Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
United European Gastroenterol J. 2021 Apr;9(3):378-387. doi: 10.1177/2050640620965317. Epub 2021 Feb 18.
Laterally spreading tumours represent a major challenge for endoscopic detection and resection.
To examine synchronous and metachronous neoplasms in patients with laterally spreading tumours.
We prospectively collected colonoscopy and histopathology data from patients who underwent colonoscopy in our centre at up to 6 years' follow-up. Post-resection surveillance outcomes between laterally spreading tumours, flat colorectal neoplasms 10 mm or greater, and large polypoid colorectal neoplasms, polypoid colorectal neoplasms 10 mm or greater, were compared.
Between 2008 and 2012, 8120 patients underwent colonoscopy for symptoms (84.6%), screening (6.7%) or surveillance (8.7%). At baseline, 151 patients had adenomatous laterally spreading tumours and 566 patients had adenomatous large polypoid colorectal neoplasms. Laterally spreading tumour patients had more synchronous colorectal neoplasms than large polypoid colorectal neoplasm patients (mean 3.34 vs. 2.34, p < 0.001). Laterally spreading tumour patients significantly more often developed metachronous colorectal neoplasms (71.6% vs. 54.2%, p = 0.0498) and colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients (36.4% vs. 15.8%, p < 0.001). After correction for age and gender, laterally spreading tumour patients were more likely than large polypoid colorectal neoplasm patients to develop a colorectal neoplasm with high grade dysplasia or submucosal invasion (hazard ratio 2.9, 95% confidence interval 1.8-4.6). The risk of metachronous colorectal cancer was not significantly different in laterally spreading tumours compared to large polypoid colorectal neoplasm patients.
Patients with laterally spreading tumours developed more metachronous colorectal neoplasms with high grade dysplasia/submucosal invasion than large polypoid colorectal neoplasm patients. Based on these findings endoscopic treatment and surveillance recommendations for patients with laterally spreading tumours should be optimised.
侧向伸展肿瘤是内镜检测和切除的主要挑战。
检查侧向伸展肿瘤患者的同时性和异时性肿瘤。
我们前瞻性地收集了在我们中心进行结肠镜检查的患者的结肠镜检查和组织病理学数据，随访时间长达 6 年。比较了侧向伸展肿瘤、直径≥10mm 的平坦结直肠肿瘤和大型息肉状结直肠肿瘤、直径≥10mm 的息肉状结直肠肿瘤之间的切除后监测结果。
2008 年至 2012 年，8120 例患者因症状（84.6%）、筛查（6.7%）或监测（8.7%）而行结肠镜检查。在基线时，151 例患者有腺瘤性侧向伸展肿瘤，566 例患者有腺瘤性大型息肉状结直肠肿瘤。侧向伸展肿瘤患者的同时性结直肠肿瘤比大型息肉状结直肠肿瘤患者多（平均 3.34 比 2.34，p<0.001）。侧向伸展肿瘤患者发生异时性结直肠肿瘤的比例显著高于大型息肉状结直肠肿瘤患者（71.6%比 54.2%，p=0.0498），且发生高级别异型增生/黏膜下浸润的结直肠肿瘤的比例也显著高于大型息肉状结直肠肿瘤患者（36.4%比 15.8%，p<0.001）。在调整年龄和性别后，侧向伸展肿瘤患者比大型息肉状结直肠肿瘤患者更有可能发生高级别异型增生或黏膜下浸润的结直肠肿瘤（风险比 2.9，95%置信区间 1.8-4.6）。侧向伸展肿瘤患者发生异时性结直肠癌的风险与大型息肉状结直肠肿瘤患者无显著差异。
侧向伸展肿瘤患者发生高级别异型增生/黏膜下浸润的异时性结直肠肿瘤比大型息肉状结直肠肿瘤患者多。基于这些发现，应优化侧向伸展肿瘤患者的内镜治疗和监测建议。
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