大连NEJM:腺瘤切除后长期的结直肠癌的死亡率（独家编译）
NEJM:腺瘤切除后长期的结直肠癌的死亡率（独家编译）
Long-Term Colorectal-Cancer Mortality after Adenoma Removal
腺瘤切除后长期的结直肠癌的死亡率
BACKGROUND
Although colonoscopic surveillance of patients afterremoval of adenomas is widely promoted, little is known about colorectal-cancermortality among these patients.
背景
虽然在腺瘤切除后应用结肠镜筛查患者被广泛的应用，但是对于这些患有结直肠癌患者的死亡率知之甚少。
METHODS
Using the linkage of the Cancer Registry and the Cause ofDeath Registry of Norway, we estimated colorectal-cancer mortality amongpatients who had undergone removal of colorectal adenomas during the periodfrom 1993 through 2007. Patients were followed through 2011. We calculatedstandardized incidence-based mortality ratios (SMRs) using rates for theNorwegian population at large for comparison. Norwegian guidelines recommendedcolonoscopy after 10 years for patients with high-risk adenomas (adenomas withhigh-grade dysplasia, a villous component, or a size ≥10 mm) and after 5 yearsfor patients with three or more adenomas; no surveillance was recommended forpatients with low-risk adenomas. Polyp size and exact number were not availablein the registry. We defined high-risk adenomas as multiple adenomas andadenomas with a villous component or high-grade dysplasia.
方法
使用挪威癌症注册和死亡因素注册之间的关联，我们对1993年-2007年之间接受过结直肠腺瘤切除的患者进行了结直肠死亡率的评估。在2011年对患者进行了随访。我们使用挪威整体人口SMRs（标准化死亡比）作为对比，（对这些患者）评估了SMRs。挪威相关指南建议具有高风险腺瘤（高分化发育异常的腺瘤，覆盖有绒毛的部分，或者≥10 mm）的患者10年后进行结肠镜复查,具有2个或多个腺瘤的患者建议5年后复查，对于低风险的腺瘤患者没有没有建议复查。息肉大小和精确的数量没有在注册的数据中获得。我们定义以下高风险腺瘤：多个腺瘤和覆盖有绒毛的腺瘤，或者高分化异常腺瘤。
RESULTS
We identified 40,826 patients who had had colorectaladenomas removed. During a median follow-up of 7.7 years (maximum, 19.0), 1273patients were given a diagnosis of colorectal cancer. A total of 398 deathsfrom colorectal cancer were expected and 383 were observed, for an SMR of 0.96(95% confidence interval [CI], 0.87 to 1.06) among patients who had hadadenomas removed. Colorectal-cancer mortality was increased among patients withhigh-risk adenomas (expected deaths, 209; observed deaths, 242; SMR, 1.16; 95%CI, 1.02 to 1.31), but it was reduced among patients with low-risk adenomas(expected deaths, 189; observed deaths, 141; SMR, 0.75; 95% CI, 0.63 to 0.88).
结果
我们确认了40826例接受过结直肠腺瘤切除的患者。在中位数7.7年（最大，19.0）随访期间，1273例患者被诊断为结直肠癌。预计总共会有398例结肠癌患者死亡，实际观察到383例患者死亡，在切除腺瘤的患者中SMR是0.96（95%置信区间[CI] ,0.87 - 1.06）。结直肠癌死亡率在高风险腺瘤的患者中升高（预计死亡数，209，观察到的死亡数，242；SMR,1.16, 95% CI, 1.02 -1.31），但是在低风险腺瘤的患者中降低了（预计死亡数， 189; 观察到的死亡数， 141; SMR, 0.75; 95% CI, 0.63 - 0.88）。
CONCLUSIONS
After a median of 7.7 years of follow-up,colorectal-cancer mortality was lower among patients who had had low-riskadenomas removed and moderately higher among those who had had high-riskadenomas removed, as compared with the general population. (Funded by theNorwegian Cancer Society and others.)
结论
与一般人群相比，中位数7.7年的随访后，结直肠癌死亡率在低风险腺瘤切除的患者中较低，在高风险腺瘤切除的患者中中度升高。
原文：N Engl J Med 2014; 371:799-807August 28, 2014DOI: 10.1056/NEJMoa1315870
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