瑞典卡罗林斯卡研究所Jonas F Ludvigsson团队研究了结直肠息肉患者一级亲属患结直肠癌的风险。2021年5月4日，该研究发表在《英国医学杂志》上。
为了评估结直肠癌前病变（息肉）患者的一级亲属（父母和兄弟姐妹）患结直肠癌（CRC）的风险，研究组在瑞典进行了一项组织病理学队列的病例对照研究。共招募了68060例结直肠癌患者和333753名匹配的对照者。根据结直肠息肉一级亲属的数量、息肉的组织学和一级亲属的诊断年龄，多变量校正CRC的优势比。根据年龄进行分组分析，评估结肠息肉家族史与CRC家族史的联合关系。
校正CRC家族史和其他协变量后，大肠息肉一级亲属关系（病例组为8.4%，对照组为5.7%）与CRC的高风险相关，优势比为1.40。增生性息肉的优势比为1.23，管状腺瘤的优势比为1.44。为了更好地评估这一风险，根据瑞典2018年全国CRC发病率，根据息肉家族史估计结肠癌和直肠癌的年龄特异性绝对风险。例如，60-64岁有和没有结肠息肉家族史的男性患结肠癌的绝对风险分别为94.3/10万和67.9/10万，女性分别为89.1/10万和64.1/10万。
息肉家族史与CRC风险之间的相关性随着息肉一级亲属数量的增加和息肉诊断年龄下降而加强。在50岁以前诊断的早发性CRC中相关性最强。在联合分析中，有两个及以上一级亲属患有息肉但没有CRC的个体中CRC的优势比为1.79，有一个一级亲属患有CRC但没有息肉的个体中优势比为1.70，有两个及以上一级亲属同时患有息肉和CRC的个体中优势比为5.00。
综上，校正CRC家族史后，结直肠息肉患者的兄弟姐妹和子女仍有较高的CRC风险，尤其是早发CRC。息肉患者的一级亲属可考虑早期筛查CRC。
附：英文原文
Title: Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden
Author: Mingyang Song, Louise Emilsson, Bjorn Roelstraete, Jonas F Ludvigsson
Issue&Volume: 2021/05/04
Abstract:
Objective To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC.
Design Case-control study.
Setting Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden.
Participants 68060 patients with CRC and 333753 matched controls.
Main outcome measures Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC.
Results After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4% (5742/68060) in cases and 5.7% (18860/333753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (≥2 first degree relatives: 1.70, 1.52 to 1.90, P<0.001 for trend) and decreasing age at polyp diagnosis (<50 years: 1.77, 1.57 to 1.99, P<0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years (≥2 first degree relatives: 3.34, 2.05 to 5.43, P=0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P<0.001 for interaction).
Conclusions After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.
DOI: 10.1136/bmj.n877
Source: https://www.bmj.com/content/373/bmj.n877
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
