates included index findings, endoscopist adenoma detection rates, sex, smoking, body mass index, follow-up time (months), bowel preparation quality, and family history of CRC.
In our sample of 12,380 adults, absolute risk for metachronous AA was lower for younger patients than for patients aged ≥60. After adjusting for covariates, when comparing with the 60+ group (reference), the lowest risk was observed in those younger than 40 years (odds ratio, .19; 95% confidence interval, .05-.80). Of note, similar risks were observed in the 40 to 49 age group (odds ratio, .61; 95% confidence interval, .41-.92) and 50 to 59 age group (odds ratio, .71; 95% confidence interval, .58-.86). The risk for large metachronous serrated polyps was not associated with age.
Younger adults aged <40 with index adenomas had a lower risk for metachronous AAs than those aged ≥60. The 40- to 49-year age group was found to have metachronous risk similar to the 50- to 59-year age group, with both less than the ≥60 age group. These data suggest that current surveillance interval guidelines for patients aged ≥50 years may appropriately be used with younger adults.
近期50岁以下成年人结直肠癌（CRC）发病率上升，导致该年龄组接受结肠镜检查的人数增加。因此，50岁以下检测出息肉的成年人数量可能会增加。有人担心年轻成年人可能需要更密切的随访。我们的目标是利用新罕布什尔州结肠镜检查登记处（NHCR）的数据，研究在接受随访结肠镜检查的年轻与年长成年人中，异时性高级别腺瘤（AA）和大（>1 cm）锯齿状息肉的风险。
我们的队列由NHCR参与者组成，这些参与者在初次检查时至少有1个息肉，并在初次检查后至少1年进行了随访结肠镜检查。结局指标是异时性AA（腺瘤≥1 cm，伴有绒毛成分或高级别异型增生，或CRC）和大（≥1 cm）锯齿状息肉的风险。我们展示了根据初次结肠镜检查时的年龄（<40、40 - 49、50 - 59和60岁以上[参照组]）分层的逻辑回归模型的绝对风险和调整后风险。协变量包括初次检查结果、内镜医师腺瘤检出率、性别、吸烟、体重指数、随访时间（月）、肠道准备质量和CRC家族史。
在我们的12380名成年人样本中，年轻患者异时性AA的绝对风险低于60岁及以上患者。在调整协变量后，与60岁以上组（参照组）相比，40岁以下人群的风险最低（比值比，0.19；95%置信区间，0.05 - 0.80）。值得注意的是，40至49岁年龄组（比值比，0.61；95%置信区间，0.41 - 0.92）和50至59岁年龄组（比值比，0.71；95%置信区间，0.58 - 0.86）的风险相似。大的异时性锯齿状息肉的风险与年龄无关。
初次检查时患有腺瘤的40岁以下年轻成年人发生异时性AA的风险低于60岁及以上成年人。发现40至49岁年龄组的异时性风险与50至59岁年龄组相似，两者均低于60岁及以上年龄组。这些数据表明，目前针对50岁及以上患者的监测间隔指南可能适用于年轻成年人。
