METHODS: Single-institution retrospective chart review identified EO-CRC and AO-CRC patients with colonoscopy and no evidence of disease. Surveillance intervals and time to development of advanced neoplasia (CRC and advanced polyps [adenoma/sessile serrated]) were examined. For each group, 3 serial surveillance colonoscopies were evaluated. Statistical analyses were performed utilizing log-ranked Kaplan-Meier method and Cox proportional hazards.
RESULTS: A total of 1259 patients with CRC were identified, with 612 and 647 patients in the EO-CRC and AO-CRC groups, respectively. Compared with patients with AO-CRC, patients with EO-CRC had a 29% decreased risk of developing advanced neoplasia from time of initial surgery to first surveillance colonoscopy (hazard ratio, 0.71; 95% confidence interval, 0.52-1.0). Average follow-up time from surgical resection to first surveillance colonoscopy was 12.6 months for both cohorts. Overall surveillance findings differed between cohorts (P = .003), and patients with EO-CRC were found to have less advanced neoplasia compared with their counterparts with AO-CRC (12.4% vs 16.0%, respectively). Subsequent colonoscopies found that, while patients with EO-CRC returned for follow-up surveillance colonoscopy earlier than patients with AO-CRC, the EO-CRC cohort did not have more advanced neoplasia nor non-advanced adenomas.
CONCLUSIONS: Patients with EO-CRC do not have an increased risk of advanced neoplasia compared with patients with AO-CRC and therefore do not require more frequent colonoscopy surveillance than current guidelines recommend.
方法:单机构回顾性分析确定EO-CRC和AO-CRC患者行结肠镜检查,无疾病证据。检查了晚期瘤形成(CRC和晚期息肉(腺瘤/无柄锯齿状))的监测间隔和发展时间。对于每个小组,评估了3次连续监测结肠镜检查.利用对数排序的Kaplan-Meier方法和Cox比例风险进行统计分析。
结果:共确定了1259例CRC患者,EO-CRC和AO-CRC组中有612和647名患者,分别。与AO-CRC患者相比,EO-CRC患者从初次手术到首次结肠镜检查发生晚期肿瘤的风险降低了29%(HR=0.71,95%CI0.52-1.0)。两组患者从手术切除到首次结肠镜检查的平均随访时间为12.6个月。总体监测结果在队列之间有所不同(p=0.003),与AO-CRC相比,EO-CRC的晚期瘤形成较少(12.4%vs16.0%,分别)。随后的结肠镜检查发现,尽管EO-CRC患者比AO-CRC患者更早返回进行结肠镜检查。EO-CRC队列没有更晚期的瘤形成,也没有非晚期的腺瘤.
结论:EO-CRC患者与AO-CRC患者相比,晚期肿瘤形成的风险没有增加,因此不需要比目前指南推荐的更频繁的结肠镜检查。