SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Roger FAROUX
Coup de coeur :
 
 
Gastroenterology
  2016/05  
 
  2016 Apr;150(4):895-902.e5  
  doi: 10.1053/j.gastro.2015.11.046  
 
  Increased Risk of Colorectal Cancer Development Among Patients With Serrated Polyps.  
 
  Erichsen R, Baron JA, Hamilton-Dutoit SJ, Snover DC, Torlakovic EE, Pedersen L, Frøslev T, Vyberg M, Hamilton SR, Sørensen HT  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=2016+Apr%3B150%284%29%3A895-902.e5.+doi%3A+10.1053%2Fj.gastro.2015.11.046  
 
 

BACKGROUND & AIMS:

Sessile serrated adenomas/polyps (SSA/Ps) and traditional serrated adenomas (TSAs) are now distinguished from hyperplastic polyps and recognized as precursors to colorectal cancer (CRC). We studied CRC risks associated with serrated polyps.

METHODS:

By using Danish databases (1977-2009), we conducted a nationwide population-based, case-control study nested within individuals who had received colonoscopies (n = 272,342), and identified 2045 CRC cases and 8105 CRC-free individuals (controls). For each case and control, we identified the first colorectal polyp(s) that underwent a biopsy or were excised during or after the initial colonoscopy, and obtained tissue blocks for hyperplastic lesions. Four expert pathologists reviewed these lesions using current terminology for serrated polyps. We used logistic regression to compute odds ratios (ORs) to associate the risk of CRC with polyp type and estimated the absolute risks by multiplying the risk in patients with no polyps by these ORs.

RESULTS:

Seventy-nine cases and 142 controls had SSA/Ps (OR, 3.07; 95% confidence interval [CI], 2.30-4.10). SSA/Ps with cytology markers of dysplasia were associated with a particularly high OR (4.76; 95% CI, 2.59-8.73). Women with SSA/P had a higher risk for CRC than men with SSA/P (OR for women, 5.05; 95% CI, 3.05-8.37 vs OR for men, 2.18; 95% CI, 1.24-3.82); patients with SSA/P proximal to the splenic flexure had the highest risk for CRC (OR, 12.42; 95% CI, 4.88-31.58). The OR for CRC was 4.84 in the 14 cases vs 17 controls with TSAs (95% CI, 2.36-9.93), 2.51 in the 757 cases vs 1698 controls with conventional adenomas (95% CI, 2.25-2.80), and 1.30 in the 55 cases vs 235 controls with hyperplastic polyps (95% CI, 0.96-1.77). The 10-year risk for CRC was 4.4% for patients with SSA/P with dysplasia, 4.5% for patients with TSAs, and 2.3% for patients with conventional adenomas.

CONCLUSION:

Patients with SSA/P or TSA are at increased risk for CRC; their level of risk is similar to or higher than that of patients with conventional adenomas.

 

 
Question posée
 
Les polypes festonnés sont-ils associés à un sur risque de cancer colorectal ?
 
Question posée
 
Sur cette large étude rétrospective, les polypes festonnés sessiles et les adénomes festonnés traditionnels sont associés à un sur risque de cancer, au moins aussi élevé que les adénomes classiques.
 
Commentaires

Les adénomes festonnés, de détection endoscopique parfois difficiles et qui peuvent représenter  plus d’un tiers des polypes colorectaux, confirment  leur risque de dégénérescence élevé. Leur reconnaissance par les endoscopistes et les anatomopathologistes est essentielle .Selon les recommandations récentes de l’HAS, la surveillance des polypes adénomateux festonnés après résection complète suit la même règle que pour les adénomes classiques.

 
www.snfge.org