Serrated Polyposis Syndromeの最新知見

Latest Opinion of Serrated Polyposis Syndrome

要旨●近年大腸に鋸歯状腫瘍の多発するSPSの報告が散見されるようになってきた．筆者らは当院で経験したSPSについて発生率や臨床病理学的所見，予後の検討を行った．33例のSPS患者を経験し，発生率は0.06%であった．癌は5例に認め，2例はT1以深癌であった．経過観察症例で，Tis癌を1例に認めたが，内視鏡治療にて根治可能であった．手術拒否の原病死を1例に認めたが，その他の死亡例がないことから，SPSは大腸癌の高リスク疾患ではあるものの，適切な治療計画とサーベイランスによって，疾患のコントロールが可能であることが示唆された．

　SPS（serrated polyposis syndrome）, formerly known as hyperplastic polyposis syndrome, is the most common colorectal polyposis syndrome and is characterized by an accumulation of SPs（serrated polyps）and adenomas associated with an increased risk of both prevalent and incident CRC（colorectal cancer）. This study aimed to clarify the clinicopathological features and prognosis of SPS in Japanese patients. We retrieved records of patients diagnosed with HPS（hepatopulmonary syndrome）from April 2008 to December 2019 from the endoscopy database of Hiroshima University Hospital. The data collected from the database and the questionnaires included patient age, sex, number of hyperplastic/serrated polyps and tubular adenomas, size of the largest polyp, polyp location, resection for polyps, the coexistence of HPS with CRC, the diagnostic criterion, and prognosis met. Of the 54,622 patients who underwent colonoscopy, 33（0.06%）patients met the criteria for SPS. In our institution, among the 16 patients followed up for more than 5 years, only one patient has this cancer. One patient died from T1 CRC, and the other patients are alive. In conclusion, SPS is a high-risk disease of CRC ; however, apposite endoscopic management can be prevented in colorectomy.