Kolon polipleri sayı ve büyüklüğü malignite göstergesi olabilir mi?

Öz

Giriş ve Amaç: Önceden var olan kolorektal poliplerden, özellikle adenomlardan birkaç yıl sonra gelişen kolorektal karsinom gastrointestinal sistemin maligniteleri olup üçüncü en sık görülen kanserdir. Kolorektal karsinom insidans ve mortalitesi dünya çapında belirgin değişiklik göstermektedir. Bu coğrafi farklılık diyete, çevresel maruziyete ve genetik yatkınlığa bağlı gibi gözükmektedir. Bölgemizde kolorektal poliplerin histomorfolojik özelliklerinin değerlendirilmesi ve adenomatöz-nonadenomatöz poliplerin risk katmanlaşmasının belirlenmesi amaçlandı. Gereç ve Yöntem: Fırat Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı’nda Haziran 2016-Aralık 2016 tarihleri arasında 6 aylık bir periyotta kolonoskopi işlemi uygulanan toplam 827 kişiden kolonik polip saptanan 305 hastanın verileri retrospektif olarak incelendi. Hastaların demografik verileri, patoloji ve kolonoskopi bulguları kaydedildi. Poliplerin özellikleri; kalın barsakta dağılımları, lokalizasyonu, büyüklükleri, sayısı, histolojik tipleri kaydedildi. Polip büyüklükleri <5 mm, 5-10 mm arası ve >10 mm olmak üzere 3 gruba ayrıldı. Polip sayıları 5’ten az, 5-10 arası ve 10’dan fazla olarak 3 sınıfa ayrıldı. Histoloji tipleri nonadenömatöz (hiperplastik), adenömatöz ve adenokarsinom olarak sınıflandırıldı. Yüksek derecede displazi ve / veya invaziv kanser bulunan, boyu 1 cm veya daha büyük adenomlar, villöz histoloji olanlar ileri adenom (advanced adenom) olarak sınıflandırıldı. Bulgular: Toplam 827 hastaya kolonoskopi yapılmış ve 305’inde (%36,9) polip saptanmıştı. Polip saptanan olguların 100’ü (%32,8) kadın, 205’i (%67,2) erkekti. Yaş ortalaması 57,6±13,6 (min-max: 18-88) yıldı. Polip patolojik dağılımı 115’i (%37,7) hiperplastik, 173’ü (%56,7) adenomatöz, 17’si (%5,6) adenokarsinom olarak saptandı. Adenömatöz poliplerin 106’sı (%61,2) ileri adenom özellikteydi. Polipler hastaların 71’inde (%23,3) sağ kolon yerleşimli iken, 204’ünde (%66,9) sol kolon, 30’unda (%9,8) pankolonik yerleşimliydi. Adenomların çoğu (%64) sol kolon yerleşimliydi ve tüm poliplerin %27,9, %24,6 ve %2,3’ü sırasıyla tübüler, tübülovillöz, villöz adenomdu. Sonuç: Erkek cinsiyet, ileri yaş ve artan polip sayısı, ileri adenom ve adenokarsinom gelişimi ile ilişkili bulundu. Bu grup hastaların yakın takip ve izlemi gerekmektedir. Ülkemizde polip özelliklerinin belirlenmesi amaçlı, geniş katılımlı çok merkezli prospektif çalışmalara gereksinim vardır.

Anahtar Kelimeler

• Polip,adenom,kolorektal karsinom

Can the number and size of colon polyps be indicative of malignancy?

Öz

Background and Aims: Colorectal carcinoma is a gastrointestinal cancer that originates from colorectal polyps, particularly from adenomas, and it is the third most common cancer worldwide. The incidence and mortality rate of colorectal carcinoma markedly vary worldwide. These geographical differences may be related to dietary habits, environmental factors, and genetic susceptibility. In this study, the histomorphological features of colorectal polyps were evaluated in our region (Elazığ) and the risk stratification of adenomatous and nonadenomatous polyps was determined. Materials and Methods: Subjects who underwent colonoscopy during a 6-month period from June 2016 to December 2016 at the Gastroenterology Department of Firat University Hospital were retrospectively studied. Among 827 subjects, the data of 305 subjects who had colonic polyps were examined. Demographic features and colonoscopic and pathologic findings of the subjects were recorded. Polyp features including colonic distribution, localization, number, size, and histologic type were recorded. Polyps were divided into three subgroups based on their size as follows: <5 mm, between 5 and 10 mm, and >10 mm. Polyps were further divided into three subgroups based on their number as follows: <5, from 5 to 10, and >10 polyps. The histological types of polyps were classified as nonadenomatous (hyperplastic) adenomatous and adenocarcinoma. Polyps with a high degree of dysplasia and/ or invasive carcinoma, a size of >10 mm, and of the villous histological type were classified as advanced adenomas. Results: Among 827 subjects, 305 (36.9%) had colonic polyps. Among these, 100 (32.8%) were females and 205 (67.2%) were males. Their mean age was 57.6 ± 13.6 years (min–max: 18–88). Based on the histological type, 115 subjects (37.7%) had nonadenomatous polyps, 173 (56.7%) had adenomatous polyps, and 17 (5.6%) had adenocarcinomas. Among the 173 subjects with adenomatous polyps, 106 (61.2%) had advanced adenomas. The polyps were pancolonic in 30 subjects (9.8%) and located in the right colon in 71 subjects (23,3%) and in the left colon in 204 subjects (66.9%). Most of adenomas (64%) were located in the left colon. Among all polyps, 27.9%, 24.6%, and 2.3% were classified as tubular, tubulovillous, and villous adenomas, respectively. Conclusions: Male gender, advanced age, and increasing polyp number were found to be related to the development of advanced adenomas and adenocarcinomas. The close monitoring and follow-up of this group of patients are required. Prospective multicenter studies with a large number of patients are needed to determine the features of colonic polyps in Turkey.

