Prevalence and predictors of interval colorectal cancers in medicare beneficiaries.
Prevalence and predictors of interval colorectal cancers in medicare beneficiaries.
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DOI：
10.1002/cncr.26602
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发表时间：
2012-06-15
期刊：
影响因子：
6.2
通讯作者：
Koroukian SM
中科院分区：
文献类型：
--
作者：
Cooper GS;Xu F;Barnholtz Sloan JS;Schluchter MD;Koroukian SM
在结肠镜检查为阴性癌症后，一部分患者可能被诊断为结直肠癌，也称为间歇性癌症。在以人口为基础的美国队列中，这种频率和预测因素还没有得到很好的研究。使用链接的SEER-Medicare数据库，我们确定了57,839名≥69岁的结直肠癌患者，这些患者在1994年至2005年期间被诊断为结直肠癌，并在癌症诊断后6个月内接受了结肠镜检查。结肠镜检查在癌症诊断前36至6个月进行，是间歇性癌症的替代指标。使用病例定义，7.2%的患者发展为间歇性癌症。与间歇性癌相关的因素包括肿瘤近端部位(远端结肠多变量OR 0.42，95%CI 0.390~0.46，直肠OR 0.47，95%CI 0.42~0.53)、合并症增加(OR 1.89，95%CI 1.68~2.14)、有憩室病诊断史(OR 6.00，95%CI 5.57~6.46)、息肉切除史(OR 1.74，95%CI 1.62~1.87)。内窥镜水平的危险因素包括较低的息肉切除率(OR 0.70，95%CI 0.63~0.78)、较高的结肠镜检查量(OR 1.27，95%CI 1.13~1.43)和非消化科(结直肠外科OR 1.45，95%CI 1.16~1.83；普通外科OR 1.42，95%CI 1.24~1.62；内科OR 1.38，95%CI 1.17~1.63；家庭执业OR 1.16，95%CI 1.00~1.35)。相当大比例的患者发展为间歇性结直肠癌，尤其是在近端结肠。致病因素可能包括程序因素和生物因素，并强调仔细检查粘膜的重要性。
Following a colonoscopy that is negative for cancer, a subset of patients may be diagnosed with colorectal cancer, also termed interval cancer. The frequency and predictors have not been well studied in a population-based U.S. cohort. Using the linked SEER-Medicare database, we identified 57,839 patients aged ≥ 69 with colorectal cancer diagnosed between 1994 and 2005 and who underwent colonoscopy within 6 months of cancer diagnosis. Colonoscopy performed between 36 to 6 months prior to cancer diagnosis was a proxy for interval cancer. Using the case definition, 7.2% of patients developed interval cancers. Factors associated with interval cancers included proximal tumor location (distal colon multivariable OR 0.42, 95% CI 0.390–0.46, rectum OR 0.47, 95% CI 0.42–0.53), increased comorbidity (OR 1.89 95% CI 1.68 2.14 for 3 or more comorbidities), a previous diagnosis of diverticulosis (OR 6.00 95% CI 5.57–6.46), and prior polypectomy (OR 1.74, 95% CI 1.62–1.87). Risk factors at the endoscopist level included a lower polypectomy rate (OR 0.70, 95% CI 0.63–0.78 for the highest quartile), higher colonoscopy volume (OR 1.27, 95% CI 1.13–1.43) and specialty other than gastroenterology (colorectal surgery OR 1.45, 95% CI 1.16–1.83; general surgery OR 1.42, 95% CI 1.24–1.62; internal medicine OR 1.38, 95% CI 1.17–1.63, family practice OR 1.16, 95% CI 1.00–1.35). A significant proportion of patients develop interval colorectal cancer, particularly in the proximal colon. Contributing factors likely include both procedural and biologic factors, and emphasize the importance of meticulous examination of the mucosa.
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影响因子：
120.7
作者：
Begg, CB;Cramer, LD;Brennan, MF
通讯作者：
Brennan, MF
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158.5
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7.7
作者：
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