Robbins Emma C, Wooldrage Kate, Rutter Matthew D, Veitch Andrew M, Cross Amanda J
Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK
Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Gut. 2025 Aug 7;74(9):1419-1429. doi: 10.1136/gutjnl-2024-334242.
Recommendations for the first postpolypectomy surveillance colonoscopy (SC1), based on stratifying postpolypectomy colorectal cancer (CRC) risk, are well established. Limited data inform recommendations for surveillance beyond SC1.
We investigated which patient groups need surveillance beyond SC1.
Retrospective analysis of patients who underwent colonoscopy with polypectomy at 17 UK hospitals, mostly from 2000 to 2010, and had ≥1 surveillance colonoscopies. Cancer and death data were collected through 2017. We examined patients in groups defined by risk at baseline and SC1, applying risk definitions from the 2020 UK postpolypectomy surveillance guidelines: 'low risk, low risk' (LR-LR), 'high risk, low risk' (HR-LR), 'low risk, high risk' (LR-HR) and 'high risk, high risk' (HR-HR). We examined CRC incidence after SC1, censoring at any second surveillance colonoscopy (SC2), and after SC2 through end of follow-up. We compared incidence with general population incidence using standardised incidence ratios (SIRs).
Analyses included 10 508 patients: LR-LR=6587 (63%), HR-LR=3272 (31%), LR-HR=248 (2%) and HR-HR=401 (4%). Median follow-up from SC1 was 8.0 years and 151 CRCs were diagnosed. Compared with the general population, CRC incidence after SC1 was lower in the LR-LR group (SIR 0.48, 95% CI 0.34 to 0.67), non-significantly different in the HR-LR (SIR 1.17, 0.85 to 1.58) or LR-HR (SIR 2.51, 0.81 to 5.85) groups, but higher in the HR-HR group (SIR 2.84, 1.30 to 5.39). After SC2, CRC incidence in the HR-HR group was no longer higher than in the general population (SIR 1.86, 0.89 to 3.42).
Patients with high-risk findings at both baseline and SC1 needed an SC2, while those with low-risk findings at SC1 did not, regardless of their baseline findings.
基于对息肉切除术后结直肠癌（CRC）风险进行分层，首次息肉切除术后监测结肠镜检查（SC1）的建议已确立。关于SC1之后监测的建议所依据的数据有限。
我们调查了哪些患者群体需要在SC1之后进行监测。
对在英国17家医院接受息肉切除结肠镜检查的患者进行回顾性分析，这些患者大多在2000年至2010年期间接受检查，且进行了≥1次监测结肠镜检查。通过2017年收集癌症和死亡数据。我们根据基线和SC1时的风险对患者进行分组，采用2020年英国息肉切除术后监测指南中的风险定义：“低风险，低风险”（LR-LR）、“高风险，低风险”（HR-LR）、“低风险，高风险”（LR-HR）和“高风险，高风险”（HR-HR）。我们检查了SC1之后的CRC发病率，在任何第二次监测结肠镜检查（SC2）时进行截尾，并在SC2之后直至随访结束。我们使用标准化发病率比（SIR）将发病率与一般人群发病率进行比较。
分析纳入10508例患者：LR-LR = 6587例（63%），HR-LR = 3272例（31%），LR-HR = 248例（2%），HR-HR = 401例（4%）。从SC1开始的中位随访时间为8.0年，诊断出151例CRC。与一般人群相比，LR-LR组SC1之后的CRC发病率较低（SIR 0.48，95%CI 0.34至0.67），HR-LR组（SIR 1.17，0.85至1.58）或LR-HR组（SIR 2.51，0.81至5.85）无显著差异，但HR-HR组较高（SIR 2.84，1.30至5.39）。在SC2之后，HR-HR组的CRC发病率不再高于一般人群（SIR 1.86，0.89至3.42）。
在基线和SC1时均有高风险发现的患者需要进行SC2，而在SC1时有低风险发现的患者则不需要，无论其基线发现如何。
