目的:锯齿状息肉病综合征(SPS)的特征是在整个结肠直肠出现大量锯齿状病变,并增加结直肠癌(CRC)的风险。然而,SPS一直是一种未被认可的CRC易感性综合征,以及SPS中CRC的真实风险,无论是整体还是在监测中,不知道。本系统综述和荟萃分析的目的是描述SPS患者的CRC风险。
方法:在2021年3月25日搜索电子数据库,寻找描述SPS中CRC风险的研究。进行随机效应荟萃分析以评估SPS患者的合并CRC风险。主要结果是在SPS诊断时和SPS诊断后的监测期间发生CRC的风险。次要结果包括SPS诊断前的CRC风险和世界卫生组织亚型对CRC风险的影响。
结果:分析中纳入了36项研究,包括2788例SPS患者。SPS中CRC的总体风险为19.9%(95%置信区间[CI],15.3%-24.5%)。诊断时的CRC风险为14.7%(95%CI,11.4%-18.8%),而监测期间的风险为2.8%(95%CI,1.8%-4.4%),或每1000人年7例。SPS患者在SPS诊断前也有很高的CRC病史(7.0%;95%CI,4.6%-11.7)。根据世界卫生组织的亚型,亚组分析没有发现任何显着差异。
结论:我们的荟萃分析表明,SPS患者的CRC风险升高,在诊断时最高,提示早期SPS识别和筛查对改变CRC风险的重要性.监测期间CRC风险持续升高支持当前指南建议加强监测方案。
OBJECTIVE: Serrated
polyposis syndrome (SPS) is characterized by development of numerous serrated lesions throughout the colorectum and increased risk of colorectal cancer (CRC). However, SPS has been an underrecognized CRC predisposition syndrome, and the true risk of CRC in SPS, both overall and in surveillance, is not known. The aim of this systematic
review and meta-analysis is to describe the risk of CRC in patients with SPS.
METHODS: Electronic databases were searched on March 25, 2021, for studies describing CRC risk in SPS. Random-effects meta-analysis was performed to assess pooled risk of CRC among SPS patients. Primary outcomes were risk of CRC at time of SPS diagnosis and during surveillance following diagnosis of SPS. Secondary outcomes included risk of CRC prior to diagnosis of SPS and effect of World Health Organization subtype on CRC risk.
RESULTS: Thirty-six studies including 2788 patients with SPS were included in the analysis. Overall risk of CRC in SPS was 19.9% (95% confidence interval [CI], 15.3%-24.5%). CRC risk at the time of diagnosis was 14.7% (95% CI, 11.4%-18.8%), while risk during surveillance was 2.8% (95% CI, 1.8%-4.4%), or 7 cases per 1000 person-years. SPS patients also had a high incidence of history of CRC prior to SPS diagnosis (7.0%; 95% CI, 4.6%-11.7). Subgroup analysis did not reveal any significant differences based on World Health Organization subtype.
CONCLUSIONS: Our meta-analysis demonstrated that patients with SPS have an elevated risk of CRC, which is highest at the time of diagnosis and suggests the importance of early SPS recognition and screening to modify CRC risk. The persistently elevated CRC risk during surveillance supports current guidelines recommending heightened surveillance protocols.