NYU Langone Health, New York, New York; VA New York Harbor Health Care System, New York, New York.
University of Minnesota, Minneapolis, Minnesota; Minneapolis VA Health Care System, Minneapolis, Minnesota.
Clin Gastroenterol Hepatol. 2021 Jul;19(7):1327-1336. doi: 10.1016/j.cgh.2021.02.014. Epub 2021 Feb 10.
The purpose of this expert review is to describe the role of medications for the chemoprevention of colorectal neoplasia. Neoplasia is defined as precancerous lesions (e.g., adenoma and sessile serrated lesion) or cancer. The scope of this review excludes dietary factors and high-risk individuals with hereditary syndromes or inflammatory bowel disease.
The best practice advice statements are based on a review of the literature to provide practical advice. A formal systematic review and rating of the quality of evidence or strength of recommendation were not performed. BEST PRACTICE ADVICE 1: In individuals at average risk for CRC who are (1) younger than 70 years with a life expectancy of at least 10 years, (2) have a 10-year cardiovascular disease risk of at least 10%, and (3) not at high risk for bleeding, clinicians should use low-dose aspirin to reduce CRC incidence and mortality. BEST PRACTICE ADVICE 2: In individuals with a history of CRC, clinicians should consider using aspirin to prevent recurrent colorectal neoplasia. BEST PRACTICE ADVICE 3: In individuals at average risk for CRC, clinicians should not use non-aspirin NSAIDs to prevent colorectal neoplasia because of a substantial risk of cardiovascular and gastrointestinal adverse events. BEST PRACTICE ADVICE 4: In individuals with type 2 diabetes, clinicians may consider using metformin to prevent colorectal neoplasia. BEST PRACTICE ADVICE 5: In individuals with CRC and type 2 diabetes, clinicians may consider using metformin to reduce mortality. BEST PRACTICE ADVICE 6: Clinicians should not use calcium or vitamin D (alone or together) to prevent colorectal neoplasia. BEST PRACTICE ADVICE 7: Clinicians should not use folic acid to prevent colorectal neoplasia. BEST PRACTICE ADVICE 8: In individuals at average risk for CRC, clinicians should not use statins to prevent colorectal neoplasia. BEST PRACTICE ADVICE 9: In individuals with a history of CRC, clinicians should not use statins to reduce mortality.
本专家综述旨在阐述药物在结直肠肿瘤化学预防中的作用。肿瘤是指癌前病变（如腺瘤和无蒂锯齿状病变）或癌症。本综述范围不包括饮食因素和遗传性综合征或炎症性肠病的高危个体。
最佳实践建议陈述是基于对文献的回顾，旨在提供实用建议。未进行正式的系统评价和证据质量或推荐强度的分级。最佳实践建议 1：对于结直肠癌平均风险的个体（1）年龄小于 70 岁，预期寿命至少 10 年，（2）心血管疾病风险至少为 10%，（3）无出血高风险，临床医生应使用低剂量阿司匹林降低 CRC 发病率和死亡率。最佳实践建议 2：对于结直肠癌病史的个体，临床医生应考虑使用阿司匹林预防结直肠肿瘤复发。最佳实践建议 3：对于结直肠癌平均风险的个体，临床医生不应使用非阿司匹林 NSAIDs 预防结直肠肿瘤，因为心血管和胃肠道不良事件的风险很高。最佳实践建议 4：对于 2 型糖尿病患者，临床医生可能会考虑使用二甲双胍预防结直肠肿瘤。最佳实践建议 5：对于结直肠癌和 2 型糖尿病患者，临床医生可能会考虑使用二甲双胍降低死亡率。最佳实践建议 6：临床医生不应使用钙或维生素 D（单独或联合使用）预防结直肠肿瘤。最佳实践建议 7：临床医生不应使用叶酸预防结直肠肿瘤。最佳实践建议 8：对于结直肠癌平均风险的个体，临床医生不应使用他汀类药物预防结直肠肿瘤。最佳实践建议 9：对于结直肠癌病史的个体，临床医生不应使用他汀类药物降低死亡率。
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