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Gut: journal of the British Society of Gastroenterology v.66 no.3, 2017년, pp.446 - 453   SCI SCIE
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Risk stratification of individuals with low-risk colorectal adenomas using clinical characteristics: a pooled analysis

Gupta, Samir (Department of Medicine, Section of Gastroenterology, Veteran Affairs San Diego Healthcare System, , San Diego, California, USA ) ; Jacobs, Elizabeth T (Department of Epidemiology and Biostatistics, Arizona Cancer Center, Arizona College of Public Health, University of Arizona, , Tucson, Arizona, USA ) ; Baron, John A (Department of Medicine, University of North Carolina School of Medicine, , Chapel Hill, North Carolina, USA ) ; Lieberman, David A (Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Cente and Oregon Health and Science University, , Portland, Oregon, USA ) ; Murphy, Gwen (Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, , Bethesda, Maryland, USA ) ; Ladabaum, Uri (Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, , Stanford, California, USA ) ; Cross, Amanda J (Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, , Rockville, Maryland, USA ) ; Jover, Rodrigo (Unidad de Gastro ) ; Liu, Lin ; Martinez, Maria Elena ;
  • 초록  

    Objective For individuals with 1–2 small (<1 cm) low-risk colorectal adenomas, international guidelines range from no surveillance to offering surveillance colonoscopy in 5–10 years. We hypothesised that the risks for metachronous advanced neoplasia (AN) among patients with low-risk adenomas differ based on clinical factors distinct from those currently used. Design We pooled data from seven prospective studies to assess the risk of metachronous AN. Two groups with 1–2 small adenomas were defined based on guidelines from the UK (n=4516) or the European Union (EU)/US (n=2477). Results Absolute risk of metachronous AN ranged from a low of 2.9% to a high of 12.2%, depending on specific risk factor and guideline used. For the UK group, the highest absolute risks for metachronous AN were found among individuals with a history of prior polyp (12.2%), villous histology (12.2%), age ≥70 years (10.9%), high-grade dysplasia (10.9%), any proximal adenoma (10.2%), distal and proximal adenoma (10.8%) or two adenomas (10.1%). For the EU/US group, the highest absolute risks for metachronous AN were among individuals with a history of prior polyp (11.5%) or the presence of both proximal and distal adenomas (11.0%). In multivariate analyses, strong associations for increasing age and history of prior polyps and odds of metachronous AN were observed, whereas more modest associations were shown for baseline proximal adenomas and those with villous features. Conclusions Risks of metachronous AN among individuals with 1–2 small adenomas vary according to readily available clinical characteristics. These characteristics may be considered for recommending colonoscopy surveillance and require further investigation.


  • 주제어

    ADENOMA .   SURVEILLANCE .   EPIDEMIOLOGY .   COLORECTAL CANCER .   POLYP.  

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