The American journal of gastroenterology · 2026
Impact of Baseline Synchronous Adenoma Burden on the Risk of Metachronous Advanced Neoplasia.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chang Wei-Yuan, Chang Li-Chun, Chou Chu-Kuang, Tseng Cheng-Hao, Chang Chi-Yang, Chen Chi-Yi, Hsu Wen-Feng, Chen Yen-Nien, Chen Chieh-Chang, Tu Chia-Hung, Chen Mei-Jyh, Lee Ching-Tai, Chen Po-Yueh, Wu Ming-Shiang, Chiu Han-Mo
Аннотация
BACKGROUND AND STUDY AIM: Individuals classified as "high-risk" at initial colonoscopy face an elevated risk of metachronous advanced colorectal neoplasms (meta-ACRN), but risk heterogeneity within this group remains unclear. We aimed to stratify meta-ACRN risk among high-risk individuals based on their synchronous neoplastic burden.
PATIENTS AND METHODS: This prospective cohort study utilized data from a Taiwanese multicenter trial (NCT03373136). We included participants with conventional high-risk findings (3-10 low-risk adenomas [LRAs] or any high-risk adenoma [HRA]). The primary outcome was meta-ACRN incidence. Adjusted incidence rate ratios (aIRRs) were calculated using multivariable Poisson regression, stratifying patients by baseline synchronous burden, with the 3-4 LRAs group as reference.
RESULTS: Among 730 participants undergoing surveillance (mean follow-up 2.4 years), 81 (11.1%) developed meta-ACRN. A single HRA did not significantly increase meta-ACRN risk compared to 3-4 LRAs (aIRR 2.02; 95% confidence interval(CI) 0.83-4.90). However, risk escalated significantly when the index HRA was accompanied by synchronous LRA(s) (aIRR 2.56; 95% CI 1.24-5.39) or synchronous HRA(s) (aIRR 3.93; 95% CI 1.77-8.73) (P for trend = .001). Furthermore, applying a more severe modified advanced adenoma criteria, an identical dose-response pattern emerged, culminating in a >5-fold increased risk for severe metachronous outcomes (aIRR 5.23; 95% CI 1.50-18.22) when accompanied by synchronous HRA(s) .
CONCLUSIONS: Meta-ACRN risk within the conventional high-risk population is highly heterogeneous and driven primarily by baseline synchronous neoplastic burden. Surveillance intervals should be personalized, reserving shorter intervals for patients with advanced lesions accompanied by synchronous adenomas.
PATIENTS AND METHODS: This prospective cohort study utilized data from a Taiwanese multicenter trial (NCT03373136). We included participants with conventional high-risk findings (3-10 low-risk adenomas [LRAs] or any high-risk adenoma [HRA]). The primary outcome was meta-ACRN incidence. Adjusted incidence rate ratios (aIRRs) were calculated using multivariable Poisson regression, stratifying patients by baseline synchronous burden, with the 3-4 LRAs group as reference.
RESULTS: Among 730 participants undergoing surveillance (mean follow-up 2.4 years), 81 (11.1%) developed meta-ACRN. A single HRA did not significantly increase meta-ACRN risk compared to 3-4 LRAs (aIRR 2.02; 95% confidence interval(CI) 0.83-4.90). However, risk escalated significantly when the index HRA was accompanied by synchronous LRA(s) (aIRR 2.56; 95% CI 1.24-5.39) or synchronous HRA(s) (aIRR 3.93; 95% CI 1.77-8.73) (P for trend = .001). Furthermore, applying a more severe modified advanced adenoma criteria, an identical dose-response pattern emerged, culminating in a >5-fold increased risk for severe metachronous outcomes (aIRR 5.23; 95% CI 1.50-18.22) when accompanied by synchronous HRA(s) .
CONCLUSIONS: Meta-ACRN risk within the conventional high-risk population is highly heterogeneous and driven primarily by baseline synchronous neoplastic burden. Surveillance intervals should be personalized, reserving shorter intervals for patients with advanced lesions accompanied by synchronous adenomas.