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Gastroenterology:结肠镜检查发现高风险腺瘤与无腺瘤患者相比结直肠癌的发生风险和死亡率都会增加

2021-05-14 MedSci原创 MedSci原创

大肠癌(CRC)是世界上第三大最常见的恶性肿瘤,也是与癌症相关的死亡的第四大主要原因。

      大肠癌(CRC)是世界上第三大最常见的恶性肿瘤,也是与癌症相关的死亡的第四大主要原因。筛查和结肠镜检查与结肠癌的发病率降低有关,根据结肠镜检查时结肠直肠息肉的特征,研究人员将结肠息肉分为三大类(数量,大小和组织学)。它们被分类为(1)低风险腺瘤(LRA),定义为1至2个<10 mm的管状腺瘤伴低度发育不良,(2)高风险腺瘤(HRA),定义为晚期腺瘤(恶性组织学) ,高度不典型增生或≥10 mm)或≥3腺瘤,以及(3)无腺瘤。目前尚不清楚在指标结肠镜检查中发现无腺瘤,低危腺瘤(LRA)或高危腺瘤(HRA)的患者发生大肠癌的风险。因此,本项研究旨在比较每组基线结肠镜检查后异时CRC和CRC相关死亡率的发生率的差异。

 

      研究人员在PubMed,Embase,Google Scholar和Cochrane数据库中进行了文献搜索,将所有关于结肠镜检查后CRC和腺瘤特征的发生率的文献纳入本项研究。主要观察结果是所有组在基线结肠镜检查后每10,000人年随访中发生异时CRC和CRC相关死亡率的几率。

 

      最后研究人员共纳入了12项符合条件的文献,包含了510019名患者(平均年龄,59.2±2.6岁;男性,占55%;平均随访时间,8.5±3.3年)。与没有腺瘤的患者相比,LRA的患者每10,000人年的CRC发生率略高(4.5 vs 3.4;[OR]为1.26; 95%CI为1.06-1.51;I2 = 0),但与无腺瘤的患者相比,HRA的患者显着更高(13.8 vs 3.4;[OR],2.92; 95%CI,2.31-3.69;I 2 = 0),然而,与没有腺瘤的患者相比,LRA患者每10,000人年的CRC相关死亡率没有显着差异(OR为1.15; 95%CI为0.76–1.74;I 2 = 0),但在HRA患者中则显着更高(OR,2.48; 95%CI,1.30–4.75;I 2 = 38%)。

图:荟萃分析显示结肠镜和肿瘤死亡率的关系

      本项研究最终表明HRA患者的CRC的发生率和死亡风险显着较高,但是LRA患者的这种风险非常低,与无腺瘤的患者相当。

 

 

原始出处:

Abhiram Duvvuri. Et al. Risk of Colorectal Cancer and Cancer Related Mortality After Detection of Low-risk or High-risk Adenomas, Compared With No Adenoma, at Index Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterology.2021.

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    2021-10-04 许安
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    2021-05-16 zhouqu_8
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    2021-05-14 神盾医疗局局长Jack

    本项研究最终表明HRA患者的CRC的发生率和死亡风险显着较高,但是LRA患者的这种风险非常低,与无腺瘤的患者相当

    0

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