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原文
Long-Term Colorectal-Cancer Mortality afterAdenoma Removal Magnus Løberg, M.D., Mette Kalager, M.D.,Ph.D., Øyvind Holme, M.D., Geir Hoff, M.D., Ph.D., Hans-Olov Adami, M.D.,Ph.D., and Michael Bretthauer, M.D., Ph.D. N Engl J Med 2014; 371:799-807August 28,2014DOI: 10.1056/NEJMoa1315870 Background Although colonoscopic surveillance ofpatients after removal of adenomas is widely promoted, little is known aboutcolorectal-cancer mortality among these patients. Methods Using the linkage of the Cancer Registryand the Cause of Death Registry of Norway, we estimated colorectal-cancermortality among patients who had undergone removal of colorectal adenomasduring the period from 1993 through 2007. Patients were followed through 2011.We calculated standardized incidence-based mortality ratios (SMRs) using ratesfor the Norwegian population at large for comparison. Norwegian guidelinesrecommended colonoscopy after 10 years for patients with high-risk adenomas(adenomas with high-grade dysplasia, a villous component, or a size ≥10 mm) andafter 5 years for patients with three or more adenomas; no surveillance wasrecommended for patients with low-risk adenomas. Polyp size and exact numberwere not available in the registry. We defined high-risk adenomas as multipleadenomas and adenomas with a villous component or high-grade dysplasia. Results We identified 40,826 patients who had hadcolorectal adenomas removed. During a median follow-up of 7.7 years (maximum,19.0), 1273 patients were given a diagnosis of colorectal cancer. A total of398 deaths from colorectal cancer were expected and 383 were observed, for anSMR of 0.96 (95% confidence interval [CI], 0.87 to 1.06) among patients who hadhad adenomas removed. Colorectal-cancer mortality was increased among patientswith high-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). 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.) |
