Time to Colonoscopy and Risk of Colorectal Cancer in Patients With Positive Results From Fecal Immunochemical Tests
Time to Colonoscopy and Risk of Colorectal Cancer in Patients With Positive Results From Fecal Immunochemical Tests
复制标题
DOI：
10.1016/j.cgh.2018.10.041
复制
发表时间：
2019-06-01
影响因子：
12.6
通讯作者：
Chen, Hsiu-Hsi
中科院分区：
文献类型：
--
作者：
Lee, Yi-Chia;Fann, Jean Ching-Yuan;Chen, Hsiu-Hsi
背景与目的：在粪便免疫化学试验(FIT)阳性的患者中，未能及时接受结肠镜检查可能与结直肠癌(CRC)和晚期结直肠癌的风险增加有关。对于FIT阳性结果的患者，我们评估了任何结直肠癌和与延迟随访结肠镜检查相关的晚期结直肠癌的患病率。方法：我们收集了从2004年到2012年参加台湾全国筛查计划的39,346名患者(年龄50-69岁)的数据，这些患者在FIT呈阳性结果后一个多月完成了结肠镜检查。使用Logistic回归模型评估任何结直肠癌和晚期结直肠癌(III-IV期)的风险，结果以调整后的优势比(AORS)和相应的95%CI表示。结果：在我们的队列中，2003名患者被诊断为任何结直肠癌，445名患者被发现患有晚期疾病。与1-3个月内的结肠镜检查(每1000名患者中50例，晚期疾病11例)相比，结直肠癌(AOR，1.31；95%CI，1.04-1.64；每1000名患者68例)和晚期疾病(AOR，2.09；95%CI，1.43-3.06；每1000名患者24例)延迟6个月以上的风险显著增加。当结肠镜检查延迟12个月以上时，结直肠癌(AOR，2.17；95%CI，1.44~3.26；每1000名患者中有98例)和晚期疾病(AOR，2.84；95%CI，1.43-5.64；每1000名患者中有31例)的风险持续增加。在3-6个月的结肠镜随访中，结直肠癌的风险(AOR，0.98；95%CI，0.86-1.12；每1000名患者49例)或晚期疾病(AOR，0.95；95%CI，0.72-1.25；每1000名患者10例)的风险没有显著差异。结论：在台湾全国筛查计划的数据分析中，我们发现，在FIT结果为阳性的患者中，CRC和晚期疾病的风险随着时间的推移而增加。这些发现表明在FIT阳性结果后及时进行结肠镜检查的重要性。
BACKGROUND & AIMS: In patients with positive results from a fecal immunochemical test (FIT), failure to receive a timely follow-up colonoscopy may be associated with higher risks of colorectal cancer (CRC) and advanced-stage CRC. We evaluated the prevalence of any CRC and advanced-stage CRC associated with delays in follow-up colonoscopies for patients with positive results from a FIT.METHODS: We collected data from 39,346 patients (age, 50-69 years) who participated in the Taiwanese Nationwide Screening Program from 2004 through 2012 and had completed a colonoscopy more than 1 month after a positive result from a FIT. Risks of any CRC and advanced-stage CRC (stage III-IV) were evaluated using logistic regression models and results expressed as adjusted odds ratios (aORs) and corresponding 95% CIs.RESULTS: In our cohort, 2003 patients received a diagnosis of any CRC and 445 patients were found to have advanced-stage disease. Compared with colonoscopy within 1-3 months (cases per 1000 patients: 50 for any CRC and 11 for advanced-stage disease), risks were significantly higher when colonoscopy was delayed by more than 6 months for any CRC (aOR, 1.31; 95% CI, 1.04-1.64; 68 cases per 1000 patients) and advanced-stage disease (aOR, 2.09; 95% CI, 1.43-3.06; 24 cases per 1000 patients). The risks continuously increased when colonoscopy was delayed by more than 12 months for any CRC (aOR, 2.17; 95% CI, 1.44-3.26; 98 cases per 1000 patients) and advanced-stage disease (aOR, 2.84; 95% CI, 1.43-5.64; 31 cases per 1000 patients). There were no significant differences for colonoscopy follow up at 3-6 months for risk of any CRC (aOR, 0.98; 95% CI, 0.86-1.12; 49 cases per 1000 patients) or advanced-stage disease (aOR, 0.95; 95% CI, 0.72-1.25; 10 cases per 1000 patients).CONCLUSIONS: In an analysis of data from the Taiwanese Nationwide Screening Program, we found that among patients with positive results from a FIT, risks of CRC and advanced-stage disease increase with time. These findings indicate the importance of timely colonoscopy after a positive result from a FIT.