The Incidence and Risk Factors of Metachronous Colorectal Cancer: An Indication for Follow-up
The Incidence and Risk Factors of Metachronous Colorectal Cancer: An Indication for Follow-up
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DOI：
10.1097/dcr.0b013e318249db00
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发表时间：
2012-05-01
影响因子：
3.9
通讯作者：
van Leerdam, Monique E.
中科院分区：
文献类型：
--
作者：
Mulder, Sanna A.;Kranse, Ries;van Leerdam, Monique E.
背景：结直肠癌患者有发生异时性结直肠癌的风险。治疗后监测的目的是检测和清除癌前病变，以防止异时性结直肠癌。目的：本研究的目的是调查新诊断结直肠癌患者中异时性结直肠癌的发病率和预测因素。从荷兰鹿特丹癌症登记处获得1995年至2006年期间所有新诊断的结直肠癌患者的数据，并对异时结直肠癌进行研究。结局指标：计算年发病率和标准化发病率比。结果：总共有10，283例患者被诊断为结直肠癌;随访39，974人年。在10年随访期间，异时性结直肠癌的平均年发病率为314/100，000人-年，相当于平均年发病率为0.3%，3年累积发病率为1.1%，6年为2.0%，10年为3.1%。首次结直肠癌切除术后异时结直肠癌的发病率显著高于年龄和性别匹配的一般人群中结直肠癌的发病率（标准化发病率比1.3，95% CI 1.1-1.5）。这种差异在首次结直肠癌诊断后的前3年尤其明显（标准化发病率比1.4，95% CI 1.1-1.8）。同时性结直肠癌的存在是发展为异时性结直肠癌的唯一显著危险因素（相对危险度13.9，95%CI 4.7-41.0）。结论：尽管结肠镜检查的可用性，异时性结直肠癌仍然是在随访期间观察到的结直肠癌患者，最高的风险是在最初诊断后的前3年。因此，在结直肠癌诊断后的短期间隔内进行随访结肠镜检查是有用的。在首次诊断结直肠癌时同时存在结直肠癌是发生异时性结直肠癌的唯一预测风险因素。在诊断为同步性肿瘤的患者中，可以考虑定制的监测计划。
BACKGROUND: Patients with colorectal cancer are at risk for developing metachronous colorectal cancer. The purpose of posttreatment surveillance is to detect and remove premalignant lesions to prevent metachronous colorectal cancer.OBJECTIVE: The aim of this study was to investigate the incidence of and predictive factors for metachronous colorectal cancer in patients with newly diagnosed colorectal cancer.DESIGN AND PATIENTS: The data on all patients with newly diagnosed colorectal cancer between 1995 and 2006 were obtained from the Rotterdam Cancer Registry in The Netherlands and studied for metachronous colorectal cancer.MAIN OUTCOME MEASURES: The annual incidence rate and the standardized incidence ratios were calculated.RESULTS: In total, colorectal cancer was diagnosed in 10,283 patients; there were 39,974 person-years of follow-up. The mean annual incidence rate of metachronous colorectal cancer was 314/100,000 person-years at risk during 10 years of follow-up, corresponding with a mean annual incidence of 0.3% and a cumulative incidence of 1.1% at 3 years, 2.0% at 6 years, and 3.1% at 10 years. The incidence of metachronous colorectal cancer after resection of a first colorectal cancer is significantly higher than the incidence of colorectal cancer in an age-and sex-matched general population (standardized incidence ratio 1.3, 95% CI 1.1-1.5). This difference is especially seen during the first 3 years after first colorectal cancer diagnosis (standardized incidence ratio 1.4, 95% CI 1.1-1.8). The presence of synchronous colorectal cancer was the only significant risk factor for developing metachronous colorectal cancer (relative risk 13.9, 95% CI 4.7-41.0).CONCLUSIONS: Despite the availability of colonoscopy, metachronous colorectal cancer is still seen during follow-up in patients with colorectal cancer; the highest risk is during the first 3 years after initial diagnosis. For this reason, a follow-up colonoscopy is useful at a short-term interval after colorectal cancer diagnosis. The presence of synchronous colorectal cancer at the time of first colorectal cancer diagnosis is the only predictive risk factor for developing metachronous colorectal cancer. Tailored surveillance programs may be considered in patients with a diagnosis of synchronous tumors.