Anahtar Kelimeler

• Polyp,adenoma,colorectal carcinoma

Kaynakça

1. Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut Epub 2016 Jan 27.
2. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010;127:2893-917.
3. Winawer SJ, Sherlock P. Colorectal cancer screening. Best Prac Res Clin Gastroenterol 2007;21:1031-48.
4. Eddy DM. Screening for colorectal cancer. Ann Intern Med. 1990;113:373-84.
5. Parkin DM, Pisani, P, Ferlay, J. Global cancer statistics. CA Cancer J Clin 1999;49:33-64.
6. Ashktorab H, Nouraie M, Hosseinkhah F, et al. A 50-year review of colorectal cancer in African Americans: implications for prevention and treatment. Dig Dis Sci 2009;54:1985-90.
7. Sung JJ, Ng SC, Chan FK, et al; Asia Pacific Working Group. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut 2015;64:121-32.
8. Cherian T, Mahadevan P, Chandramathi S, et al. Increasing cancer incidence in a tertiary care hospital in a developing country, India. Indian J Cancer 2015;52:133-8.

9. Trimbath JD, Giardiello FM. Review article: Genetic testing and counselling for hereditary colorectal cancers. Aliment Pharmacol Ther 2002;16:1843-57.
10. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993;329:1977-81.
11. Risio M. The natural history of adenomas. Best Pract Res Clin Gastroenterol 2010;24:271-80.
12. Paik JH, Jung EJ, Ryu CG, Hwang DY. Detection of polyps after resection of colorectal cancer. Ann Coloproctol 2015;31:182-6.
13. Brenner H, Hoffmeister M, Stegmaier C, et al. Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840.149 screening colonoscopies. Gut 2007;56:1585-9.
14. Atkin WS, Saunders BP, British Society for Gastroenterology; Association of Coloproctology for Great Britain and Ireland. Surveillance guidelines after removal of colorectal adenomatous polyps. Gut 2002;51:V6-9.
15. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658-62.
16. Winawer SJ, Zauber AG, Gerdes H, et al. Risk of colorectal cancer in the families of patients with adenomatous polyps. National Polyp Study Workgroup. N Engl J Med 1996;334:82-7.
17. Strum WB. Colorectal adenomas. N Engl J Med 2016;374:1065-75.
18. Fairley KJ, Li J, Komar M, et al. Predicting the risk of recurrent adenoma and incident colorectal cancer based on findings of the baseline colonoscopy. Clin Transl Gastroenterol 2014;5:e64.
19. Müller AD, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32.702 veterans. Ann Intern Med 1995;123:904-10.
20. Burt RW, DiSario JA, Cannon-Albright L. Genetics of colon cancer: impact of inheritance on colon cancer risk. Annu Rev Med 1995; 46:371-9.
21. Ashktorab H, Laiyemo AO, Lee E, et al. Prevalence and features of colorectal lesions among Hispanics: A hospital-based study. World J Gastroenterol 2015;21:13095-100.
22. Corley DA, Jensen CD, Marks AR, et al. Variation of adenoma prevalence by age, sex, race, and colon location in a large population: implications for screening and quality programs. Clin Gastroenterol Hepatol 2013;11:172-80.
23. Wang FW, Hsu PI, Chuang HY, et al. Prevalence and risk factors of asymptomatic colorectal polyps in Taiwan. Gastroenterol Res Pract. 2014;2014:985205.
24. Laird-Fick HS, Chahal G, Olomu A, et al. Colonic polyp histopathology and location in a community-based sample of older adults. BMC Gastroenterol 2016;16:90.
25. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.
26. Nguyen SP, Bent S, Chen YH, Terdiman JP. Gender as a risk factor for advanced neoplasia and colorectal cancer: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2009;7:676-81.e1-3.
27. Odom SR, Duffy SD, Barone JE, et al. The rate of adenocarcinoma in endoscopically removed colorectal polyps. Am Surg. 2005;71:1024-6.
28. Winawer SJ, Zauber AG, O’Brien MJ, et al. The National Polyp Study. Design, methods, and characteristics of patients with newly diagnosed polyps. The National Polyp Study Workgroup. Cancer 1992;70(5 Suppl):1236-45.