结肠镜监测间隔是基于息肉切除后发生异时性结直肠癌（CRC）的预测风险。然而，由于许多患者存在多个息肉，对每种息肉亚型的风险估计非常困难。为了实现每种息肉亚型的风险估计，我们研究了基于共同发现的存在或缺失的亚组的异时性CRC风险。在荷兰CRC筛查计划中，我们对2014年至2020年间阳性粪便免疫化学检测后进行的高质量筛查结肠镜检查进行了研究，应用Cox回归分析评估基线结肠镜检查结果与异时性CRC之间的关联。对于我们的主要结局，我们将每个患者分配到基线结肠镜检查中存在或缺失的移除的息肉亚型的唯一亚组，并将无息肉的组用作参考。高风险亚组包括高风险锯齿状息肉（定义为锯齿状息肉≥10 mm、具有异型性的乳突状锯齿状损害或传统乳突状腺瘤）以及高风险腺瘤（定义为腺瘤≥10 mm或含有高度异型性）。共纳入了253,833例结肠镜检查。在中位随访时间36个月（IQR，21-57）内，我们发现了504例异时性CRC。相对于无息肉的患者，高风险锯齿状息肉未伴高风险腺瘤的患者的异时性CRC风险比为1.70（95% CI，1.07-2.69），高风险腺瘤未伴高风险锯齿状息肉的患者的异时性CRC风险比为1.22（0.96-1.55），高风险锯齿状息肉伴高风险腺瘤的患者的异时性CRC风险比为2.00（1.19-3.39）。考虑共同发现，在具有高风险锯齿状息肉和高风险腺瘤的情况下，或者在具有高风险锯齿状息肉而无高风险腺瘤的情况下，我们观察到了增加的异时性CRC风险。这些发现可以提供更多证据来支持息肉切除后的监测指南。无。© 2023 The Author(s).

Colonoscopy surveillance intervals are based on the predicted risk of metachronous colorectal cancer (CRC) after polyp removal. However, risk estimation per polyp subtype is difficult due to the fact that many patients have multiple polyps. To enable risk estimation per polyp subtypes we examined the metachronous CRC risk of subgroups based on presence or absence of co-occurring findings.Using high-quality screening colonoscopies performed after a positive fecal immunochemical test between 2014 and 2020 within the Dutch CRC screening program, we applied Cox regression analysis to evaluate the association between findings at baseline colonoscopy and metachronous CRCs. For our primary outcome, we appointed each patient to unique subgroups based on removed polyp subtypes that were present or absent at baseline colonoscopy and used the groups without polyps as reference. High-risk subgroups were individuals with high-risk serrated polyps, defined as serrated polyp ≥10 mm, sessile serrated lesions with dysplasia, or traditional serrated adenomas, as well as high-risk adenomas, defined as adenoma ≥10 mm or containing high-grade dysplasia.In total 253,833 colonoscopies were included. Over a median follow-up of 36 months (IQR, 21-57), we identified 504 metachronous CRCs. Hazard ratios for metachronous CRC was 1.70 (95% CI, 1.07-2.69) for individuals with high-risk serrated polyps without high-risk adenomas, 1.22 (0.96-1.55) for individuals with high-risk adenomas without high-risk serrated polyps, and 2.00 (1.19-3.39) for individuals with high-risk serrated polyps and high-risk adenomas, compared to patients without polyps.Accounting for co-occurring findings, we observed an increased metachronous CRC risk for individuals that had high-risk serrated polyps with the presence of high-risk adenomas, or individuals with high-risk serrated polyps without high-risk adenomas. These findings could provide more evidence to support post-polypectomy surveillance guidelines.None.© 2023 The Author(s).