Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.
Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Aliment Pharmacol Ther. 2022 Feb;55(4):412-421. doi: 10.1111/apt.16686. Epub 2021 Oct 30.
Women and men with colorectal adenomas are at increased risk of colorectal cancer and colonoscopic surveillance is recommended. However, the long-term cancer risk remains unknown.
To investigate colorectal cancer incidence and mortality after adenoma removal in women and men METHODS: We identified all individuals who had adenomas removed in Norway from 1993 to 2007, with follow-up through 2018. We calculated standardized incidence ratios (SIR) and incidence-based mortality ratios (SMR) with 95% confidence intervals (CI) for colorectal cancer in women and men using the female and male population for comparison. We defined high-risk adenomas as ≥2 adenomas, villous component, or high-grade dysplasia.
The cohort comprised 40 293 individuals. During median follow-up of 13.0 years, 1079 women (5.5%) and 866 men (4.2%) developed colorectal cancer; 328 women (1.7%) and 275 men (1.3%) died of colorectal cancer. Colorectal cancer incidence was more increased in women (SIR 1.64, 95% CI 1.54-1.74) than in men (SIR 1.12, 95% CI 1.05-1.19). Colorectal cancer mortality was increased in women (SMR 1.13, 95% CI 1.02-1.26) and reduced in men (SMR 0.79, 95% CI 0.71-0.89). Women with high-risk adenomas had an increased risk of colorectal cancer death (SMR 1.37, 95% CI 1.19-1.57); women with low-risk adenomas (SMR 0.90, 95% CI 0.76-1.07) and men with high-risk adenomas had a similar risk (SMR 0.89, 95% CI 0.76-1.04), while men with low-risk adenomas had reduced risk (SMR 0.70, 95% CI 0.59-0.84).
After adenoma removal, women had an increased risk of colorectal cancer death, while men had reduced risk, compared to the general female and male populations. Sex-specific surveillance recommendations after adenoma removal should be considered.
患有结直肠腺瘤的女性和男性患结直肠癌的风险增加，建议进行结肠镜监测。然而，长期癌症风险尚不清楚。
调查女性和男性腺瘤切除后结直肠癌的发病率和死亡率。
我们从 1993 年至 2007 年在挪威确定了所有接受腺瘤切除术的个体，并随访至 2018 年。我们使用女性和男性人口作为比较，计算了女性和男性结直肠癌的标准化发病比（SIR）和基于发病率的死亡率比（SMR）的 95%置信区间（CI）。我们将高危腺瘤定义为≥2 个腺瘤、绒毛成分或高级别异型增生。
该队列包括 40293 名个体。在中位随访 13.0 年期间，1079 名女性（5.5%）和 866 名男性（4.2%）发生结直肠癌；328 名女性（1.7%）和 275 名男性（1.3%）死于结直肠癌。女性结直肠癌发病率高于男性（SIR1.64，95%CI1.54-1.74）。女性结直肠癌死亡率升高（SMR1.13，95%CI1.02-1.26），男性结直肠癌死亡率降低（SMR0.79，95%CI0.71-0.89）。患有高危腺瘤的女性结直肠癌死亡风险增加（SMR1.37，95%CI1.19-1.57）；患有低危腺瘤的女性（SMR0.90，95%CI0.76-1.07）和患有高危腺瘤的男性具有相似的风险（SMR0.89，95%CI0.76-1.04），而患有低危腺瘤的男性结直肠癌风险降低（SMR0.70，95%CI0.59-0.84）。
与一般女性和男性人群相比，腺瘤切除后女性结直肠癌死亡风险增加，而男性风险降低。应该考虑腺瘤切除后基于性别的监测建议。
