一项针对有蒂和小的无蒂管状及管状绒毛状腺瘤患者的随机监测研究。菲英岛腺瘤随访研究。

A randomized surveillance study of patients with pedunculated and small sessile tubular and tubulovillous adenomas. The Funen Adenoma Follow-up Study.

作者信息

Jørgensen O D, Kronborg O, Fenger C

机构信息

Dept. of Surgery, Odense University Hospital, Denmark.

出版信息

Scand J Gastroenterol. 1995 Jul;30(7):686-92. doi: 10.3109/00365529509096314.

DOI:10.3109/00365529509096314

PMID:7481533

Abstract

BACKGROUND

We wanted to assess the influence of various surveillance intervals on the risk of new neoplasia after removal of pedunculated and small sessile tubular and tubulovillous adenomas.

METHODS

After initial colonoscopic polypectomy patients were randomized to surveillance with either 2 years (group A) or 4 years (group B) between colorectal examinations.

RESULTS

The cumulated risk of a patient having new adenomas was 35.0% (28.7-41.4%) in group A and 35.5% (28.4-42.7%) in group B after 48 months. The risk increased to 44.9% (36.0-53.9%) and 60.1% (48.5-71.7%), respectively, after 96 months. The risk of significant neoplasia (carcinoma or adenoma with villous structure, severe dysplasia, or diameter > 10 mm) was 5.2% (2.3-8.1%) and 8.6% (3.8-13.3%) after 48 months and 8.6% (4.2-13.0%) and 17.4% (7.6-27.2%) after 96 months. More than one adenoma at first examination was associated with higher risk of new adenomas. Furthermore, we found a tendency for age above 60 years and male gender to be associated with higher risk of new adenomas. More than two adenomas at first examination was the only factor found to be associated with a higher risk of new significant neoplasia. One patient in group A and two patients in group B developed cancer, which is not significantly different from the number expected (3.43) in the average Danish population (RR = 0.9, 0.2-2.6).

CONCLUSION

After colonoscopy with removal of all polyps, colorectal examination at 4 years resulted in a similar risk of new adenomas compared with examinations at 2 and 4 years. However, new significant neoplasia tended to be more frequent when first surveillance was at 4 years. Extending the surveillance to 8 years also tended to increase the risk more in the group being examined every 4 years, but reduction of the number of surveillance examinations by more than 50% and a probable reduction of complications from surveillance examinations themselves may justify a recommendation for the longest interval.

摘要

背景

我们想要评估不同监测间隔对带蒂和小的无蒂管状及绒毛状腺瘤切除术后新发肿瘤风险的影响。

方法

在首次结肠镜息肉切除术后，患者被随机分为两组，分别接受每2年（A组）或每4年（B组）一次的结直肠检查监测。

结果

48个月后，A组患者发生新腺瘤的累积风险为35.0%（28.7 - 41.4%），B组为35.5%（28.4 - 42.7%）。96个月后，风险分别增至44.9%（36.0 - 53.9%）和60.1%（48.5 - 71.7%）。48个月时，发生重大肿瘤（癌或具有绒毛结构、重度发育异常或直径>10 mm的腺瘤）的风险分别为5.2%（2.3 - 8.1%）和8.6%（3.8 - 13.3%），96个月时分别为8.6%（4.2 - 13.0%）和17.4%（7.6 - 27.2%）。首次检查时发现一个以上腺瘤与发生新腺瘤的较高风险相关。此外，我们发现60岁以上和男性发生新腺瘤的风险有升高趋势。首次检查时发现两个以上腺瘤是唯一与发生新的重大肿瘤较高风险相关的因素。A组有1例患者发生癌症，B组有2例患者发生癌症，这与丹麦普通人群预期的3.43例无显著差异（相对危险度 = 0.9，0.2 - 2.6）。

结论

在结肠镜检查切除所有息肉后，每4年进行一次结直肠检查与每2年和每4年进行一次检查相比，发生新腺瘤的风险相似。然而，首次监测为每4年时，新的重大肿瘤往往更常见。将监测延长至8年也往往会使每4年检查一次的组中的风险增加更多，但监测检查次数减少50%以上以及监测检查本身并发症可能减少，这可能证明推荐最长间隔时间是合理的。