Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer.
Impact of adenoma detection on the benefit of faecal testing vs. colonoscopy for colorectal cancer.
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腺瘤检测对粪便检测与结肠镜检查对结直肠癌的益处的影响。
DOI：
10.1002/ijc.30933
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发表时间：
2017
影响因子：
6.4
通讯作者：
Lansdorp-Vogelaar,Iris
中科院分区：
文献类型：
--
作者：
Meester,ReinierGS;Doubeni,ChykeA;Zauber,AnnG;vanBallegooijen,Marjolein;Corley,DouglasA;Lansdorp-Vogelaar,Iris
结肠镜检查质量（以腺瘤检出率衡量）在不同提供者之间差异很大，并且与患者结肠镜检查后癌症风险呈负相关。这对于粪便免疫化学检测 (FIT) 与粪便免疫化学检测 (FIT) 的益处有何影响尚不清楚。结肠直肠癌的初步结肠镜检查筛查。使用已建立的微观模拟模型，我们预测了年度 FITvs 对终生结直肠癌发病率和死亡率的益处。 10 年一次不同 ADR 水平（五分位数；平均 15.3-38.7%）的结肠镜检查筛查，结肠镜检查性能假设是根据基于社区的医生 ADR 数据和患者结肠镜检查后患癌症风险的数据估计的。对于接受 FIT 筛查并由 ADR 最高五分之一的医生进行随访结肠镜检查的患者，模拟终生癌症发病率和死亡率分别为每 1000 人 28.8 例和 5.4 例，而初次结肠镜筛查为 20.6 和 4.4（发病率风险比，RR = 1.40；95% 概率区间 (PI)，1.19–1.71；死亡率 RR = 1.22；95%PI，1.02–1.54）。 ADR 每降低 5%，FITv 的终生癌症发病率预计将平均增加 9.0%。与结肠镜检查相比，死亡率增加了 12.3%，死亡率增加了 9.9%。 13.3%。在 ADR 五分位数 1 中，FIT 的模拟死亡率低于结肠镜筛查（10.1 比 11.8；RR = 0.85；95%PI，0.83–0.90），而发生率则更为相似。这表明 FITv 的癌症发病率和死亡率相对降低。结肠镜检查可能因 ADR 的不同而不同，在 ADR 较高的环境中，结肠镜检查筛查的预测死亡人数较少，而在 ADR 较低的环境中，每年 FIT 筛查的预测死亡人数较少。
Colonoscopy quality, as measured by adenoma detection rates, varies widely across providers and is inversely related to patients' post‐colonoscopy cancer risk. This has unknown consequences for the benefits of faecal immunochemical testing (FIT)vs. primary colonoscopy screening for colorectal cancer. Using an established microsimulation model, we predicted the lifetime colorectal cancer incidence and mortality benefits of annual FITvs. 10‐yearly colonoscopy screening at differing ADR levels (quintiles; averages 15.3–38.7%), with colonoscopy performance assumptions estimated from community‐based data on physician ADRs and patients' post‐colonoscopy risk of cancer. For patients receiving FIT screening with follow‐up colonoscopy by physicians from the highest ADR quintile, simulated lifetime cancer incidence and mortality were 28.8 and 5.4 per 1,000, respectively,vs. 20.6 and 4.4 for primary colonoscopy screening (risk ratios, RR = 1.40; 95% probability interval (PI), 1.19–1.71 for incidence, and RR = 1.22; 95%PI, 1.02–1.54 for mortality). With every 5% point ADR decrease, lifetime cancer incidence was predicted to increase on average 9.0% for FITvs. 12.3% for colonoscopy, and mortality increased 9.9%vs. 13.3%. In ADR quintile 1, simulated mortality was lower for FIT than colonoscopy screening (10.1vs. 11.8; RR = 0.85; 95%PI, 0.83–0.90), while incidences were more similar. This suggests that relative cancer incidence and mortality reductions for FITvs. colonoscopy screening may differ by ADR, with fewer predicted deaths with colonoscopy screening in higher ADR settings and fewer deaths with annual FIT screening in lower ADR settings.