Harewood Rhea, Wooldrage Kate, Robbins Emma C, Kinross James, von Wagner Christian, 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.
BMJ Open Gastroenterol. 2025 Jun 23;12(1):e001787. doi: 10.1136/bmjgast-2025-001787.
Colorectal cancer screening with flexible sigmoidoscopy focuses on the distal colorectum, but it is unclear which distal polyp characteristics are associated with future proximal colon cancer incidence. We examined associations between distal adenoma or hyperplastic polyp characteristics and long-term incident proximal colon cancer.
In secondary, observational analyses of UK Flexible Sigmoidoscopy Screening Trial data, we obtained data on the number and size of distal hyperplastic polyps (n=4872) and adenomas (n=4581), adenoma histology and dysplasia from endoscopy and pathology reports for screened asymptomatic participants. Adjusted HRs and 95% CIs for the association between distal polyp characteristics and proximal colon cancer incidence were estimated using multivariable Cox proportional hazard models.
Over a median of 20.7 years of follow-up (IQR 16.5-21.7), 110 proximal colon cancers were diagnosed among participants with distal adenomas and 96 were diagnosed among those with only distal hyperplastic polyps detected at baseline. Larger adenoma size (6-9 mm vs ≤5 mm: HR 1.67 (95%CI: 1.07 to 2.59) and ≥10 mm vs ≤5 mm: HR 2.08 (95%CI: 0.98 to 4.43); p=0.037) and high-grade (vs low-grade) adenoma dysplasia (HR 2.82, 95% CI: 1.34 to 5.93; p=0.012) at baseline were positively associated with proximal colon cancer incidence. No associations were observed for distal adenoma number overall or histology, or the number or size of hyperplastic polyps and proximal colon cancer incidence.
We found some evidence that larger distal adenomas and those with high-grade dysplasia at baseline were positively associated with proximal colon cancer incidence. Larger studies are needed to confirm these findings.
ISRCTN28352761.
乙状结肠镜检查用于结直肠癌筛查时主要关注远端结肠，但目前尚不清楚哪些远端息肉特征与未来近端结肠癌的发病相关。我们研究了远端腺瘤或增生性息肉特征与长期近端结肠癌发病之间的关联。
在对英国乙状结肠镜筛查试验数据进行的二次观察性分析中，我们从无症状筛查参与者的内镜检查和病理报告中获取了远端增生性息肉（n = 4872）和腺瘤（n = 4581）的数量和大小、腺瘤组织学和发育异常的数据。使用多变量Cox比例风险模型估计远端息肉特征与近端结肠癌发病率之间关联的调整后风险比（HR）和95%置信区间（CI）。
在中位随访20.7年（四分位间距16.5 - 21.7年）期间，基线时发现有远端腺瘤的参与者中有110例被诊断为近端结肠癌，仅发现远端增生性息肉的参与者中有96例被诊断为近端结肠癌。基线时腺瘤较大（6 - 9毫米 vs ≤5毫米：HR 1.67（95%CI：1.07至2.59）；≥10毫米 vs ≤5毫米：HR 2.08（95%CI：0.98至4.43）；p = 0.037）以及高级别（vs低级别）腺瘤发育异常（HR 2.82，95%CI：1.34至5.93；p = 0.012）与近端结肠癌发病率呈正相关。未观察到远端腺瘤总数或组织学以及增生性息肉的数量或大小与近端结肠癌发病率之间存在关联。
我们发现一些证据表明，较大的远端腺瘤以及基线时具有高级别发育异常的腺瘤与近端结肠癌发病率呈正相关。需要更大规模的研究来证实这些发现。
ISRCTN28352761。
