Thomas Raj Jessica, Ali Adel Hajj, Bolwell Jacquelyn, Butler Robert, Burke Carol A, Liska David, Macaron Carole
Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH.
Department of Internal Medicine, Indiana University, Indianapolis, IN.
J Clin Gastroenterol. 2025 Aug 1;59(7):660-667. doi: 10.1097/MCG.0000000000002072.
The risk of metachronous advanced colorectal neoplasia (mACRN) in young adults with advanced lesions at baseline colonoscopy is not well defined.
To examine the risk for (mACRN) in adults <50 years old who had advanced neoplasia (AN) at baseline colonoscopy and determine factors associated with mACRN in these patients.
Patients 18 to 49 years of age with ≥1 AN [tubular adenoma (TA) ≥10 mm or with villous features or high-grade dysplasia (HGD), sessile serrated lesion (SSL) ≥10 mm or with dysplasia, traditional serrated adenoma (TSA)] on baseline colonoscopy between 2011 and 2021 who had surveillance colonoscopy >6 months after their baseline examination were included. Outcomes were assessed based on age at baseline colonoscopy, <45 years versus 45 to 49 years, and by follow-up colonoscopy findings: (1) normal, (2) nonadvanced neoplasia (NAN), and (3) AN.
Three hundred sixty-six patients with AN underwent ≥1 surveillance colonoscopy: 310 (84.7%) <45 years versus 56 (15.3%) 45 to 49 years. The mean follow-up time was longer for the <45-year-olds versus the 45 to 49-year-olds (43±26.4 vs. 28.4±12.8 mo respectively, P <0.001). The absolute risk of mACRN was 13.5% in the <45 age group versus 16.1% in the 45 to 49 age group, P =0.28. The 3-year cumulative incidence rates of mACRN were comparable for patients <45 and 45 to 49 years old: 10% (95% CI: 10% to 42%) versus 20% (95% CI: 7% to 15%), P =0.065. BMI was the only risk factor associated with mACRN OR 1.045 [95% CI (1.001 to 1.09)].
In our cohort of patients <50 years old with AN at baseline, mACRN occurred at a similar rate to that reported by guidelines in 50 years and older, suggesting that current recommended post polypectomy surveillance is appropriate for this age group. BMI was independently associated with mACRN. Future studies should examine how weight management in patients with high BMI mitigates the recurrence of advanced neoplasia.
基线结肠镜检查发现有进展期病变的年轻成年人发生异时性晚期结直肠肿瘤（mACRN）的风险尚不明确。
研究基线结肠镜检查发现有进展期肿瘤（AN）的50岁以下成年人发生mACRN的风险，并确定这些患者中与mACRN相关的因素。
纳入2011年至2021年间基线结肠镜检查发现有≥1个AN[管状腺瘤（TA）≥10mm或具有绒毛特征或高级别异型增生（HGD）、无蒂锯齿状病变（SSL）≥10mm或伴有异型增生、传统锯齿状腺瘤（TSA）]且在基线检查后6个月以上进行了结肠镜复查的18至49岁患者。根据基线结肠镜检查时的年龄（<45岁与45至49岁）以及结肠镜复查结果评估结局：（1）正常，（2）非进展期肿瘤（NAN），（3）AN。
366例患有AN的患者接受了≥1次结肠镜复查：310例（84.7%）<45岁，56例（15.3%）45至49岁。<45岁患者的平均随访时间长于45至49岁患者（分别为43±26.4个月和28.4±12.8个月，P<0.001）。<45岁年龄组mACRN的绝对风险为13.5%，45至49岁年龄组为16.1%，P=0.28。<45岁和45至49岁患者mACRN的3年累积发病率相当：10%（95%CI：10%至42%）与20%（95%CI：7%至15%），P=0.065。BMI是与mACRN相关的唯一危险因素，OR为1.045[95%CI（1.001至1.09）]。
在我们的基线时有AN的<50岁患者队列中，mACRN的发生率与5岁及以上指南报告中的发生率相似，这表明目前推荐的息肉切除术后监测适用于该年龄组。BMI与mACRN独立相关。未来的研究应探讨高BMI患者的体重管理如何减轻晚期肿瘤的复发。
