Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.
Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.
Gastroenterology. 2021 May;160(6):1986-1996.e3. doi: 10.1053/j.gastro.2021.01.214. Epub 2021 Jan 29.
BACKGROUND & AIMS: The risk of metachronous colorectal cancer (CRC) among patients with no adenomas, low-risk adenomas (LRAs), or high-risk adenomas (HRAs), detected at index colonoscopy, is unclear. We performed a systematic review and meta-analysis to compare incidence rates of metachronous CRC and CRC-related mortality after a baseline colonoscopy for each group.
We searched the PubMed, Embase, Google Scholar, and Cochrane databases for studies that reported the incidence of CRC and adenoma characteristics after colonoscopy. The primary outcome was odds of metachronous CRC and CRC-related mortality per 10,000 person-years of follow-up after baseline colonoscopy for all the groups.
Our final analysis included 12 studies with 510,019 patients (mean age, 59.2 ± 2.6 years; 55% male; mean duration of follow up, 8.5 ± 3.3 years). The incidence of CRC per 10,000 person-years was marginally higher for patients with LRAs compared to those with no adenomas (4.5 vs 3.4; odds ratio [OR], 1.26; 95% CI, 1.06-1.51; I=0), but significantly higher for patients with HRAs compared to those with no adenoma ( 13.8 vs 3.4; odds ratio [OR], 2.92; 95% CI, 2.31-3.69; I=0 ) and patients with HRAs compared to LRAs (13.81 vs 4.5; OR, 2.35; 95% CI, 1.72-3.20; I=55%). However, the CRC-related mortality per 10,000 person-years did not differ significantly for patients with LRAs compared to no adenomas (OR, 1.15; 95% CI, 0.76-1.74; I=0) but was significantly higher in persons with HRAs compared with LRAs (OR, 2.48; 95% CI, 1.30-4.75; I=38%) and no adenomas (OR, 2.69; 95% CI, 1.87-3.87; I=0).
The results of this systematic review and meta-analysis demonstrate that the risk of metachronous CRC and mortality is significantly higher for patients with HRAs, but this risk is very low in patients with LRAs, comparable to patients with no adenomas. Follow-up of patients with LRAs detected at index colonoscopy should be the same as for persons with no adenomas.
在接受基线结肠镜检查时未发现腺瘤、低风险腺瘤（LRAs）或高风险腺瘤（HRAs）的患者中，发生异时性结直肠癌（CRC）的风险尚不清楚。我们进行了一项系统评价和荟萃分析，以比较每组基线结肠镜检查后异时性 CRC 和 CRC 相关死亡率的发生率。
我们在 PubMed、Embase、Google Scholar 和 Cochrane 数据库中搜索了报告结肠镜检查后 CRC 发生率和腺瘤特征的研究。主要结局是所有组基线结肠镜检查后每 10,000 人年随访的异时性 CRC 和 CRC 相关死亡率的比值。
我们的最终分析纳入了 12 项研究，共 510,019 名患者（平均年龄 59.2±2.6 岁；55%为男性；平均随访时间 8.5±3.3 年）。与无腺瘤患者相比，LRAs 患者的 CRC 发生率每 10,000 人年略有升高（4.5 比 3.4；比值比[OR]，1.26；95%CI，1.06-1.51；I=0），但与无腺瘤患者相比，HRAs 患者的 CRC 发生率显著升高（13.8 比 3.4；OR，2.92；95%CI，2.31-3.69；I=0）和与 LRAs 患者相比（13.81 比 4.5；OR，2.35；95%CI，1.72-3.20；I=55%）。然而，LRAs 患者与无腺瘤患者相比，CRC 相关死亡率每 10,000 人年无显著差异（OR，1.15；95%CI，0.76-1.74；I=0），但与 HRAs 患者相比（OR，2.48；95%CI，1.30-4.75；I=38%）和无腺瘤患者相比（OR，2.69；95%CI，1.87-3.87；I=0）显著升高。
这项系统评价和荟萃分析的结果表明，HRAs 患者发生异时性 CRC 和死亡的风险显著更高，但 LRAs 患者的风险非常低，与无腺瘤患者相当。对于在基线结肠镜检查中发现的 LRAs 患者，应与无腺瘤患者一样进行随访。
