Department of Anorectal Surgery, Shenzhen Longhua District Central Hospital, Guanlan Avenue 187, Shenzhen, 518100, Guangdong, China.
Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Road, Guangzhou, 510655, Guangdong, China.
Surg Endosc. 2024 Jul;38(7):3783-3798. doi: 10.1007/s00464-024-10898-5. Epub 2024 May 28.
Many studies reported the presence of adenomas with high-grade dysplasia (HGD) at index colonoscopy increased the incidence of advanced neoplasia (AN) and colorectal cancer (CRC) following. However, the conclusion remains obscure due to lack of studies on the specific population of adenomas with HGD. This study aimed to assess the long-term risk of AN and CRC after removal of adenomas with HGD.
A total of 814 patients who underwent adenomas with HGD removal between 2010 and 2019 were retrospectively analyzed. The outcomes were the incidences of AN and CRC during surveillance colonoscopy. Cox proportional hazards models were utilized to identify risk factors associated with AN and CRC.
During more than 2000 person-years of follow-up, we found that AN and CRC incidence densities were 44.3 and 4.4 per 1000 person-years, respectively. The 10-year cumulative incidence of AN and CRC were 39.1% and 5.5%, respectively. In the multivariate model, synchronous low-risk polyps (HR 1.80, 95% CI 1.10-2.93) and synchronous high-risk polyps (HR 3.99, 95% CI 2.37-6.72) were risk factors for AN, whereas participation in surveillance colonoscopy visits (HR 0.56, 95% CI 0.36-0.88 for 1 visit; HR 0.10, 95% CI 0.06-0.19 for ≥ 2 visits) were associated with decreased AN incidence. Additionally, elevated baseline carcinoembryonic antigen (CEA) level (HR 10.19, 95% CI 1.77-58.59) was a risk factor for CRC, while participation in ≥ 2 surveillance colonoscopy visits (HR 0.11, 95% CI 0.02-0.56) were associated with decreased CRC incidence. Interestingly, for 11 patients who developed CRC after removal of adenomas with HGD, immunohistochemistry revealed that 8 cases (73%) were deficient mismatch repair CRCs.
Patients who have undergone adenoma with HGD removal are at higher risk of developing AN and CRC, while surveillance colonoscopy can reduce the risk. Patients with synchronous polyps, or with elevated baseline CEA level are considered high-risk populations and require more frequent surveillance.
许多研究报告称，在索引结肠镜检查中发现存在高级别异型增生（HGD）的腺瘤会增加后续进展期腺瘤（AN）和结直肠癌（CRC）的发生率。然而，由于缺乏对具有 HGD 腺瘤的特定人群的研究，结论仍不明确。本研究旨在评估切除具有 HGD 的腺瘤后 AN 和 CRC 的长期风险。
回顾性分析了 2010 年至 2019 年间接受 HGD 腺瘤切除术的 814 例患者。研究结果为监测结肠镜检查中 AN 和 CRC 的发生率。利用 Cox 比例风险模型确定与 AN 和 CRC 相关的危险因素。
在超过 2000 人年的随访期间，我们发现 AN 和 CRC 的发生率密度分别为 44.3 和 4.4/1000 人年。10 年 AN 和 CRC 的累积发生率分别为 39.1%和 5.5%。在多变量模型中，同步低危息肉（HR 1.80，95%CI 1.10-2.93）和同步高危息肉（HR 3.99，95%CI 2.37-6.72）是 AN 的危险因素，而参加监测结肠镜检查（HR 0.56，95%CI 0.36-0.88 为 1 次检查；HR 0.10，95%CI 0.06-0.19 为≥2 次检查）与 AN 发生率降低相关。此外，基线癌胚抗原（CEA）水平升高（HR 10.19，95%CI 1.77-58.59）是 CRC 的危险因素，而参加≥2 次监测结肠镜检查（HR 0.11，95%CI 0.02-0.56）与 CRC 发生率降低相关。有趣的是，在 11 例接受 HGD 腺瘤切除后发生 CRC 的患者中，免疫组织化学显示 8 例（73%）为错配修复缺陷 CRC。
接受 HGD 腺瘤切除术的患者发生 AN 和 CRC 的风险较高，而监测结肠镜检查可降低风险。有同步息肉或基线 CEA 水平升高的患者被认为是高危人群，需要更频繁的监测。
