PREVENTION OF COLORECTAL-CANCER BY COLONOSCOPIC POLYPECTOMY
PREVENTION OF COLORECTAL-CANCER BY COLONOSCOPIC POLYPECTOMY
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DOI：
10.1056/nejm199312303292701
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发表时间：
1993-12-30
影响因子：
158.5
通讯作者：
STEWART, ET
中科院分区：
文献类型：
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作者：
WINAWER, SJ;ZAUBER, AG;STEWART, ET
背景。目前切除结肠和直肠腺瘤性息肉的做法是基于这样一种信念，即这将预防结直肠癌。为了验证结肠镜下息肉切除术可降低结直肠癌发病率这一假设，我们结合其他已发表的结果分析了国家息肉研究的结果。
方法。研究队列包括1418名患者，他们接受了完整的结肠镜检查，在此期间切除了一个或多个结肠或直肠腺瘤。患者随后在平均5.9年的随访期间定期接受结肠镜检查，并确定了结直肠癌的发病率。在对性别、年龄和息肉大小进行调整后，将结直肠癌的发病率与三个参照组进行了比较，其中包括两个未切除结肠息肉的队列和一个普通人群登记处。
结果。97%的患者接受了临床随访，总计8401人年，80%的患者按计划进行了一次或多次结肠镜检查。通过结肠镜检查发现了5例无症状的早期结直肠癌（恶性息肉）（3例在3年时，1例在6年时，1例在7年时）。未发现有症状的癌症。根据三个参照组的发病率预期的结直肠癌数量分别为48.3例、43.4例和20.7例，结直肠癌发病率分别降低了90%、88%和76%（P<0.001）。
Background. The current practice of removing adenomatous polyps of the colon and rectum is based on the belief that this will prevent colorectal cancer. To address the hypothesis that colonoscopic polypectomy reduces the incidence of colorectal cancer, we analyzed the results of the National Polyp Study with reference to other published results.Methods. The study cohort consisted of 1418 patients who had a complete colonoscopy during which one or more adenomas of the colon or rectum were removed. The patients subsequently underwent periodic colonoscopy during an average follow-up of 5.9 years, and the incidence of colorectal cancer was ascertained. The incidence rate of colorectal cancer was compared with that in three reference groups, including two cohorts in which colonic polyps were not removed and one general-population registry, after adjustment for sex, age, and polyp size.Results. Ninety-seven percent of the patients were followed clinically for a total of 8401 person-years, and 80 percent returned for one or more of their scheduled colonoscopies. Five asymptomatic early-stage colorectal cancers (malignant polyps) were detected by colonoscopy (three at three years, one at six years, and one at seven years). No symptomatic cancers were detected. The numbers of colorectal cancers expected on the basis of the rates in the three reference groups were 48.3, 43.4, and 20.7, for reductions in the incidence of colorectal cancer of 90, 88, and 76 percent, respectively (P