目的:传统的锯齿状腺瘤(TSA)可能增加结直肠癌(CRC)的风险。我们这项研究的目的是检查与TSA诊断相关的临床特征和长期结局。
方法:我们在1999年至2018年间对年龄≥18岁且TSA≥1的美国退伍军人进行了回顾性队列研究。基线特征,结肠镜检查结果,并提取了事件性和致命性CRC的诊断。晚期肿瘤定义为CRC或伴有高度异型增生的腺瘤,绒毛组织学,或尺寸≥1厘米。随访是通过CRC诊断,死亡,或研究结束(2018年12月31日)。
结果:共确定了853名具有基线TSA的退伍军人;74%的年龄≥60岁,96%是男性,14%是黑人,73%是非西班牙裔白人。大约64%是当前或以前的吸烟者。随访总人数超过2044人年,共有11例CRC事件和1例CRC死亡.累积CRC发生率为1.34%(95%置信区间[CI],0.67%-2.68%),累积CRC死亡为0.12%(95%CI,0.00%-0.35%)。在378例TSA患者中,结肠镜检查≥1例,65.1%的人在随访中有高危肿瘤。TSA患者的CRC发生率显著高于基线结肠镜检查正常患者的比较队列(风险比,3.70;95%CI,1.63-8.41),与基线常规晚期腺瘤的比较队列相似(风险比,0.86;95%CI,0.45-1.64)。
结论:根据累积CRC发生率,TSA患者有很大的CRC风险,以及在后续监测结肠镜检查中发生其他高危肿瘤的显著风险。这些数据强调了TSA诊断后密切结肠镜检查监测的当前建议的重要性。
Traditional serrated adenomas (TSAs) may confer increased risk for colorectal cancer (CRC). Our objective with this study was to examine clinical characteristics and long-term outcomes associated with TSA diagnosis.
We conducted a retrospective cohort study of U.S. Veterans ≥18 years of age with ≥1 TSA between 1999 and 2018. Baseline characteristics, colonoscopy findings, and diagnosis of incident and fatal CRC were abstracted. Advanced neoplasia was defined by CRC or adenoma with high-grade dysplasia, villous histology, or size ≥1 cm. Follow-up was through CRC diagnosis, death, or end of study (December 31, 2018).
A total of 853 Veterans with a baseline TSA were identified; 74% were ≥60 years of age, 96% were men, 14% were Black, and 73% were non-Hispanic White. About 64% were current or former smokers. Over 2044 total person-years at follow-up, there were 11 incident CRC cases and 1 CRC death. Cumulative CRC incidence was 1.34% (95% confidence interval [CI], 0.67%-2.68%), and cumulative CRC death was 0.12% (95% CI, 0.00%-0.35%). Among the subset of 378 TSA patients with ≥1 surveillance colonoscopy, 65.1% had high-risk neoplasia on follow-up. CRC incidence among TSA patients was significantly higher than in a comparison cohort of patients with normal baseline colonoscopy at baseline (hazard ratio, 3.70; 95% CI, 1.63-8.41) and similar to a comparison cohort with baseline conventional advanced adenoma (hazard ratio, 0.86; 95% CI, 0.45-1.64).
Individuals with TSA have substantial risk for CRC based on their cumulative CRC incidence, as well as significant risk of developing other high-risk neoplasia at follow-up surveillance colonoscopy. These data underscore importance of current recommendations for close colonoscopy surveillance after TSA diagnosis.