The effect of using fecal testing after a negative sigmoidoscopy on the risk of death from colorectal cancer.
The effect of using fecal testing after a negative sigmoidoscopy on the risk of death from colorectal cancer.
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乙状结肠镜检查阴性后进行粪便检测对结直肠癌死亡风险的影响。
DOI：
10.1177/0969141320921427
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发表时间：
2021-06
影响因子：
2.9
通讯作者：
Weiss NS
中科院分区：
文献类型：
--
作者：
Doubeni CA;Corley DA;Jensen CD;Schottinger JE;Lee JK;Ghai NR;Levin TR;Zhao WK;Saia CA;Wainwright JV;Mehta SJ;Selby K;Doria-Rose VP;Zauber AG;Fletcher RH;Weiss NS
为了检验乙状结肠镜检查结果为阴性后接受粪便潜血试验是否会降低结直肠癌的死亡率。
我们在2006 - 2012年期间，在一个综合医疗系统环境中，对1877740名50 - 90岁的人群的历史队列采用了巢式病例对照设计，并进行了发病密度匹配。我们选取了1758名死于结直肠癌的平均风险患者以及3503名匹配的未患结直肠癌的人员。结直肠癌特异性死亡是从癌症和死亡登记处确定的。筛查历史是根据参考日期前5 - 10年的电子和图表审核临床数据确定的。我们评估了在参考日期前2 - 6年乙状结肠镜检查结果为阴性的患者在参考日期后5年内接受后续粪便潜血试验的情况。
在5261名患者中，831名患者（204例结直肠癌死亡/627例对照）要么仅乙状结肠镜检查结果为阴性（n = 592），要么乙状结肠镜检查结果为阴性且后续接受了粪便潜血筛查试验（n = 239）。在204名死于结直肠癌的患者中，有56名（27.5%），在627名未患结直肠癌的患者中，有183名（29.2%）在乙状结肠镜检查结果为阴性后接受了粪便潜血试验。条件回归分析发现，总体而言（调整后的优势比 = 0.93，置信区间：0.65 - 1.33），或者对于右半结肠（优势比 = 1.02，置信区间：0.65 - 1.60）或左半结肠/直肠（优势比 = 0.77，置信区间：0.39 - 1.52）癌症，粪便潜血试验的接受情况与结直肠癌死亡风险之间没有显著关联。在采用不同的暴露确定窗口或粪便潜血试验时间的敏感性分析中也得到了类似的结果。
我们的研究结果表明，在乙状结肠镜检查结果为阴性后的几年内接受至少一次粪便潜血试验并没有显著降低结直肠癌的死亡率。
To examine whether receiving a fecal occult blood test after a negative sigmoidoscopy reduced mortality from colorectal cancer. We used a nested case–control design with incidence-density matching in historical cohorts of 1,877,740 50–90-year-old persons during 2006–2012, in an integrated health-system setting. We selected 1758 average risk patients who died from colorectal cancer and 3503 matched colorectal cancer-free persons. Colorectal cancer-specific death was ascertained from cancer and mortality registries. Screening histories were determined from electronic and chart–audit clinical data in the 5- to 10-year period prior to the reference date. We evaluated receipt of subsequent fecal occult blood test within five years of the reference date among patients with negative sigmoidoscopy two to six years before the reference date. Of the 5261 patients, 831 patients (204 colorectal cancer deaths/627 controls) had either negative sigmoidoscopy only (n = 592) or negative sigmoidoscopy with subsequent screening fecal occult blood test (n = 239). Fifty-six (27.5%) of the 204 patients dying of colorectal cancer and 183 (29.2%) of the 627 colorectal cancer-free patients received fecal occult blood test following a negative sigmoidoscopy. Conditional regressions found no significant association between fecal occult blood test receipt and colorectal cancer death risk, overall (adjusted odds ratio = 0.93, confidence interval: 0.65–1.33), or for right (odds ratio = 1.02, confidence interval: 0.65–1.60) or left-colon/rectum (odds ratio = 0.77, confidence interval: 0.39–1.52) cancers. Similar results were obtained in sensitivity analyses with alternative exposure ascertainment windows or timing of fecal occult blood test. Our results suggest that receipt of at least one fecal occult blood test during the several years after a negative sigmoidoscopy did not substantially reduce mortality from colorectal cancer.
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影响因子：
24.5
作者：
Doubeni CA;Corley DA;Quinn VP;Jensen CD;Zauber AG;Goodman M;Johnson JR;Mehta SJ;Becerra TA;Zhao WK;Schottinger J;Doria-Rose VP;Levin TR;Weiss NS;Fletcher RH
通讯作者：
Fletcher RH
影响因子：
39.2
作者：
Selby K;Jensen CD;Lee JK;Doubeni CA;Schottinger JE;Zhao WK;Chubak J;Halm E;Ghai NR;Contreras R;Skinner C;Kamineni A;Levin TR;Corley DA
通讯作者：
Corley DA
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
7.7
作者：
Lieberman, David;Nadel, Marion;Winawer, Sidney
通讯作者：
Winawer, Sidney
影响因子：
5
作者：
HOGUE, CJR;GAYLOR, DW;SCHULZ, KF
通讯作者：
SCHULZ, KF