Meester Reinier G S, van Herk Marinika M A G C, Lansdorp-Vogelaar Iris, Ladabaum Uri
Department of Medicine, Stanford University, Stanford, California; Department of Public Health, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands.
Department of Public Health, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands.
Gastroenterology. 2020 Jul;159(1):105-118.e25. doi: 10.1053/j.gastro.2020.03.025. Epub 2020 Mar 18.
BACKGROUND & AIMS: Sessile serrated polyps (SSPs) could account for a substantial proportion of colorectal cancers. We aimed to increase clarity on SSP prevalence and clinical features.
We performed a systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases for original studies published in English since 2000. We included studies of different populations (United States general or similar), interventions (colonoscopy, autopsy), comparisons (world regions, alternative polyp definitions, adenoma), outcomes (prevalence, clinical features), and study designs (cross-sectional). Random-effects regression was used for meta-analysis where possible.
We identified 74 relevant colonoscopy studies. SSP prevalence varied by world region, from 2.6% in Asia (95% confidence interval [CI], 0-5.9) to 10.5% in Australia (95% CI, 2.8-18.2). Prevalence values did not differ significantly between the United States and Europe (P = .51); the pooled prevalence was 4.6% (95% CI, 3.4-5.8), and SSPs accounted for 9.4% of polyps with malignant potential (95% CI, 6.6-12.3). The mean prevalence was higher when assessed through high-performance examinations (9.1%; 95% CI, 4.0-14.2; P = .04) and with an alternative definition of clinically relevant serrated polyps (12.3%; 95% CI, 9.3-15.4; P < .001). Increases in prevalence with age were not statistically significant, and prevalence did not differ significantly by sex. Compared with adenomas, a higher proportion of SSPs were solitary (69.0%; 95% CI, 45.9-92.1; P = .08), with diameters of 10 mm or more (19.3%; 95% CI, 12.4-26.2; P = .13) and were proximal (71.5%; 95% CI, 63.5-79.5; P = .008). The mean ages for detection of SSP without dysplasia, with any or low-grade dysplasia, and with high-grade dysplasia were 60.8 years, 65.6 years, and 70.2 years, respectively. The range for proportions of SSPs with dysplasia was 3.7%-42.9% across studies, possibly reflecting different study populations.
In a systematic review, we found that SSPs are relatively uncommon compared with adenoma. More research is needed on appropriate diagnostic criteria, variations in detection, and long-term risk.
无蒂锯齿状息肉（SSP）可能在结直肠癌中占相当大的比例。我们旨在更清楚地了解SSP的患病率和临床特征。
我们对MEDLINE、Web of Science、Embase和Cochrane数据库进行了系统综述，以查找自2000年以来发表的英文原创研究。我们纳入了不同人群（美国普通人群或类似人群）、干预措施（结肠镜检查、尸检）、比较对象（世界区域、息肉的替代定义、腺瘤）、结局指标（患病率、临床特征）以及研究设计（横断面研究）的研究。尽可能使用随机效应回归进行荟萃分析。
我们确定了74项相关的结肠镜检查研究。SSP的患病率因世界区域而异，在亚洲为2.6%（95%置信区间[CI]，0 - 5.9），在澳大利亚为10.5%（95%CI，2.8 - 18.2）。美国和欧洲之间的患病率值无显著差异（P = 0.51）；合并患病率为4.6%（95%CI，3.4 - 5.8），SSP占具有恶性潜能息肉的9.4%（95%CI，6.6 - 12.3）。通过高性能检查评估时平均患病率较高（9.1%；95%CI，4.0 - 14.2；P = 0.04），使用临床相关锯齿状息肉的替代定义时患病率也较高（12.3%；95%CI，9.3 - 15.4；P < 0.001）。患病率随年龄增加无统计学显著差异，且患病率在性别上也无显著差异。与腺瘤相比，更高比例的SSP为单发（69.0%；95%CI，45.9 - 92.1；P = 0.08），直径为10毫米或更大（19.3%；95%CI，12.4 - 26.2；P = 0.13），且位于近端（71.5%；95%CI，63.5 - 79.5；P = 0.008）。未发生发育异常、发生任何或低级别发育异常以及发生高级别发育异常的SSP的平均检出年龄分别为60.8岁、65.6岁和70.2岁。各研究中SSP发生发育异常的比例范围为3.7% - 42.9%，这可能反映了不同研究人群的差异。
在一项系统综述中，我们发现与腺瘤相比，SSP相对不常见。需要对适当的诊断标准、检测差异和长期风险进行更多研究。
