Síndrome metabólico, pólipos e cancro colorectal: uma associação nefasta

Existem vários factores de risco comuns entre doenças cardiovasculares e o desenvolvimento de neoplasias. A resistência à insulina e hiperinsulinémia, elemento essencial na génese da síndrome metabólica (SM), tem sido considerada factor de risco da carcinogénese colo-rectal. De facto, estudos recentes de países asiáticos mostraram que a SM está associada a neoplasias colo-rectais. No entanto, não existe informação suficiente em países ocidentais ou europeus acerca da associação entre esta Síndrome e adenomas ou adenocarcinoma colo-rectal. Com este estudo, pretendemos investigar a associação entre SM e adenomas/adenocarcinoma colo-rectal, numa população portuguesa. Na nossa série, encontrou-se uma associação estatisticamente significativa entre SM e adenomas/adenocarcinoma colo-rectal. Do nosso conhecimento, trata-se do primeiro estudo a demonstrar esta associação no nosso País. Sugerem-se estudos futuros multicêntricos noutros países ocidentais com elevada prevalência de SM, que avaliem a necessidade de rastreio do cancro colo-rectal nesta população específica de doentes.

Autores e Afiliações:

Daniel Trabulo, Suzane Ribeiro, Cláudio Martins, CristinaTeixeira, Cláudia Cardoso, João Mangualde, Ricardo Freire, Élia Gamito, Ana L Alves, Fátima Augusto, Ana P Oliveira, Isabelle Cremers.

Serviço de Gastrenterologia, Hospital de São Bernardo, Centro Hospitalar de Setúbal, 2910-446 Setúbal, Portugal

Abstract:

AIM: to evaluate the association of metabolic syndrome (MS) and colorectal cancer and adenomas in a Western country, where the incidence of MS is over 27%.

METHODS: This was a prospective study between March 2013 and March 2014. MS was diagnosed according to the National Cholesterol Education Program-ATP III. Demographic characteristics, anthropometric measurements, metabolic risk factors, and colonoscopic pathologic findings were assessed in patients with MS (group 1) who underwent routine colonoscopy at our department. This data was compared with consecutive patients without metabolic syndrome (group 2), with no differences regarding sex and age. Patients with incomplete colonoscopy, family history, or past history of colorectal neoplasm were excluded. Informed consent was obtained and the ethics committee approved this study. Statistical analysis was performed using Student’s t -test and χ2 test, with a P value ≤ 0.05 being considered statistically significant.

RESULTS: Of 258 patients, 129 had MS; 51% males; mean-age 67.1 years (50 87). Among the MS group, 94% had high blood pressure, 91% had increased waist circumference, 60% had diabetes, 55% had low high-density lipoprotein cholesterol level, 50% had increased triglyceride level, and 54% were obese [body mass index (BMI) 30 kg/m2]. 51% presented 4 criteria of MS. MS was associated with increased prevalence of adenomas (43% vs 25%, p = 0.004) and colorectal cancer (13% vs 5%, p = 0.027), compared with patients without MS. MS was also positively associated with multiple (≥ 3) adenomas (35% vs 9%, p = 0.024) and sessile adenomas (69% vs 53%, p = 0.05). No difference existed between location (p = 0.086), grade of dysplasia (p = 0.196), or size (p= 0.841) of adenomas. In addition, no difference was found between BMI (p = 0.078), smoking (p = 0.146), alcohol consumption (p = 0.231), and the presence of adenomas.

CONCLUSION: MS is positively associated with adenomas and colorectal cancer. However, there is not enough information in western European countries to justify screening in patients with MS. To our knowledge, no previous study has has evaluated this association in Portuguese patients.

Revista: World Journal of Gastroenterology 2015 May 7; 21(17): 5320-5327

Link: http://www.wjgnet.com/1007-9327/full/v21/i17/5320.htm