High-grade dysplasia and invasive carcinoma in colorectal adenomas: a multivariate analysis of the impact of adenoma and patient characteristics
| Autor: | Michael Gschwantler, Stephan Kriwanek, Bernhard Göritzer, Erich Langner, Hans Feichtinger, Eva Brownstone, Werner Weiss, C Schrutka-Kölbl |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Adenoma
Adult Male medicine.medical_specialty Pathology Adolescent Colonoscopy Rectum Gastroenterology Malignant transformation Internal medicine Adenoma Villous Odds Ratio medicine Humans Clinical significance Risk factor Aged Aged 80 and over Hepatology medicine.diagnostic_test business.industry Odds ratio Middle Aged medicine.disease digestive system diseases Logistic Models medicine.anatomical_structure Dysplasia Multivariate Analysis Female Colorectal Neoplasms business |
| Zdroj: | European Journal of Gastroenterology & Hepatology. 14:183-188 |
| ISSN: | 0954-691X |
| DOI: | 10.1097/00042737-200202000-00013 |
| Popis: | Most colorectal carcinomas develop from preformed adenomas, but only a minority of adenomas undergo malignant transformation. The clinical significance of polyps of size0.5 cm is controversial. The primary goal of this study was to assess the independent risk factors of adenoma and patient characteristics associated with advanced pathological features (APF; i.e. high-grade dysplasia or invasive carcinoma) in colorectal adenomas. A secondary goal was to assess the malignant potential of adenomas with a diameter of0.5 cm.Patients who underwent total colonoscopy at our Medical Department between 1978 and 1996 and had at least one colorectal adenoma were considered for this study. Patients with a history of colorectal cancer, prior polypectomy or colorectal surgery were excluded. A total of 7590 adenomas removed from 4216 patients were included in this analysis. Logistic regression analysis was used to study the impact of different adenoma and patient characteristics on the risk of APF.Size proved to be the most important risk factor for APF. The percentage of adenomas with APF was 3.4%, 13.5% and 38.5% for adenomas of diameter0.5 cm, 0.5-1 cm and1 cm, respectively. Villous or tubulovillous histology, left-sided location and ageor= 60 years were also associated with APF, whereas sex and number of adenomas had no significant impact. Logistic regression analysis revealed that the risk of an adenoma containing APF was best described by a model incorporating the factors size, location, age, and the age by histology interaction. In the class of adenomas with diameter0.5 cm, no invasive carcinoma was found, but 3.4% of adenomas had high-grade dysplasia.The risk of a colorectal adenoma containing APF can be estimated only by a complex model taking into account several adenoma and patient characteristics. Size, histological type, location and age are independent risk factors for APF in colorectal adenomas. As a considerable percentage of adenomas with diameter0.5 cm contain high-grade dysplasia, the clinical conclusion from our study is that all adenomas, including those with diameter0.5 cm, should be removed whenever possible. |
| Databáze: | OpenAIRE |
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