Debinski H S, Love S, Spigelman A D, Phillips R K
Colorectal Unit, St. Mark's Hospital, London, England.
Gastroenterology. 1996 Apr;110(4):1028-30. doi: 10.1053/gast.1996.v110.pm8612989.
BACKGROUND & AIMS: In familial adenomatous polyposis, colorectal cancer prevention is by prophylactic colectomy, but dietary or chemopreventative strategies have been recently proposed in low-risk individuals. The aim of this study was to define predictive risk factors for colorectal cancer in familial adenomatous polyposis.
Between 1918 and 1993, 317 patients underwent colectomy. A multivariate analysis was performed to assess the relationship between colorectal cancer risk and polyp count, sex, and age at colectomy.
The median polyp count was 842 (range, 78-7500), and cancer was found in 22% of patients. Polyp count and age, but not sex, predicted cancer risk. Patients with >1000 polyps had 2.3 times greater risk of cancer than those with <1000 polyps (P=0.006). Synchronous cancers increased with poly count (P<0.05). Each 10-year age group had a 2.4-fold difference in cancer risk (95% confidence interval, 1.9-3.2; P<0.001). Four cases of cancer occurred in patients at low risk (younger than 30 years of age, <1000 polyps; 3.3%).
More adenomas and older age are associated with a higher risk of colorectal cancer. However, cancer does occur in low-risk individuals and may be missed by surveillance, making alternatives to prophylactic surgery inadvisable.
在家族性腺瘤性息肉病中，结直肠癌的预防方法是进行预防性结肠切除术，但最近已有人针对低风险个体提出饮食或化学预防策略。本研究的目的是确定家族性腺瘤性息肉病中结直肠癌的预测风险因素。
1918年至1993年间，317例患者接受了结肠切除术。进行多因素分析以评估结直肠癌风险与息肉数量、性别以及结肠切除时年龄之间的关系。
息肉数量中位数为842（范围78 - 7500），22%的患者发现患有癌症。息肉数量和年龄而非性别可预测癌症风险。息肉数>1000的患者患癌风险是息肉数<1000的患者的2.3倍（P = 0.006）。同时性癌随着息肉数量增加而增多（P<0.05）。每个10岁年龄组的癌症风险相差2.4倍（95%置信区间，1.9 - 3.2；P<0.001）。4例癌症发生在低风险患者中（年龄小于30岁，息肉数<1000；3.3%）。
更多的腺瘤和更高的年龄与结直肠癌风险增加相关。然而，癌症确实会发生在低风险个体中，且可能在监测中被漏诊，这使得预防性手术以外的替代方法不可取。
