Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA.
Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Dig Dis Sci. 2022 Jun;67(6):2526-2534. doi: 10.1007/s10620-021-07069-0. Epub 2021 Jun 4.
Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice.
We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy.
We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50-75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan-Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression.
The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%-9.62%). Age 60-69 or 70-75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0-9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41-30.84), including CRC (OR 7.00; 95% CI 2.84-17.28), but not extra-colonic malignancies.
Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.
结直肠癌（CRC）筛查指南建议在有≥10 个累积腺瘤的个体中频繁进行结肠镜检查并考虑基因检测。然而，目前尚不清楚这些指南在常规实践中的应用情况。
我们估计了在筛查人群中发现有≥10 个累积腺瘤的参与者的比例，并描述了他们进展性肿瘤（AN）、CRC 和结外恶性肿瘤的结局。
我们对 VA CSP#380 进行了二次分析，该研究包括 3121 名年龄在 50-75 岁之间的退伍军人，他们在筛查结肠镜检查后随访了 10 年。我们通过 Kaplan-Meier 方法计算了≥10 个累积腺瘤的累积风险。我们比较了有和没有≥10 个累积腺瘤的参与者的基线风险因素，以及 AN（腺瘤≥1cm、绒毛状腺瘤或高级别异型增生或 CRC）和结外恶性肿瘤的风险通过多变量逻辑回归。
在 10.5 年内，≥10 个累积腺瘤的累积风险为 6.51%（95%CI 4.38%-9.62%）。基线结肠镜检查时年龄为 60-69 岁或 70-75 岁是唯一与发现≥10 个累积腺瘤相关的因素。与有 0-9 个累积腺瘤的参与者相比，有≥10 个累积腺瘤的参与者更有可能患有 AN（OR 17.03；95%CI 9.41-30.84），包括 CRC（OR 7.00；95%CI 2.84-17.28），但没有结外恶性肿瘤。
在这个筛查人群中，大约 6.5%的参与者在 10.5 年内发现有≥10 个累积腺瘤，这在 60 岁之前并不常见。与累积腺瘤较低的参与者相比，这些参与者发现 AN 和 CRC 的发生率显著更高。
