Background Surveillance colonoscopy after polyp removal is recommended to prevent subsequent colorectal cancer (CRC). It is known that advanced adenomas have a substantially higher risk than non-advanced ones, but optimal intervals for surveillance remain unclear. Design We prospectively followed 156 699 participants who had undergone a colonoscopy from 2007 to 2017 in a large integrated healthcare system. Using multivariable Cox proportional hazards regression we estimated the subsequent risk of CRC and high-risk polyps, respectively, according to index colonoscopy polyps, colonoscopy quality measures, patient characteristics and the use of surveillance colonoscopy. Results After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 (95% CI 4.20 to 16.59), respectively). Recurrence of high-risk polyps showed a similar risk distribution. The use of surveillance colonoscopy was associated with lower risk of CRC, with an HR of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps. Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and interval polyps in the same segments. Conclusion Patients with high-risk polyp findings were at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years. The subsite distribution of the index and recurrent high-risk polyps suggests the contribution of incomplete resection and missed lesions to the development of interval neoplasia. Data are available upon reasonable request.

中文翻译：

---

常规腺瘤和锯齿状息肉切除后结直肠肿瘤的风险：风险因素和监测使用的综合评估


背景 建议在息肉切除后进行结肠镜监测以预防随后的结直肠癌 (CRC)。众所周知，晚期腺瘤的风险明显高于非晚期腺瘤，但最佳监测间隔仍不清楚。设计 我们前瞻性地跟踪了 156 699 名参与者，他们从 2007 年到 2017 年在一个大型综合医疗系统中接受了结肠镜检查。使用多变量 Cox 比例风险回归，我们根据结肠镜检查息肉指数、结肠镜检查质量测量、患者特征和监测结肠镜检查的使用，分别估计了 CRC 和高风险息肉的后续风险。结果 经过中位随访 5.3 年，我们记录了 309 例 CRC 病例和 3053 例高危息肉病例。与初次结肠镜检查时没有息肉的参与者相比，患有高风险腺瘤和高风险锯齿状息肉的参与者在随访期间患 CRC 的风险始终较高，其中在息肉切除术后 3 年观察到的风险最高（多变量 HR 5.44（95 % CI 分别为 3.56 至 8.29) 和 8.35 (95% CI 4.20 至 16.59)。高风险息肉的复发表现出类似的风险分布。使用监测结肠镜检查与结直肠癌风险较低相关，高危息肉患者的 HR 为 0.61（95% CI 0.39 至 0.98），低危息肉患者的 HR 为 0.57（95% CI 0.35 至 0.92）。在 1548 名在指数结肠镜检查和监测结肠镜检查中均患有高危息肉的患者中，65% 的指数息肉位于近端结肠，30% 的指数息肉和间隔息肉位于同一节段。结论 发现高危息肉的患者后续发生 CRC 和高危息肉的风险较高，可能受益于 3 年内的早期监测。 指数和复发性高危息肉的亚位点分布提示不完全切除和漏诊病灶对间期瘤形成的发展的贡献。数据可根据合理要求提供。