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Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden
The BMJ ( IF 105.7 ) Pub Date : 2021-05-04 , DOI: 10.1136/bmj.n877
Mingyang Song , Louise Emilsson , Bjorn Roelstraete , Jonas F Ludvigsson

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 68 060 patients with CRC and 333 753 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% (5742/68 060) in cases and 5.7% (18 860/333 753) 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.

中文翻译:

大肠息肉患者一级亲属的大肠癌风险:瑞典的全国病例对照研究

目的评估患有前体病变(息肉)的患者一级亲属(父母和全兄弟姐妹)患结直肠癌(CRC)的风险。设计案例对照研究。在瑞典建立与多代登记册和胃肠道ESPRESSO(在瑞典流行病学方面被组织病理学报告所加强)的链接。参与者68 060例CRC患者和333 753例对照者。主要结局指标根据一级结直肠息肉的一级亲属的数量以及一级亲属在诊断时的息肉组织学和年龄,对CRC进行多变量调整比值比。还根据CRC诊断时的年龄进行了亚组分析,并评估了结直肠息肉家族史和CRC家族史的联合关联。结果在校正了CRC和其他协变量的家族史后,与结直肠息肉相关的一级相关性(病例中为8.4%(5742/68 060),对照组中为5.7%(18 860/333 753))与更高的相关性。发生CRC的风险(赔率1.40,95%置信区间1.35至1.45)。增生性息肉的比值比范围为1.23至肾小管性腺瘤的比值比范围为1.44。为了更好地了解这种风险,根据息肉的家族史根据瑞典2018年全国CRC发病率估算了特定年龄的结肠癌和直肠癌绝对风险。例如,有和没有大肠息肉家族史的60-64岁个体的结肠癌绝对风险分别为,男性分别为94.3和67.9 / 100 000,女性为89.1和64.1 / 100 000。息肉的家族史与CRC风险之间的关联因息肉的一级亲属数量增加(≥2个一级亲属:1.70,1.52至1.90,趋势P <0.001)和息肉诊断时年龄的降低(<50)而得到加强年:1.77,1.57至1.99,趋势P <0.001)。发现在50岁之前被诊断为CRC的早期发作尤其密切(≥2个一级亲属:3.34、2.05至5.43,对于CRC诊断年龄的异质性,P = 0.002)。在联合分析中,具有两个或两个以上一级息肉但没有息肉的人的CRC的优势比为1.79(1.52至2.10),其中一个一级相对于CRC但没有息肉的人的CRC的比值是1.70(1.65至1.76),息肉和CRC的两个或多个一级亲属的比率为5.00(3.77至6.63)(相互作用P <0.001)。结论校正结直肠癌的家族史后,结直肠息肉患者的兄弟姐妹和儿童仍然有较高的结直肠癌风险,尤其是早期发病的结直肠癌。对于息肉患者的一级亲属,可考虑对CRC进行早期筛查。
更新日期:2021-05-04
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