Long-term colorectal-cancer incidence and mortality after lower endoscopy.
Long-term colorectal-cancer incidence and mortality after lower endoscopy.
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DOI：
10.1056/nejmoa1301969
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发表时间：
2013-09-19
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影响因子：
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通讯作者：
Chan AT
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作者：
Nishihara R;Wu K;Lochhead P;Morikawa T;Liao X;Qian ZR;Inamura K;Kim SA;Kuchiba A;Yamauchi M;Imamura Y;Willett WC;Rosner BA;Fuchs CS;Giovannucci E;Ogino S;Chan AT
结肠镜检查和乙状结肠镜检查提供了对结直肠癌的保护，但保护的程度和持续时间，特别是对近端结肠癌的保护，仍然不确定。我们在护士健康研究和卫生专业人员随访研究的参与者中检查了下消化道内镜检查（从1988年到2008年每两年更新一次）与结直肠癌发病率（到2010年6月）和结直肠癌死亡率（到2012年6月）的相关性。在88，902名参与者中，我们记录了1815例结肠直肠癌事件和474例结肠直肠癌死亡。与未进行内镜检查相比，息肉切除术后结直肠癌的多变量风险比为0.57（95%置信区间[CI]，0.45 - 0.72），乙状结肠镜检查阴性后为0.60（95% CI，0.53 - 0.68），结肠镜检查阴性后为0.44（95% CI，0.38 - 0.52）。结肠镜检查阴性与近端结肠癌发生率降低相关（多变量风险比，0.73; 95%CI，0.57 - 0.92）。结肠直肠癌死亡的多变量风险比在乙状结肠镜检查后为0.59（95%CI，0.45 - 0.76），在结肠镜检查后为0.32（95%CI，0.24 - 0.45）。结肠镜检查后近端结肠癌的死亡率降低（多变量风险比，0.47; 95%CI，0.29 - 0.76），但乙状结肠镜检查后未观察到。与结肠镜检查后5年以上或既往未接受过内镜检查的患者相比，结肠镜检查后5年内诊断的患者更可能以CpG岛甲基化表型（CIMP）为特征。（多变量比值比，2.19; 95% CI，1.14至4.21）和微卫星不稳定性（多变量比值比，2.10; 95% CI，1.10至4.02）。结肠镜检查和乙状结肠镜检查与远端结肠直肠癌发病率降低相关;结肠镜检查也与近端结肠癌发病率适度降低相关。筛查性结肠镜检查和乙状结肠镜检查与结直肠癌死亡率降低相关;只有结肠镜检查与近端结肠癌死亡率降低相关。在结肠镜检查后5年内诊断的结直肠癌比在此期间后诊断的癌症或先前没有内窥镜检查的癌症更可能具有CIMP和微卫星不稳定性。（由美国国立卫生研究院和其他机构资助。
Colonoscopy and sigmoidoscopy provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against cancer of the proximal colon, remain uncertain. We examined the association of the use of lower endoscopy (updated biennially from 1988 through 2008) with colorectal-cancer incidence (through June 2010) and colorectal-cancer mortality (through June 2012) among participants in the Nurses’ Health Study and the Health Professionals Follow-up Study. Among 88,902 participants followed over a period of 22 years, we documented 1815 incident colorectal cancers and 474 deaths from colorectal cancer. With endoscopy as compared with no endoscopy, multivariate hazard ratios for colorectal cancer were 0.57 (95% confidence interval [CI], 0.45 to 0.72) after polypectomy, 0.60 (95% CI, 0.53 to 0.68) after negative sigmoidoscopy, and 0.44 (95% CI, 0.38 to 0.52) after negative colonoscopy. Negative colonoscopy was associated with a reduced incidence of proximal colon cancer (multivariate hazard ratio, 0.73; 95% CI, 0.57 to 0.92). Multivariate hazard ratios for death from colorectal cancer were 0.59 (95% CI, 0.45 to 0.76) after screening sigmoidoscopy and 0.32 (95% CI, 0.24 to 0.45) after screening colonoscopy. Reduced mortality from proximal colon cancer was observed after screening colonoscopy (multivariate hazard ratio, 0.47; 95% CI, 0.29 to 0.76) but not after sigmoidoscopy. As compared with colorectal cancers diagnosed in patients more than 5 years after colonoscopy or without any prior endoscopy, those diagnosed in patients within 5 years after colonoscopy were more likely to be characterized by the CpG island methylator phenotype (CIMP) (multivariate odds ratio, 2.19; 95% CI, 1.14 to 4.21) and microsatellite instability (multivariate odds ratio, 2.10; 95% CI, 1.10 to 4.02). Colonoscopy and sigmoidoscopy were associated with a reduced incidence of cancer of the distal colorectum; colonoscopy was also associated with a modest reduction in the incidence of proximal colon cancer. Screening colonoscopy and sigmoidoscopy were associated with reduced colorectal-cancer mortality; only colonoscopy was associated with reduced mortality from proximal colon cancer. Colorectal cancer diagnosed within 5 years after colonoscopy was more likely than cancer diagnosed after that period or without prior endoscopy to have CIMP and microsatellite instability. (Funded by the National Institutes of Health and others.)