Increased Risk of Colorectal Cancer Development Among Patients With Serrated Polyps

详细信息    查看全文

• 作者：Rune Erichsen¹ ; ^{re@clin.au.dk" class="auth_mail" title="E-mail the corresponding author} ; John A. Baron¹ ; ² ; Stephen J. Hamilton-Dutoit³ ; Dale C. Snover⁴ ; Emina Emilia Torlakovic⁵ ; Lars Pedersen¹ ; Trine Frø ; slev¹ ; Mogens Vyberg⁶ ; Stanley R. Hamilton⁷ ; Henrik Toft Sø ; rensen¹ ; ²
• 关键词：Tumor ; Colorectal Neoplasm ; Risk Factor ; Early Detection
• 刊名：Gastroenterology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：150
• 期：4
• 页码：895-902.e5
• 全文大小：664 K

文摘

Sessile serrated adenomas/polyps (SSA/Ps) and traditional serrated adenomas (TSAs) are now distinguished from hyperplastic polyps and recognized as precursors to colorectal cancer (CRC). We studied CRC risks associated with serrated polyps.

Methods

By using Danish databases (1977–2009), we conducted a nationwide population-based, case-control study nested within individuals who had received colonoscopies (n = 272,342), and identified 2045 CRC cases and 8105 CRC-free individuals (controls). For each case and control, we identified the first colorectal polyp(s) that underwent a biopsy or were excised during or after the initial colonoscopy, and obtained tissue blocks for hyperplastic lesions. Four expert pathologists reviewed these lesions using current terminology for serrated polyps. We used logistic regression to compute odds ratios (ORs) to associate the risk of CRC with polyp type and estimated the absolute risks by multiplying the risk in patients with no polyps by these ORs.

Results

Seventy-nine cases and 142 controls had SSA/Ps (OR, 3.07; 95% confidence interval [CI], 2.30–4.10). SSA/Ps with cytology markers of dysplasia were associated with a particularly high OR (4.76; 95% CI, 2.59–8.73). Women with SSA/P had a higher risk for CRC than men with SSA/P (OR for women, 5.05; 95% CI, 3.05–8.37 vs OR for men, 2.18; 95% CI, 1.24–3.82); patients with SSA/P proximal to the splenic flexure had the highest risk for CRC (OR, 12.42; 95% CI, 4.88–31.58). The OR for CRC was 4.84 in the 14 cases vs 17 controls with TSAs (95% CI, 2.36–9.93), 2.51 in the 757 cases vs 1698 controls with conventional adenomas (95% CI, 2.25–2.80), and 1.30 in the 55 cases vs 235 controls with hyperplastic polyps (95% CI, 0.96–1.77). The 10-year risk for CRC was 4.4% for patients with SSA/P with dysplasia, 4.5% for patients with TSAs, and 2.3% for patients with conventional adenomas.

Conclusion

Patients with SSA/P or TSA are at increased risk for CRC; their level of risk is similar to or higher than that of patients with conventional adenomas.