背景:早发性结直肠癌(CRC)的发病率在全球范围内持续增加。中国目前的指南推荐平均风险个体在50岁开始CRC筛查。
目的:探讨胃组织病理学与结直肠肿瘤之间的关系,以确定可能指导年龄<50岁个体早期结肠镜检查的CRC危险因素。
方法:对2020年11月7日至2022年11月14日同时接受胃镜和结肠镜检查的8819例50岁以下患者进行了回顾性横断面研究。采用多因素logistic回归分析各种胃组织病理学检查是否为不同类型结直肠息肉的危险因素。报告比值比(OR)和相应的95%置信区间(CI)。
结果:50岁以下的大肠息肉患者共3390例(38.44%)。高龄(OR1.66,95CI1.57-1.76),男性(OR2.67,95CI2.33-3.08),幽门螺杆菌(H.幽门螺杆菌)感染(OR1.43,95CI1.24-1.65),胃息肉(OR1.29,95CI1.10-1.52),低级别上皮内瘤变(LGIN)(OR2.52,95CI1.39-4.57)是结直肠腺瘤的独立危险因素。对于非腺瘤性息肉,反流性食管炎(OR1.38,95CI1.11~1.71)也是独立的危险因素.此外,年龄较大(OR1.90,95CI1.66-2.18),男性(OR2.15,95CI1.60-2.87),幽门螺杆菌感染(OR1.67,95CI1.24-2.24)与晚期肿瘤(晚期腺瘤和CRC)的高风险相关。
结论:对于50岁以下患有幽门螺杆菌感染的个体,可能需要考虑早期结肠镜检查以进行识别和筛查。LGIN,胃息肉,和反流性食管炎.适应风险的CRC筛查开始年龄允许个性化和精确的筛查。
BACKGROUND: The incidence of early-onset colorectal cancer (CRC) is continuously increasing worldwide. Current guidelines in China recommend average-risk individuals starting CRC screening at age 50.
OBJECTIVE: To investigate the relationship between the gastric histopathology and colorectal neoplasms to identify CRC risk factors which potentially guide earlier colonoscopy in individuals aged < 50 years.
METHODS: A retrospective cross-sectional
study was conducted on 8819 patients younger than age 50 who underwent gastroscopy and colonoscopy simultaneously between November 7, 2020 and November 14, 2022. Multivariate logistic regression was used to evaluate whether various gastric histopathology are risk factors for different types of colorectal polyps, reporting odds ratios (ORs) with corresponding 95% confidence intervals (CIs).
RESULTS: A total of 3390 cases (38.44%) under 50 years old were diagnosed as colorectal polyps. Advanced age (OR 1.66, 95%CI 1.57-1.76), male sex (OR 2.67, 95%CI 2.33-3.08), Helicobacter pylori (H. pylori) infection (OR 1.43, 95%CI 1.24-1.65), gastric polyps (OR 1.29, 95%CI 1.10-1.52), and low-grade intraepithelial neoplasia (LGIN) (OR 2.52, 95%CI 1.39-4.57) were independent risk factors for colorectal adenomas. For non-adenomatous polyps, reflux esophagitis (OR 1.38, 95%CI 1.11-1.71) was also an independent risk factor. Besides, older age (OR 1.90, 95%CI 1.66-2.18), male sex (OR 2.15, 95%CI 1.60-2.87), and H. pylori infection (OR 1.67, 95%CI 1.24-2.24) were associated with a higher risk of advanced neoplasms (advanced adenoma and CRC).
CONCLUSIONS: Earlier colonoscopy for identification and screening may need to be considered for individuals younger than 50 years old with H. pylori infection, LGIN, gastric polyps, and reflux esophagitis. Risk-adapted CRC screening initiation age allows a personalized and precise screening.