一项回顾性汇总研究表明，与大腺瘤相比，伴有高级别异型增生的小腺瘤和微小腺瘤的绝对数量要高得多。
The absolute number of small and diminutive adenomas with high-grade dysplasia is substantially higher compared with large adenomas: a retrospective pooled study.
作者信息
Zhang Jiancheng, Sun Huajun, Xiong Fei, Lei Shan, Zhou Guanyu, Xiao Xun, Liu Lin, Wang Pu
机构信息
Department of Gastroenterology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Department of Pathology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
出版信息
Front Oncol. 2024 Feb 12;14:1294745. doi: 10.3389/fonc.2024.1294745. eCollection 2024.
INTRODUCTION
The risk that a large polyp (≥10 mm) evolves into high-grade dysplasia (HGD) is relatively high compared with that of a small/diminutive polyp (<10 mm). Recently, the detection of small and diminutive polyps has been substantially improved with the advancement of endoscopy. However, further research is needed on the role of the incidence of HGD caused by the co-occurrence of small and diminutive polyps in the progression of HGD. In this study, we aim to investigate whether and how the small and diminutive polyps correlate with the incidence of HGD in the population.
METHODS
The pooled data were deeply analyzed from four published randomized controlled trials (RCTs) regarding colon polyp detection. All polyps detected were examined and confirmed by pathologists. The primary outcome was the composition ratio of the HGD polyps in each polyp size category.
RESULTS
Among a total of 3,179 patients with 2,730 polyps identified, there were 83 HGD polyps confirmed, and 68 patients had at least one polyp with HGD. The risk of development of HGD was lower for a single small and diminutive polyp than for one large polyp (2.18% vs. 22.22%, < 0.0001). On the contrary, the composition ratio for HGD from small and diminutive polyps was significantly higher than that from the large ones (68.67% vs. 31.33%, < 0.0001). The combined number of HGD presented a trend negatively correlated to size.
CONCLUSIONS
Our data demonstrated that the absolute number of HGD significantly derives more from small and diminutive polyps than from the large ones, and the collective number of small and diminutive polyps per patient is indicative of his/her HGD exposure. These findings positively provide novel perspectives on the management of polyps and may further optimize the prevention of colorectal cancer.
SYSTEMATIC REVIEW REGISTRATION
http://www.chictr.org.cn, identifier ChiCTR1900025235, ChiCTR1800017675, ChiCTR1800018058, and ChiCTR1900023086.
引言
与小/微小息肉（<10 mm）相比，大息肉（≥10 mm）发展为高级别上皮内瘤变（HGD）的风险相对较高。近年来，随着内镜技术的进步，小息肉和微小息肉的检出率有了显著提高。然而，对于小息肉和微小息肉并存导致的HGD发生率在HGD进展中的作用，仍需进一步研究。在本研究中，我们旨在调查小息肉和微小息肉是否以及如何与人群中HGD的发生率相关。
方法
对四项已发表的关于结肠息肉检测的随机对照试验（RCT）的汇总数据进行深入分析。所有检测到的息肉均由病理学家检查并确认。主要结局是每个息肉大小类别中HGD息肉的构成比。
结果
在总共3179例患者中，共识别出2730个息肉，其中83个息肉被确认为HGD，68例患者至少有一个息肉发生HGD。单个小息肉和微小息肉发生HGD的风险低于单个大息肉（2.18%对22.22%，<0.0001）。相反，小息肉和微小息肉中HGD的构成比显著高于大息肉（68.67%对31.33%，<0.0001）。HGD的合并数量呈现出与息肉大小负相关的趋势。
结论
我们的数据表明，HGD的绝对数量更多地来自小息肉和微小息肉，而非大息肉，并且每位患者的小息肉和微小息肉总数可表明其HGD暴露情况。这些发现为息肉的管理提供了新的视角，并可能进一步优化结直肠癌的预防。
系统评价注册
http://www.chictr.org.cn，标识符为ChiCTR1900025235、ChiCTR1800017675、ChiCTR1800018058和ChiCTR-1900023086。
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