Effect of Screening Colonoscopy on Colorectal Cancer Incidence and Mortality
Effect of Screening Colonoscopy on Colorectal Cancer Incidence and Mortality
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DOI：
10.1016/j.cgh.2008.12.030
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发表时间：
2009-07-01
影响因子：
12.6
通讯作者：
Rex, Douglas K.
中科院分区：
文献类型：
--
作者：
Kahi, Charles J.;Imperiale, Thomas F.;Rex, Douglas K.
背景与目的：结肠镜检查广泛用于结直肠癌（CRC）筛查；然而，其对CRC发病率和死亡率的长期影响尚不清楚。方法：我们评估了1989年至1993年间在一所大学医院接受结肠镜筛查的一组无症状平均风险患者的CRC发病率和死亡率。通过使用标准化发病率和标准化死亡率，我们将观察到的结直肠癌发病率与监测、流行病学和最终结果（SEER）数据的预期发病率进行了比较。结果：该队列包括715例患者（平均年龄61±6.5岁，59%为男性，95%为高加索人），随访10492例患者年。12例结直肠癌：5例在基线时发现，7例在中位随访8年（范围3-16年）后发现。当排除前2年随访时，9075人年随访期间有7例CRC事件（95%置信区间[CI]， 2-13）。基于SEER数据的预期数字是21。发病率为每1000人年0.77例，标准化发病率为0.33 (95% Cl, 0.10-0.62)，与CRC发病率相对风险降低67%一致。3例患者死于结直肠癌（95% Cl, 0-9）。根据SEER数据，预计死亡人数为9人。死亡率为0.29 / 1000人年，标准化死亡率为0.35 (95% C1, 0.0-1.06)，与CRC死亡率相对降低65%相一致。结论：在这个平均风险队列中，结肠镜筛查后CRC发病率和死亡率降低。这些结果为结肠镜检查作为一种主要的CRC筛查方式的有效性提供了额外的证据。
BACKGROUND & AIMS: Colonoscopy is used widely for colorectal cancer (CRC) screening; however, its long-term impact on the incidence and mortality of CRC is not known. METHODS: We assessed CRC incidence and mortality in a group of asymptomatic average-risk patients who underwent screening colonoscopy between 1989 and 1993 at a university hospital. By using standardized incidence ratios and standardized mortality ratios, we compared our observed CRC rates with expected rates from the Surveillance, Epidemiology, and End Results (SEER) data. RESULTS: The cohort comprised 715 patients (mean age, 61 +/- 6.5 y; 59% male; 95% Caucasian) with 10,492 patient-years of follow-up. There were 12 cases of CRC: 5 found at baseline and 7 found after a median follow-up period of 8 years (range, 3-16 y). When the first 2 years of follow-up were excluded, there were 7 incident cases of CRC (95% confidence interval [CI], 2-13) over 9075 person-years of follow-up. The expected number based on SEER data was 21. The incidence rate was 0.77 cases per 1000 person-years, and the standardized incidence ratio was 0.33 (95% Cl, 0.10-0.62), consistent with a relative risk reduction in CRC incidence of 67%. Three patients died from CRC (95% Cl, 0-9). The expected number of deaths based on SEER data was 9. The mortality rate was 0.29 per 1000 person-years, and the standardized mortality ratio was 0.35 (95% C1, 0.0-1.06), consistent with a relative reduction in CRC death of 65%. CONCLUSIONS: In this average-risk cohort, CRC incidence and mortality were reduced after screening colonoscopy. These results provide additional evidence for the effectiveness of colonoscopy as a primary CRC screening modality.