한빛사 논문
Park, Suyeon MS1,2; Jeon, Seong Ran MD, PhD3; Kim, Hyun Gun MD, PhD3; Jung, Yunho MD, PhD4; Kwak, Min-Seob MD, PhD5; Kim, Su Young MD, PhD6; Kim, Jong Wook MD, PhD7; Nam, Seung-Joo MD, PhD8; Oh, Eun Hye MD, PhD9; Park, Seon-Young MD, PhD10; Park, Soo-Kyung MD, PhD11; Byeon, Jeong-Sik MD, PhD12; Boo, Sun-Jin PhD13; Baek, Dong Hoon MD, PhD14; Yoon, Soon Man MD, PhD15; Chun, Jaeyoung MD, PhD16; Lee, Jooyoung PhD2; Choi, Miyoung PhD17
1Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea;
2Department of Applied Statistics, Chung-Ang University, Seoul, Korea;
3Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea;
4Soonchunhyang University College of Medicine, Cheonan, Korea;
5Kyung Hee University School of Medicine, Seoul, Korea;
6Yonsei University Wonju College of Medicine, Wonju, Korea;
7Inje University College of Medicine, Goyang, Korea;
8Kangwon National University School of Medicine, Chuncheon, Korea;
9Hanyang University College of Medicine, Guri, Korea;
10Chonnam National University Medical School, Gwangju, Korea;
11Sungkyunkwan University School of Medicine, Seoul, Korea;
12University of Ulsan College of Medicine, Seoul, Korea;
13Jeju National University School of Medicine, Jeju, Korea;
14Pusan National University School of Medicine, Pusan, Korea;
15Chungbuk National University College of Medicine, Cheongju, Korea;
16Yonsei University College of Medicine, Seoul, Korea;
17National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
Correspondence: Seong Ran Jeosn, MD, PhD.
Abstract
INTRODUCTION:
This systematic review and meta-analysis evaluated the available evidence on the risk of metachronous advanced neoplasia (AN) and colorectal cancer (CRC) in patients with 3–4 nonadvanced adenomas (NAAs).
METHODS:
We searched MEDLINE, EMBASE, and Cochrane Library databases up to January 2021 for studies evaluating metachronous AN and CRC risk by comparing 3 groups (1–2 vs 3–4 vs ≥5 NAAs) at index colonoscopy. The estimates for risk of metachronous AN and CRC were evaluated using random-effects models.
RESULTS:
Fifteen studies (n = 36,375) were included. The risk of metachronous AN was significantly higher in the 3–4 NAAs group than in the 1–2 NAAs group (relative risk [RR] 1.264, 95% confidence interval [CI] 1.053–1.518, P = 0.012; I2 = 0%); there was no difference between the ≥ 5 NAAs and 3–4 NAAs groups (RR 1.962, 95% CI 0.972–3.958, P = 0.060; I2 = 68%). The risks of metachronous CRC between the 1–2 NAAs and 3–4 NAAs groups (RR 2.663, 95% CI 0.391–18.128, P = 0.317; I2 = 0%) or the 3–4 NAAs and ≥ 5 NAAs groups (RR 1.148, 95% CI 0.142–9.290, P = 0.897; I2 = 0%) were not significantly different.
DISCUSSION:
Although the risk of metachronous AN was greater in the 3–4 NAAs group than in the 1–2 NAAs group, the risk of metachronous AN and CRC between the 3–4 NAAs and ≥ 5 NAAs groups was not different. This suggests that further studies on metachronous AN and CRC risk in the 3–4 NAAs group are warranted to confirm a firm ≥5-year interval surveillance colonoscopy.
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