目前缺乏有效的适用于息肉切除后结直肠癌（PPCRC）的风险分层工具。我们目的在于在三个大型基于人群的队列中开发一种有效的PPCRC风险分层工具，并在一个临床队列中进行验证。通过整合三个美国基于人群的专业健康队列（护士健康研究I、II和专业健康追踪研究（HPFS））的内窥镜、组织病理学和流行病学数据，我们开发了一个风险评分来预测1986年至2017年间进行息肉切除术的26,741名患者发生PPCRC。我们在麻省布里格姆妇女医院（美国马萨诸塞州波士顿）的76,603名于2007年至2018年间进行息肉切除术的患者中验证了PPCRC分数。在这四个队列中，我们收集了患者的详细人口统计学数据、内窥镜史、息肉特征和生活方式因素。通过对NHS/HPFS队列进行每两年一次的追踪问卷调查，以及通过与马萨诸塞州癌症登记处联系，评估了PPCRC的发病率。所有四个队列中，在基线前或基线后六个月内被诊断出结直肠癌或死亡的个体被排除在外。我们使用Cox回归分析计算危险比（HR）、95%置信区间（CI），并使用C统计量和净再分类改进（NRI）来评估区分度。在NHS/HPFS队列的中位随访时间为12.8年（四分位间距（IQR）：9.3，16.7），在MGB队列为5.1年（IQR：2.7，7.8），我们分别记录了220例和241例PPCRC病例。我们基于11个预测因素确定了一个PPCRC风险评分。在验证队列中，PPCRC风险评分与PPCRC风险显示出强烈关联（高风险与低风险相比，HR为3.55，95% CI为2.59-4.88），具有C统计量（95% CI）为0.75（0.70-0.79），即使在根据当前结肠镜监测推荐定义的低风险和高风险息肉组中（C统计量分别为0.73和0.71），也具有区分度，使PPCRC患者的NRI达到45%（95% CI为36-54%）。我们开发并验证了一个PPCRC风险分层模型，可用于指导个体化的结肠镜监测。接下来需要进一步研究以确定最佳监测间隔，并测试当前研究中未包括的PPCRC其他预测因素的附加价值，以及实施研究。支持本研究的机构有US国家卫生研究院、美国癌症协会、南东挪威区域卫生局和德国研究基金会。© 2023 作者。

Effective risk stratification tools for post-polypectomy colorectal cancer (PPCRC) are lacking. We aimed to develop an effective risk stratification tool for the prediction of PPCRC in three large population-based cohorts and to validate the tool in a clinical cohort.Leveraging the integrated endoscopic, histopathologic and epidemiologic data in three U.S population-based cohorts of health professional (the Nurses' Health Study (NHS) I, II and Health Professionals Follow-up Study (HPFS)), we developed a risk score to predict incident PPCRC among 26,741 patients with a polypectomy between 1986 and 2017. We validated the PPCRC score in the Mass General Brigham (MGB) Colonoscopy Cohort (Boston, Massachusetts, U.S) of 76,603 patients with a polypectomy between 2007 and 2018. In all four cohorts, we collected detailed data on patients' demographics, endoscopic history, polyp features, and lifestyle factors at polypectomy. The outcome, incidence of PPCRC, was assessed by biennial follow-up questionnaires in the NHS/HPFS cohorts, and through linkage to the Massachusetts Cancer Registry in the MGB cohort. In all four cohorts, individuals who were diagnosed with CRC or died before baseline or within six months after baseline were excluded. We used Cox regression to calculate the hazard ratio (HR), 95% confidence interval (CI) and assessed the discrimination using C-statistics and reclassification using the Net Reclassification Improvement (NRI).During a median follow-up of 12.8 years (interquartile range (IQR): 9.3, 16.7) and 5.1 years (IQR: 2.7, 7.8) in the NHS/HPFS and MGB cohorts, we documented 220 and 241 PPCRC cases, respectively. We identified a PPCRC risk score based on 11 predictors. In the validation cohort, the PPCRC risk score showed a strong association with PPCRC risk (HR for high vs. low, 3.55, 95% CI, 2.59-4.88) and demonstrated a C-statistic (95% CI) of 0.75 (0.70-0.79), and was discriminatory even within the low- and high-risk polyp groups (C-statistic, 0.73 and 0.71, respectively) defined by the current colonoscopy surveillance recommendations, leading to a NRI of 45% (95% CI, 36-54%) for patients with PPCRC.We developed and validated a risk stratification model for PPCRC that may be useful to guide tailored colonoscopy surveillance. Further work is needed to determine the optimal surveillance interval and test the added value of other predictors of PPCRC beyond those included in the current study, along with implementation studies.US National Institutes of Health, the American Cancer Society, the South-Eastern Norway Regional Health Authority, the Deutsche Forschungsgemeinschaft.© 2023 The Author(s).