Levi F, Randimbison L, La Vecchia C
Institut universitaire de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Int J Cancer. 1993 Sep 30;55(3):415-8. doi: 10.1002/ijc.2910550315.
An association between adenomatous polyps of the large bowel and colorectal cancer has been reported, in the absence, however, of population-based estimates of risk. Subjects with histologically confirmed first diagnosis of large-bowel polyps notified to the population-based Cancer Registry of the Swiss Canton of Vaud (about 600,000 inhabitants) during the calendar period 1979-1990 were actively followed up to the end of 1990 for the subsequent occurrence of malignant neoplasms. Among 2,496 individuals with intestinal polyps, followed for a total of 10,310 person-years at risk (6,201 among males and 4,109 among females), 150 malignant neoplasms were registered versus 152 expected. Thus, the standardized incidence ratio (SIR) for all cancers combined was 0.99. A significant excess was observed for colorectal cancer, with 35 cases observed (19 males, 16 females) versus 17.0 expected (SIR = 2.1; 95% CI: 1.5-3.0). There was also an excess, although not significant, for small-bowel cancer (2 cases observed vs. 0.4 expected; SIR = 5.4). In none of the other cancer sites was SIR significantly or appreciably elevated: in subjects with colorectal polyps the SIR was 1.6 for stomach, 1.0 for lung, 0.9 for breast and 1.2 for prostate. The SIR of colorectal cancer was 3.1 in the first year since polyp registration, and declined thereafter to 1.8, in the absence, however, of any further trend with time since diagnosis. The cumulative risk of colorectal cancer in subjects with colorectal polyps was 2% at 5 years and 3% at 10 years. The quantitative estimates of this study are of interest for their population-based nature, and are potentially useful for defining and targeting screening colonoscopy programmes.
已有报道称大肠腺瘤性息肉与结直肠癌之间存在关联，然而，尚未有基于人群的风险评估。1979年至1990年期间，首次经组织学确诊为大肠息肉并上报至瑞士沃州基于人群的癌症登记处（约60万居民）的患者，被积极随访至1990年底，以观察随后恶性肿瘤的发生情况。在2496名肠道息肉患者中，共随访了10310人年的风险期（男性6201人年，女性4109人年），登记了150例恶性肿瘤，而预期为152例。因此，所有癌症合并的标准化发病率比（SIR）为0.99。观察到结直肠癌有显著超额发病，观察到35例（男性19例，女性16例），而预期为17.0例（SIR = 2.1；95%置信区间：1.5 - 3.0）。小肠癌也有超额发病，尽管不显著（观察到2例，预期为0.4例；SIR = 5.4）。在其他癌症部位，SIR均未显著或明显升高：结直肠息肉患者中，胃癌的SIR为1.6，肺癌为1.0，乳腺癌为0.9，前列腺癌为1.2。结直肠癌的SIR在息肉登记后的第一年为3.1，此后降至1.8，然而，自诊断以来没有任何随时间的进一步趋势。结直肠息肉患者患结直肠癌的累积风险在5年时为2%，10年时为3%。本研究的定量评估因其基于人群的性质而具有意义，并且可能有助于确定和定位筛查结肠镜检查项目的目标人群。
