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Asociación de los hallazgos de adenoma de la colonoscopia con la incidencia de cáncer colorrectal a largo plazo
Benjamin Click1, Paul F Pinsky2, Tom Hickey3
1Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA
|May 26, 2018
Resumen
Las personas con adenomas avanzados encontrados durante la colonoscopia enfrentan un riesgo significativamente mayor de desarrollar cáncer colorrectal (CRC) y muerte por CRC. Los adenomas no avanzados no parecen aumentar el riesgo de CCR.
Área de la Ciencia:
- Gastroenterología
- En el campo de la oncología
- La medicina preventiva
Sus antecedentes:
- Los pólipos adenomatosos requieren vigilancia por colonoscopia para prevenir el cáncer colorrectal (CRC).
- La asociación a largo plazo entre los hallazgos de la colonoscopia y la posterior incidencia de CCR sigue sin estar clara.
Objetivo del estudio:
- Para comparar la incidencia de cáncer colorrectal a largo plazo basado en los hallazgos de adenoma durante la colonoscopia.
Principales métodos:
- Un estudio de cohorte prospectivo multicéntrico en el que participaron 15.935 participantes del ensayo de cáncer de próstata, pulmón, colorrectal y ovario (PLCO).
- Los participantes se sometieron a una colonoscopia después de un resultado positivo de sigmoidoscopia flexible (FSG), con hallazgos categorizados como adenoma avanzado, adenoma no avanzado o sin adenoma.
- El seguimiento de la incidencia y la mortalidad por CCR se produjo durante una mediana de 12,9 años.
Principales resultados:
- Los participantes con adenomas avanzados tenían una incidencia significativamente mayor de CRC (20,0 por 10.000 personas-año) en comparación con los que no tenían adenomas (7,5 por 10.000 personas-año).
- Los adenomas avanzados se asociaron con un aumento de 2,7 veces el riesgo de CCR y un aumento de 2,6 veces el riesgo de muerte por CCR.
- No se observaron diferencias significativas en el riesgo o la mortalidad por CCR entre los participantes con adenomas no avanzados y los que no tenían adenomas.
Conclusiones:
- Los adenomas avanzados identificados durante la colonoscopia están relacionados con un riesgo significativamente elevado a largo plazo de cáncer colorrectal (CRC) y mortalidad por CRC.
- La presencia de adenomas no avanzados puede no estar asociada con un mayor riesgo de desarrollar CCR.
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