直肠和结肠大无蒂结直肠息肉的形态学和组织病理学比较：对内镜治疗的影响。

Comparison of the morphology and histopathology of large nonpedunculated colorectal polyps in the rectum and colon: implications for endoscopic treatment.

机构信息

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.

Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Gastrointest Endosc. 2022 Jul;96(1):118-124. doi: 10.1016/j.gie.2022.02.022. Epub 2022 Feb 24.

DOI:10.1016/j.gie.2022.02.022

PMID:35219724

Abstract

BACKGROUND AND AIMS

The risk of cancer in large nonpedunculated colorectal polyps ≥20 mm (LNPCPs) in the rectum relative to the remainder of the colon is unknown. We aimed to describe differences between rectal and colonic LNPCPs to better inform treatment decisions.

METHODS

Patients with LNPCPs referred to tertiary centers for endoscopic resection within a prospective, multicenter, observational cohort were evaluated. Data recorded were participant demographics, LNPCP location, morphology, resection modality, and histopathologic data. Multiple logistic regression analysis was used to identify those variables independently associated with rectal versus nonrectal location in the colon.

RESULTS

Patients with LNPCPs referred for endoscopic resection between July 2008 and July 2021 were included. Rectal LNPCPs (n = 618) were larger (median size, 40 mm vs 30 mm; P < .001) and more likely to be granular (79% vs 50%, P < .001) with a nodular component (53% vs 17%, P < .001) compared with nonrectal LNPCPs (n = 2787). Rectal LNPCPs were more likely to have tubulovillous histopathology (72% vs 47%, P < .001) and contain cancer (15% vs 6%, P < .001). After adjusting for the other features independently associated with location, cancer was more common in the rectum compared with the colon (odds ratio, 1.77; 95% confidence interval, 1.25-2.53).

CONCLUSIONS

This study suggests that compared with LNPCPs in the rest of the colon, rectal LNPCPs are more likely to be larger and contain more advanced pathology. These findings have implications for curative endoscopic resection techniques particularly where early cancer is present. (Clinical trial registration numbers: NCT01368289 and NCT02000141.).

摘要

背景和目的

直肠内直径大于 20 毫米（LNPCP）的大型无蒂结直肠息肉（LNPCP）与结肠其余部位相比，其患癌风险尚不清楚。我们旨在描述直肠和结肠 LNPCP 之间的差异，以便更好地为治疗决策提供依据。

方法

我们对在一个前瞻性、多中心、观察性队列中被转诊至三级中心进行内镜下切除的 LNPCP 患者进行了评估。记录的资料包括患者的人口统计学特征、LNPCP 位置、形态、切除方式和组织病理学资料。采用多因素逻辑回归分析确定与结肠中直肠位置相关的独立变量。

结果

本研究纳入了 2008 年 7 月至 2021 年 7 月期间被转诊进行内镜下切除的 LNPCP 患者。直肠 LNPCP（n=618）较非直肠 LNPCP（n=2787）更大（中位数大小：40mm 比 30mm；P<0.001），且更可能呈颗粒状（79%比 50%；P<0.001），具有结节状成分（53%比 17%；P<0.001）。直肠 LNPCP 更可能具有绒毛管状组织病理学（72%比 47%；P<0.001）和包含癌症（15%比 6%；P<0.001）。在调整了与位置相关的其他独立特征后，与结肠相比，直肠中癌症更为常见（比值比，1.77；95%置信区间，1.25-2.53）。