医学
结肠镜检查
结直肠癌
回顾性队列研究
普通外科
癌症
大肠息肉
结直肠癌筛查
内科学
肿瘤科
作者
Jasmin Zessner‐Spitzenberg,Elisabeth Waldmann,Lisa-Maria Rockenbauer,A. Demschik,Daniela Penz,Michael Trauner,Monika Ferlitsch
出处
期刊:Endoscopy
[Georg Thieme Verlag KG]
日期:2024-06-27
卷期号:56 (11): 820-827
被引量:1
摘要
Abstract Background Surveillance colonoscopy after polyps have been detected at screening aims to reduce the risk for subsequent colorectal cancer, so-called post-colonoscopy colorectal cancer (PCCRC). Inconsistencies exist as to whether the risk should be stratified by histologic subtype. We aimed to compare the risk for PCCRC mortality in screening participants with sessile serrated lesions (SSLs)/traditional serrated adenomas (TSAs), hyperplastic polyps (HPPs), or conventional adenomas. Methods Screening colonoscopy registry data were linked to death registry data between 2010 and 2022. We assessed the association of PCCRC death after a diagnosis of SSL/TSA, conventional adenoma, or HPP by Cox regression, and stratified by polyp size ≥10 and <10 mm. Results 383,801 participants were included in the analysis. There were 1490 HPPs ≥10 mm (2.6%), compared with 1853 SSL/TSAs (19.6%) and 10,960 conventional adenomas (12.9%). When adjusted for polyp location, the association of polyp size ≥10 mm with PCCRC death was of similar magnitude in participants with conventional adenomas (hazard ratio [HR] 3.68, 95%CI 2.49–5.44), SSL/TSAs (HR 2.55, 95%CI 1.13–5.72), and HPPs (HR 5.01, 95%CI 2.45–10.22). Participants with HPPs mostly died of tumors in the distal colon (54.1%; n = 20), while participants with SSL/TSAs more frequently died of proximal tumors (33.3%; n = 3). Conclusions Across all histologic types, participants with polyps ≥10 mm had at least a two-fold increase in the likelihood of PCCRC death compared with those with polyps <10 mm. These data suggest that size, rather than histologic subtype, should be a determinant for risk stratification after screening colonoscopy.
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