Spychalski Piotr, Kobiela Jarek, Wieszczy Paulina, Bugajski Marek, Reguła Jaroslaw, Kaminski Michał F
Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-210 Gdansk, Poland.
Centre of Postgraduate Medical Education, Department of Gastroenterology, Hepatology and Clinical Oncology, 01-813 Warsaw, Poland.
Cancers (Basel). 2021 Dec 23;14(1):62. doi: 10.3390/cancers14010062.
Most colorectal cancers (CRC) assumedly develop from precursor lesions, i.e., colorectal adenomas (adenoma-carcinoma sequence). Epidemiological and clinical data supporting this hypothesis are limited. Therefore, the aim of the present study is to estimate relative dynamics of colorectal adenoma-carcinoma sequence for groups of screenees stratified by BMI (body mass index) based on prevalence data from Polish Colonoscopy Screening Program (PCSP). We performed a cross-sectional analysis of database records of individuals who entered the national opportunistic colonoscopy screening program for CRC in Poland. We calculated prevalence of adenomas and CRCs adjusted for sex, 5-year age group, family history of CRC, smoking, diabetes and use of aspirin, hormonal therapy and proton-pump inhibitors use. Thereafter we calculated estimated transition rate (eTR) with confidence intervals (CIs) defined as adjusted prevalence of more advanced lesion divided by adjusted prevalence of less advanced lesion. All analyzes were stratified according to the BMI categories: normal (BMI 18.0 to <25.0), overweight (BMI 25.0 to <30.0) and obese (BMI ≥ 30.0). Results are reported in the same respective order. After exclusions we performed analyses on 147,385 individuals. We found that prevalence of non-advanced adenomas is increasing with BMI category (12.19%, 13.81%, 14.70%, respectively; < 0.001). Prevalence of advanced adenomas was increasing with BMI category (5.20%, 5.77%, 6.61%, respectively; < 0.001). Early CRCs prevalence was the highest for obese individuals (0.55%) and the lowest for overweight individuals (0.44%) with borderline significance ( = 0.055). For advanced CRC we found that prevalence seems to be inversely related to BMI category, however no statistically significant differences were observed (0.35%, 0.31%, 0.28%; = 0.274). eTR for non-advanced adenoma to advanced adenoma is higher for obese individuals than for overweight individuals with bordering CIs (42.65% vs. 41.81% vs. 44.95%) eTR for advanced adenoma to early CRC is highest for normal individuals, however CIs are overlapping with remaining BMI categories (9.02% vs. 7.67% vs. 8.39%). eTR for early CRC to advanced CRC is lower for obese individuals in comparison to both normal and overweight individuals with marginally overlapping CIs (73.73% vs. 69.90% vs. 50.54%). Obese individuals are more likely to develop adenomas, advanced adenomas and early CRC but less likely to progress to advanced CRC. Therefore, this study provides new evidence that obesity paradox exists for colorectal cancer.
大多数结直肠癌（CRC）据推测起源于前驱病变，即结直肠腺瘤（腺瘤 - 癌序列）。支持这一假说的流行病学和临床数据有限。因此，本研究的目的是基于波兰结肠镜筛查项目（PCSP）的患病率数据，估计按体重指数（BMI）分层的筛查人群中结直肠腺瘤 - 癌序列的相对动态变化。我们对进入波兰全国性结直肠癌机会性结肠镜筛查项目的个体数据库记录进行了横断面分析。我们计算了根据性别、5岁年龄组、结直肠癌家族史、吸烟、糖尿病以及阿司匹林、激素治疗和质子泵抑制剂使用情况调整后的腺瘤和结直肠癌患病率。此后，我们计算了估计转化率（eTR）及其置信区间（CI），定义为更晚期病变的调整患病率除以较早期病变的调整患病率。所有分析均根据BMI类别进行分层：正常（BMI 18.0至<25.0）、超重（BMI 25.0至<30.0）和肥胖（BMI≥30.0）。结果按相同顺序报告。排除后，我们对147,385名个体进行了分析。我们发现非晚期腺瘤的患病率随BMI类别增加（分别为12.19%、13.81%、14.70%；<0.001）。晚期腺瘤的患病率也随BMI类别增加（分别为5.20%、5.77%、6.61%；<0.001）。早期结直肠癌的患病率在肥胖个体中最高（0.55%），在超重个体中最低（0.44%），具有临界显著性（=0.055）。对于晚期结直肠癌，我们发现患病率似乎与BMI类别呈负相关，但未观察到统计学上的显著差异（0.35%、0.31%、0.28%；=0.274）。肥胖个体从非晚期腺瘤到晚期腺瘤的eTR高于超重个体，置信区间相近（42.65%对41.81%对44.95%）。从晚期腺瘤到早期结直肠癌的eTR在正常个体中最高，但其置信区间与其他BMI类别重叠（9.02%对7.67%对8.39%）。与正常和超重个体相比，肥胖个体从早期结直肠癌到晚期结直肠癌的eTR较低，置信区间略有重叠（73.73%对69.90%对50.54%）。肥胖个体更易发生腺瘤、晚期腺瘤和早期结直肠癌，但进展为晚期结直肠癌的可能性较小。因此，本研究提供了新的证据，表明结直肠癌存在肥胖悖论。
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