摘要
目的研究同时性多原发结直肠癌与散发性结直肠癌患者异时性进展期腺瘤(MAA)的发生率。方法纳入2008年1月1日至2022年9月30日在首都医科大学附属北京世纪坛医院接受结直肠癌手术(外科手术或内镜切除)并进行3年结肠镜随访的结直肠癌患者。患者在术后6~36个月内完成≥2次结肠镜随访,且2次结肠镜检查间隔时间>6个月。收集患者年龄,性别,肿瘤部位、分期、病理学特征,合并基础疾病情况,术前癌胚抗原、血红蛋白等实验室检查结果,基线结肠镜检查结果,MAA检出情况等资料。根据年龄(±2岁)、性别、原发肿瘤部位(同一节段)和肿瘤分期将同时性多原发结直肠癌患者与散发性结直肠癌患者按照病灶数1∶1进行倾向性评分匹配法配对。计算同时性多原发结直肠癌和散发性结直肠癌患者MAA的累积发生风险。采用Cox比例风险回归模型分析MAA发生的影响因素。结果共纳入814例结直肠癌患者进行配对。配对后,同时性多原发结直肠癌患者36例(78个癌灶),散发性结直肠癌患者78例(78个癌灶)。同时性多原发结直肠癌组患者1、2、3年MAA的累积发生率分别为11.1%(4/36)、22.2%(8/36)、33.3%(12/36),散发性结直肠癌组患者1、2、3年MAA的累积发生率分别为3.8%(3/78)、12.8%(10/78)、20.5%(16/78)。同时性多原发结直肠癌与MAA的3年累积发生率增高相关(HR=4.163,95%置信区间1.032~4.721,P=0.047)。指数病变位于左侧结肠时,同时性多原发结直肠癌发生MAA的风险增加(HR=7.186,95%置信区间1.602~20.787,P=0.010)。多因素Cox回归分析显示,基线结肠镜检出同时性进展期腺瘤是MAA发生的独立危险因素(HR=3.175,95%置信区间1.411~7.142,P=0.005)。结论同时性多原发结直肠癌伴同时性进展期腺瘤患者应强化结肠镜随访。
Objective To investigate the incidences of metachronous advanced adenoma(MAA)in patients with simultaneous multiple primary colorectal cancer(CRC)and patients with sporadic CRC.Methods From January 1,2008 to September 30,2022,at Beijing Shijitan Hospital,Capital Medical University,CRC patients who underwent surgery and 3 years follow-up with endoscopy were enrolled.The patients completed colonoscopy at least 2 times during follow-up in 6 to 36 months after surgery,and the interval between the 2 times colonoscopies was over 6 months.Clinical data including age,gender,and tumor location,stage,pathological features,combined underlying diseases,preoperative carcinoembryonic antigen,hemoglobin and other laboratory results,baseline colonoscopy results,and detection of MAA were collected.According to age(±2 years old),gender,location of primary lesion and stage of tumor,patients with simultaneous CRC or sporadic CRC were matched at 1∶1 ratio by propensity score matching.The cumulative risks of MAA in patients with simultaneous multiple primary CRC and patients with sporadic CRC were calculated.Cox proportional hazard regression was used to analyze the influencing factors in the occurrence of MAA.Results A total of 814 CRC patients were enrolled and matched.After paired matching,there were 36 cases of simultaneous multiple primary CRC(78 lesions)and 78 cases of sporadic CRC(78 lesions).The cumulative incidences of MAA at 1,2 and 3 years of simultaneous CRC group were 11.1%(4/36),22.2%(8/36)and 33.3%(12/36),respectively.The cumulative incidences of MAA at 1-,2-and 3-year of sporadic CRC group were 3.8%(3/78),12.8%(10/78)and 20.5%(16/78),respectively.Simultaneous CRC was correlated with an increase in the 3-year cumulative incidence of MAA(HR=4.163,95%confidence interval(95%CI)1.032 to 4.721,P=0.047).Especially in left-sided CRC,the risk of MAA in simultaneous CRC increased(HR=7.186,95%CI 1.602 to 20.787,P=0.010).The results of multivariate cox-regression analysis indicated that detection of simultaneous advanced adenom
作者
郭春梅
刘红
王亚丹
孟明明
王沧海
宿慧
吴静
Guo Chunmei;Liu Hong;Wang Yadan;Meng Mingming;Wang Canghai;Su Hui;Wu Jing(Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2023年第1期40-46,共7页
Chinese Journal of Digestion
基金
北京市属医院科研培育计划项目(PX2021030)
首都卫生发展科研专项(2020-4-2085)。
关键词
结直肠肿瘤
同时性多原发结直肠癌
散发性结直肠癌
结肠镜监测
异时性进展期腺瘤
配对分析
Colorectal neoplasms
Synchronous colorectal cancer
Solitary colorectal cancer
Surveillance colonoscopy
Metachronous advanced adenoma
Matched pair analysis
