结直肠腺瘤风险分类系统的比较：病例队列研究。
A Comparison of Risk Classification Systems of Colorectal Adenomas: A Case-Cohort Study.
机构信息
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; Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.
出版信息
Gastroenterology. 2023 Aug;165(2):483-491.e7. doi: 10.1053/j.gastro.2023.04.028. Epub 2023 May 3.
BACKGROUND & AIMS: Because post-polypectomy surveillance uses a growing proportion of colonoscopy capacity, more targeted surveillance is warranted. We therefore compared surveillance burden and cancer detection using 3 different adenoma classification systems.
METHODS
In a case-cohort study among individuals who had adenomas removed between 1993 and 2007, we included 675 individuals with colorectal cancer (cases) diagnosed a median of 5.6 years after adenoma removal and 906 randomly selected individuals (subcohort). We compared colorectal cancer incidence among high- and low-risk individuals defined according to the traditional (high-risk: diameter ≥10 mm, high-grade dysplasia, villous growth pattern, or 3 or more adenomas), European Society of Gastrointestinal Endoscopy (ESGE) 2020 (high-risk: diameter ≥10 mm, high-grade dysplasia, or 5 or more adenomas), and novel (high-risk: diameter ≥20 mm or high-grade dysplasia) classification systems. For the different classification systems, we calculated the number of individuals recommended frequent surveillance colonoscopy and estimated number of delayed cancer diagnoses.
RESULTS
Four hundred and thirty individuals with adenomas (52.7%) were high risk based on the traditional classification, 369 (45.2%) were high risk based on the ESGE 2020 classification, and 220 (27.0%) were high risk based on the novel classification. Using the traditional, ESGE 2020, and novel classifications, the colorectal cancer incidences per 100,000 person-years were 479, 552, and 690 among high-risk individuals, and 123, 124, and 179 among low-risk individuals, respectively. Compared with the traditional classification, the number of individuals who needed frequent surveillance was reduced by 13.9% and 44.2%, respectively, and 1 (3.4%) and 7 (24.1%) cancer diagnoses were delayed using the ESGE 2020 and novel classifications.
CONCLUSIONS
Using the ESGE 2020 and novel risk classifications will substantially reduce resources needed for colonoscopy surveillance after adenoma removal.
背景与目的
由于息肉切除术后的监测使用了越来越多的结肠镜检查能力，因此需要更有针对性的监测。因此，我们比较了使用 3 种不同腺瘤分类系统的监测负担和癌症检出率。
方法
在 1993 年至 2007 年间切除腺瘤的个体中进行病例对照研究，我们纳入了 675 名结直肠癌（病例）患者，他们在腺瘤切除后中位数为 5.6 年被诊断，906 名随机选择的个体（亚组）。我们比较了根据传统（高危：直径≥10mm、高级别异型增生、绒毛状生长模式或 3 个或更多腺瘤）、欧洲胃肠道内镜学会（ESGE）2020 年（高危：直径≥10mm、高级别异型增生或 5 个或更多腺瘤）和新型（高危：直径≥20mm 或高级别异型增生）分类系统定义的高风险和低风险个体中的结直肠癌发病率。对于不同的分类系统，我们计算了建议频繁进行监测性结肠镜检查的个体数量，并估计了延迟诊断癌症的数量。
结果
430 名（52.7%）腺瘤患者根据传统分类为高危，369 名（45.2%）根据 ESGE 2020 分类为高危，220 名（27.0%）根据新型分类为高危。使用传统、ESGE 2020 和新型分类，高危人群的每 100,000 人年结直肠癌发生率分别为 479、552 和 690，低危人群分别为 123、124 和 179。与传统分类相比，ESGE 2020 和新型分类分别减少了 13.9%和 44.2%需要频繁监测的个体数量，分别延迟了 1（3.4%）和 7（24.1%）例癌症诊断。
结论
使用 ESGE 2020 和新型风险分类将大大减少腺瘤切除术后结肠镜监测所需的资源。
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