Association of Colonoscopy and Death From Colorectal Cancer
Association of Colonoscopy and Death From Colorectal Cancer
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DOI：
10.7326/0003-4819-150-1-200901060-00306
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发表时间：
2009-01-06
影响因子：
39.2
通讯作者：
Rabeneck, Linda
中科院分区：
文献类型：
--
作者：
Baxter, Nancy N.;Goldwasser, Meredith A.;Rabeneck, Linda
背景：结肠镜检查被提倡用于筛查和预防结直肠癌（CRC），但没有随机试验支持这种做法的益处。目的：探讨结肠镜检查与结直肠癌死亡的关系。设计：以人群为基础的病例对照研究。环境：加拿大安大略省。患者：年龄52至90岁，1996年1月至2001年12月诊断为结直肠癌，2003年12月死于结直肠癌者。根据年龄、性别、地理位置和社会经济地位随机选择5个对照。测量方法：使用行政索赔数据来检测从1992年1月到诊断前6个月的每个病例患者的任何结肠镜检查和完全结肠镜检查（盲肠）的暴露情况，并在匹配的对照组中进行相同的指定日期。使用条件逻辑回归对病例患者和对照组的暴露进行比较，以控制合并症。进行了二次分析，以了解原发性结直肠癌的部位、年龄或性别是否存在关联差异。结果：共发现患者10 292例，对照组51 460例；719例患者（7.0%）和5031例对照组（9.8%）行结肠镜检查。与对照组相比，病例患者接受任何结肠镜检查的可能性较小（调整条件优势比[OR]， 0.69 [95% CI， 0.63至0.74;P < 0.001]）或完成结肠镜检查（调整条件优势比[OR]， 0.63 [CI， 0.57至0.69;P < 0.001]）。完全结肠镜检查与较少的左侧结直肠癌死亡密切相关（调整条件OR， 0.33 [CI， 0.28至0.39]），但与右侧结直肠癌死亡无关（调整条件OR， 0.99 [CI， 0.86至1.14]）。局限性：不能将筛查与诊断程序区分开来。结论：通常情况下，结肠镜检查与结直肠癌死亡较少相关。这种关联主要局限于左结肠癌症的死亡。
Background: Colonoscopy is advocated for screening and prevention of colorectal cancer (CRC), but randomized trials supporting the benefit of this practice are not available.Objective: To evaluate the association between colonoscopy and CRC deaths.Design: Population-based, case -control study.Setting: Ontario, Canada. Patients: Persons age 52 to 90 years who received a CRC diagnosis from January 1996 to December 2001 and died of CRC by December 2003. Five controls matched by age, sex, geographic location, and socioeconomic status were randomly selected for each case patient.Measurements: Administrative claims data were used to detect exposure to any colonoscopy and complete colonoscopy (to the cecum) from January 1992 to an index date 6 months before diagnosis in each case patient and the same assigned date in matched controls. Exposures in case patients and controls were compared by using conditional logistic regression to control for comorbid conditions. Secondary analyses were done to see whether associations differed by site of primary CRC, age, or sex.Results: 10 292 case patients and 51 460 controls were identified; 719 case patients (7.0%) and 5031 controls (9.8%) had undergone colonoscopy. Compared with controls, case patients were less likely to have undergone any attempted colonoscopy (adjusted conditional odds ratio [OR], 0.69 [95% CI, 0.63 to 0.74; P < 0.001]) or complete colonoscopy (adjusted conditional OR, 0.63 [CI, 0.57 to 0.69; P < 0.001]). Complete colonoscopy was strongly associated with fewer deaths from left-sided CRC (adjusted conditional OR, 0.33 [CI, 0.28 to 0.39]) but not from right-sided CRC (adjusted conditional OR, 0.99 [CI, 0.86 to 1.14]).Limitation: Screening could not be differentiated from diagnostic procedures.Conclusion: In usual practice, colonoscopy is associated with fewer deaths from CRC. This association is primarily limited to deaths from cancer developing in the left side of the colon.