切除的多晶中的分子标记作为异时性病变可靠预测因子的潜力仍不确定。我们的目的是评估高危腺瘤患者息肉中 KRAS 体细胞突变的作用，以预测晚期息肉或结直肠癌的风险（CRC）在 3 年内。总共 518 名患者前瞻性入组。纳入的患者在基线时患有≥10毫米的腺瘤、高度不典型增生、绒毛成分或≥3个腺瘤，并计划在3年±6个月时接受监测结肠镜检查。对从这些患者身上收集的 1189 个息肉进行了体细胞 KRAS 突变。在监测中，晚期病变被定义为尺寸≥10毫米的腺瘤。高度不典型增生或绒毛成分、锯齿状息肉≥10毫米或伴有不典型增生或结直肠癌。基线时，81 名患者 (15.6%) 至少一颗息肉有 KRAS 突变。患有 KRAS 突变息肉的患者有更频繁的绒毛组织学病变，且大小≥20 毫米。在多变量分析中，根据年龄和性别进行调整，仅年龄（优势比 [OR]，1.06；95% 置信区间 [CI]，1.02-1.09；p < 0.001），≥5 个腺瘤（OR，3.92；95% CI） ，1.96-7.82）和 KRAS 突变（OR，2.54；95% CI，1.48-4.34；p < 0.01）与监测时晚期病变的发展独立相关。我们的结果表明，在高危腺瘤患者中，KRAS 中体细胞突变的存在是晚期异时性息肉发展的独立危险因素。© 2024 作者。 《联合欧洲胃肠病学杂志》由 Wiley periodicals LLC 代表联合欧洲胃肠病学出版。

The potential of molecular markers in the removed polys as reliable predictors of metachronous lesions is still uncertain.Our aim was to evaluate the role of somatic mutations in KRAS in polyps of patients with high-risk adenomas to predict the risk of advanced polyps or colorectal cancer (CRC) within 3 years.A total of 518 patients were prospectively enrolled. The included patients had adenomas ≥10 mm, high-grade dysplasia, villous component or ≥3 more adenomas at baseline and were scheduled to undergo surveillance colonoscopy at 3 years ± 6 months. Somatic KRAS mutation was performed on 1189 polyps collected from these patients. At surveillance, advanced lesions were defined as adenomas with a size of ≥10 mm. High-grade dysplasia or villous component, serrated polyps ≥10 mm or with dysplasia or CRC.At baseline, 81 patients (15.6%) had KRAS mutations in at least one polyp. Patients with KRAS mutated polyps had more frequent villous histological lesions and size ≥20 mm. In the multivariate analysis, adjusted for age and sex, only age (odds ratios [OR], 1.06; 95% confidence interval [CI], 1.02-1.09; p < 0.001), ≥5 adenomas (OR, 3.92; 95% CI, 1.96-7.82), and KRAS mutation (OR, 2.54; 95% CI, 1.48-4.34; p < 0.01) were independently associated with the development of advanced lesions at surveillance.Our results show that, in patients with high-risk adenomas, the presence of somatic mutations in KRAS is an independent risk factor for the development of advanced metachronous polyps.© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.