Patients With Nonpolypoid (Flat and Depressed) Colorectal Neoplasms at Increased Risk for Advanced Neoplasias, Compared With Patients With Polypoid Neoplasms

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• 作者：Sarah K. McGill^&lowast ; ; ^&Dagger ; ; ^§ ; ; Roy Soetikno^&lowast ; ; ^&Dagger ; ; Robert V. Rouse^&lowast ; ; ^&Dagger ; ; Hobart Lai^&lowast ; ; Tonya Kaltenbach^&lowast ; ; ^&Dagger ; ; ^{endoresection@me.com}
• 关键词：Colon Cancer ; Progression ; Endoscopy ; Screening ; Risk Factors
• 刊名：Clinical Gastroenterology and Hepatology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：15
• 期：2
• 页码：249-256.e1
• 全文大小：656 K
• 卷排序：15

文摘

Nonpolypoid colorectal neoplasms (NP-CRNs) are more likely to contain high-grade dysplasia or early-stage cancer than polypoid neoplasms. We aimed to determine the long-term outcomes of patients with at least 1 NP-CRN.MethodsWe performed a longitudinal cohort study of 4454 patients at a Veterans’ Affairs hospital who underwent colonoscopy from 2000 through 2005; 341 were found to have 1 or more NP-CRNs and were matched (3:1) with patients found to have 1 or more polypoid neoplasms (controls, n = 1025). We collected and analyzed data on baseline colonoscopy findings and first follow-up colonoscopy results through August 2014. We calculated the incidence of advanced neoplasia at first follow-up colonoscopy, as defined by the presence of ≥1 tubular or sessile serrated adenomas ≥10 mm in diameter, tubulovillous adenoma, high-grade dysplasia, or invasive cancer.ResultsA significantly higher proportion of patients with 1 or more NP-CRNs (16.0%) were found to have advanced neoplasia at their first follow-up colonoscopy than controls (8.6%); the adjusted risk ratio was 1.6 (95% confidence interval, 1.05–2.6; P = .03). A significantly higher proportion of patients with 1 or more NP-CRNs were found to have additional NP-CRNs at the follow-up colonoscopy (17%) than controls (7%; relative risk, 2.3; 95% confidence interval, 1.5–3.5; P < .001). Similar proportions of patients in each group developed cancers after colonoscopy.ConclusionsIn a longitudinal cohort study, we found that patients with NP-CRN were more likely to develop additional NP-CRNs and to have advanced neoplasms at their first follow-up colonoscopy than patients with only polypoid neoplasms. However, patients with NP-CRN were not more likely to develop cancers after colonoscopy when surveillance guidelines were followed. Larger studies are needed to determine risk of colorectal cancer in patients with NP-CRN.