Muller Charles, Yamada Akihiro, Ikegami Sachie, Haider Haider, Komaki Yuga, Komaki Fukiko, Micic Dejan, Sakuraba Atsushi
Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
Section of Gastroenterology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):622-630.e7. doi: 10.1016/j.cgh.2021.05.057. Epub 2021 Jun 2.
BACKGROUND & AIMS: Serrated polyposis syndrome (SPS) is characterized by development of numerous serrated lesions throughout the colorectum and increased risk of colorectal cancer (CRC). However, SPS has been an underrecognized CRC predisposition syndrome, and the true risk of CRC in SPS, both overall and in surveillance, is not known. The aim of this systematic review and meta-analysis is to describe the risk of CRC in patients with SPS.
Electronic databases were searched on March 25, 2021, for studies describing CRC risk in SPS. Random-effects meta-analysis was performed to assess pooled risk of CRC among SPS patients. Primary outcomes were risk of CRC at time of SPS diagnosis and during surveillance following diagnosis of SPS. Secondary outcomes included risk of CRC prior to diagnosis of SPS and effect of World Health Organization subtype on CRC risk.
Thirty-six studies including 2788 patients with SPS were included in the analysis. Overall risk of CRC in SPS was 19.9% (95% confidence interval [CI], 15.3%-24.5%). CRC risk at the time of diagnosis was 14.7% (95% CI, 11.4%-18.8%), while risk during surveillance was 2.8% (95% CI, 1.8%-4.4%), or 7 cases per 1000 person-years. SPS patients also had a high incidence of history of CRC prior to SPS diagnosis (7.0%; 95% CI, 4.6%-11.7). Subgroup analysis did not reveal any significant differences based on World Health Organization subtype.
Our meta-analysis demonstrated that patients with SPS have an elevated risk of CRC, which is highest at the time of diagnosis and suggests the importance of early SPS recognition and screening to modify CRC risk. The persistently elevated CRC risk during surveillance supports current guidelines recommending heightened surveillance protocols.
锯齿状息肉综合征（SPS）的特征是在整个结直肠出现大量锯齿状病变，以及患结直肠癌（CRC）的风险增加。然而，SPS一直是一种未被充分认识的结直肠癌易患综合征，SPS患者患结直肠癌的真正风险，包括总体风险和监测中的风险，尚不清楚。本系统评价和荟萃分析的目的是描述SPS患者患结直肠癌的风险。
于2021年3月25日检索电子数据库，查找描述SPS患者结直肠癌风险的研究。采用随机效应荟萃分析评估SPS患者患结直肠癌的合并风险。主要结局是SPS诊断时和SPS诊断后监测期间患结直肠癌的风险。次要结局包括SPS诊断前患结直肠癌的风险以及世界卫生组织亚型对结直肠癌风险的影响。
分析纳入了36项研究，共2788例SPS患者。SPS患者患结直肠癌的总体风险为19.9%（95%置信区间[CI]，15.3%-24.5%）。诊断时患结直肠癌的风险为14.7%（95%CI，11.4%-18.8%），而监测期间的风险为2.8%（95%CI，1.8%-4.4%），即每1000人年7例。SPS患者在SPS诊断前有结直肠癌病史的发生率也很高（7.0%；95%CI，4.6%-11.7）。亚组分析未发现基于世界卫生组织亚型的任何显著差异。
我们的荟萃分析表明，SPS患者患结直肠癌的风险升高，在诊断时最高，这表明早期识别和筛查SPS以改变结直肠癌风险的重要性。监测期间持续升高的结直肠癌风险支持当前推荐加强监测方案的指南。
