Goffredo Paolo, Troester Alexander, Wolf Jack M, Rudser Kyle, Church Timothy R, Shaukat Aasma
Department of Surgery, Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Gastroenterol. 2024 Dec 17;120(9):2125-2131. doi: 10.14309/ajg.0000000000003256.
Despite reports indicating that polyps proximal to the splenic flexure have higher rates of metachronous colorectal adenocarcinoma (CRC), the role of adenoma location on surveillance recommendations remains unclear. This study aimed to analyze the association between index polyp location and postcolonoscopy CRC among participants of the Minnesota Colon Cancer Control Study.
The Minnesota Colon Cancer Control Study randomized 46,551 patients 50-80 years to usual care, annual, or biennial screening with fecal occult-blood testing. Screening was performed between 1976 and 1992. Positive fecal occult-blood testing was followed by colonoscopy. We analyzed participants whose colonoscopy revealed at least 1 adenoma. Patients were divided into those with at least 1 lesion proximal to the splenic flexure and those without.
Of 2,295 patients, 815 had proximal adenomas. The majority were men; mean age = 62 years at randomization, and 69 years at index polyp. There was a high rate of advanced adenomas: 44% ≥ 1 polyp ≥1 cm, 35% with villous histology, and 5% high-grade dysplasia. At 20 years, 87 patients had a CRC diagnosis, and the estimated cumulative incidence of CRC was 4.3%. Proximal adenomas had a higher risk of developing a postcolonoscopy CRC (subdistribution hazard ratio = 1.63, 95% confidence interval = 1.05-2.53, P = 0.03), which was attenuated after adjusting for polyp multiplicity in sensitivity analyses (subdistribution hazard ratio = 1.56, 95% confidence interval = 0.96-2.53, P = 0.07).
Although patients with proximal adenomas were found to have higher hazards of postcolonoscopy CRC, adjusting for polyp multiplicity attenuated the strength of association. Further research is warranted to determine whether polyp location should be factored in the determination of appropriate surveillance intervals.
尽管有报告表明脾曲近端息肉发生异时性结直肠癌（CRC）的几率更高，但腺瘤位置在监测建议中的作用仍不明确。本研究旨在分析明尼苏达结肠癌控制研究参与者中初始息肉位置与结肠镜检查后CRC之间的关联。
明尼苏达结肠癌控制研究将46,551名50至80岁的患者随机分为常规护理组、每年或每两年进行一次粪便潜血检测筛查组。筛查于1976年至1992年期间进行。粪便潜血检测呈阳性后进行结肠镜检查。我们分析了结肠镜检查发现至少1个腺瘤的参与者。患者分为至少有1个脾曲近端病变的患者和没有该病变的患者。
在2,295名患者中，815名有近端腺瘤。大多数为男性；随机分组时平均年龄为62岁，发现初始息肉时平均年龄为69岁。高级别腺瘤发生率很高：44%的患者有≥1个息肉且≥1厘米，35%为绒毛状组织学，5%为高级别异型增生。20年后，87名患者被诊断为CRC，CRC的估计累积发病率为4.3%。近端腺瘤发生结肠镜检查后CRC的风险更高（亚分布风险比 = 1.63，95%置信区间 = 1.05 - 2.53，P = 0.03），在敏感性分析中调整息肉数量后这种风险有所降低（亚分布风险比 = 1.56，95%置信区间 = 0.96 - 2.53，P = 0.07）。
尽管发现有近端腺瘤的患者发生结肠镜检查后CRC的风险更高，但调整息肉数量后关联强度有所减弱。有必要进行进一步研究以确定在确定合适的监测间隔时是否应考虑息肉位置。
