Protection From Colorectal Cancer After Colonoscopy A Population-Based, Case-Control Study
Protection From Colorectal Cancer After Colonoscopy A Population-Based, Case-Control Study
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DOI：
10.7326/0003-4819-154-1-201101040-00004
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发表时间：
2011-01-04
影响因子：
39.2
通讯作者：
Hoffmeister, Michael
中科院分区：
文献类型：
--
作者：
Brenner, Hermann;Chang-Claude, Jenny;Hoffmeister, Michael
背景：结肠镜检查和腺瘤切除被认为是降低结直肠癌（CRC）发病率的有力工具。然而，高质量结肠镜检查资源在人群环境中可达到的保护程度仍有待量化。目的：评估既往结肠镜检查与CRC风险之间的关联。设计：基于人群的病例对照研究。设置：德国的莱茵-内卡地区。患者：共有1688例结肠直肠癌患者和1932例年龄在50岁或以上的对照参与者。测量：CRC风险因素和预防因素的详细终生史，包括既往结肠镜检查的历史和结果，以及通过自我报告和医疗记录获得的医疗数据。在调整性别、年龄、教育水平、参与一般健康筛查检查、CRC家族史、吸烟状况、体重指数和使用非甾体类抗炎药或激素替代therapy.Results后，估计在过去10年中与结肠镜检查相关的CRC的比值比：总体而言，在过去10年中结肠镜检查与77%的CRC风险降低相关。任何CRC、右侧CRC和左侧CRC的校正比值比分别为0.23（95% CI，0.19至0.27）、0.44（CI，0.35至0.55）和0.16（CI，0.12至0.20）。在所有癌症阶段和所有年龄段都观察到了强烈的风险降低，除了50至59岁的人的右侧癌症。多年来，在右侧和左侧colon.Limitation的风险降低增加：这项研究是观察性的，与潜在的残余混杂和选择bias.Conclusion：结肠镜检查与息肉切除术可以与强烈降低风险的CRC在人口设置。除了左侧CRC的风险大幅降低外，右侧结肠癌的风险也降低了50%以上。
Background: Colonoscopy with detection and removal of adenomas is considered a powerful tool to reduce colorectal cancer (CRC) incidence. However, the degree of protection achievable in a population setting with high-quality colonoscopy resources remains to be quantified.Objective: To assess the association between previous colonoscopy and risk for CRC.Design: Population-based case-control study.Setting: Rhine-Neckar region of Germany.Patients: A total of 1688 case patients with colorectal cancer and 1932 control participants aged 50 years or older.Measurements: A detailed lifetime history of CRC risk factors and preventive factors, including history and results of previous colonoscopies, and of medical data obtained by self-reports and medical records. Odds ratios of CRC associated with colonoscopy in the preceding 10 years were estimated, after adjustment for sex, age, education level, participation in a general health screening examination, family history of CRC, smoking status, body mass index, and use of nonsteroidal anti-inflammatory drugs or hormone replacement therapy.Results: Overall, colonoscopy in the preceding 10 years was associated with 77% lower risk for CRC. Adjusted odds ratios for any CRC, right-sided CRC, and left-sided CRC were 0.23 (95% CI, 0.19 to 0.27), 0.44 (CI, 0.35 to 0.55), and 0.16 (CI, 0.12 to 0.20), respectively. Strong risk reduction was observed for all cancer stages and all ages, except for right-sided cancer in persons aged 50 to 59 years. Risk reduction increased over the years in both the right and the left colon.Limitation: The study was observational, with potential for residual confounding and selection bias.Conclusion: Colonoscopy with polypectomy can be associated with strongly reduced risk for CRC in the population setting. Aside from strong risk reduction with respect to left-sided CRC, risk reduction of more than 50% was also seen for right-sided colon cancer.