Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia.
Young-onset colorectal cancer risk among individuals with iron-deficiency anaemia and haematochezia.
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DOI：
10.1136/gutjnl-2020-321849
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发表时间：
2020-12-18
期刊：
影响因子：
24.5
通讯作者：
Gupta S
中科院分区：
文献类型：
--
作者：
Demb J;Liu L;Murphy CC;Doubeni CA;Martínez ME;Gupta S
年轻发病的结直肠癌(YCRC)发病率呈上升趋势。在出现诸如缺铁性贫血(IDA)或便血等令人担忧的症状后，关于YCRC风险的数据很少。我们研究了IDA和YCRC之间的关系，以及血吸虫病和YCRC之间的关系。1999-2016年接受退伍军人健康管理局(VHA)护理的18-49岁美国退伍军人的队列研究。根据性别、出生年份和首次VHA就诊日期(n=23.9万)，建立了IDA分析队列，将未发生IDA的人与IDA患者按4：1的比例匹配。我们使用这种方法也创建了一个不同的血吸虫病分析队列(n=653 740)。YCRC事件是通过与癌症登记和/或特定原因死亡数据的联系来确定的。我们使用COX模型计算每个队列中的累积发病率、风险差异(RD)和HR。IDA患者的5年YCRC累积发病率为0.45%，而非IDA患者为0.05%(RD：0.39%，95%CI：0.33%-0.46%)，对应的HR为10.81(95%CI：8.15-14.33)。IDA与非IDA相比，男性RD为0.78%(95%CI：0.64%-0.92%)，女性RD为0.08%(95%CI：0.03%-0.13%)，RD随年龄增长从30岁的0.14%增加到40-49岁的0.53%。有血吸者YCRC累积发病率为0.33%，而无血吸者为0.03%(RD：0.30%，95%CI：0.26%-0.33%)，对应的HR为10.66(95%CI：8.76-12.97)。比较有血吸虫和不有血吸虫，RD随年龄增加，从30岁的0.04%增加到40-49岁的0.43%。结肠镜检查应强烈考虑在50岁以上的成人缺铁性贫血或便血，没有临床证实的替代来源。
Young-onset colorectal cancer (YCRC) incidence is rising. Scant data exist on YCRC risk after presentation with concerning symptoms such as iron-deficiency anaemia (IDA) or haematochezia. We examined the association between IDA and YCRC, and haematochezia and YCRC. Cohort study of US Veterans aged 18–49 years receiving Veterans Health Administration (VHA) care 1999–2016. IDA analytic cohort was created matching individuals without incident IDA to those with IDA 4:1 based on sex, birth year and first VHA visit date (n=239 000). We used this approach to also create a distinct haematochezia analytic cohort (n=653 740). Incident YCRC was ascertained via linkage to cancer registry and/or cause-specific mortality data. We computed cumulative incidence, risk difference (RD) and HRs using Cox models in each cohort. Five-year YCRC cumulative incidence was 0.45% among individuals with IDA versus 0.05% without IDA (RD: 0.39%, 95% CI: 0.33%–0.46%), corresponding to an HR of 10.81 (95% CI: 8.15–14.33). Comparing IDA versus no IDA, RD was 0.78% for men (95% CI: 0.64%–0.92%) and 0.08% for women (95% CI: 0.03%–0.13%), and RD increased by age from 0.14% for <30 years to 0.53% for 40–49 years. YCRC cumulative incidence was 0.33% among individuals with haematochezia versus 0.03% without haematochezia (RD: 0.30%, 95% CI: 0.26%–0.33%), corresponding to an HR of 10.66 (95% CI: 8.76–12.97). Comparing haematochezia versus no haematochezia, RD increased by age from 0.04% for <30 years to 0.43% for 40–49 years. Colonoscopy should be strongly considered in adults aged <50 years with IDA or haematochezia without a clinically confirmed alternate source.
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