Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis
Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis
复制标题
DOI：
10.1001/jama.2017.3634
复制
发表时间：
2017-04-25
影响因子：
120.7
通讯作者：
Levin, Theodore R.
中科院分区：
文献类型：
--
作者：
Corley, Douglas A.;Jensen, Christopher D.;Levin, Theodore R.
粪便免疫化学试验（FIT）通常用于结直肠癌筛查，阳性试验结果需要后续结肠镜检查。然而，后续的时间间隔不同，这可能会导致肿瘤progression. ObjectiveTo评估时间结肠镜检查后，一个积极的FIT结果和它的关联与风险的结直肠癌和晚期disease at diagnosis.DESIGN，SETTING，AND PARTICIPANTS回顾性队列研究（2010年1月1日至2014年12月31日）在凯泽永久北方和南加州。研究对象为70124例年龄在50 - 70岁之间的符合结直肠癌筛查条件的患者，FIT结果为阳性，并进行了随访结肠镜检查。FIT结果为阳性后进行结肠镜检查的时间（天）。主要结局和指标结直肠癌和晚期疾病（定义为III期和IV期癌症）的风险。根据患者人口统计学和基线风险因素调整比值比（OR）和95% CI。结果在70124例FIT结果阳性的患者中（中位年龄61岁[IQR，55-67岁];男性，52.7%），有2191例结直肠癌和601例晚期疾病诊断。与结肠镜随访8 ~ 30天相比（n = 27176），2个月随访时无显著差异（n = 24 644），3个月（n = 8666），4至6个月（n = 5251），或7至9个月（n = 1335）任何结直肠癌风险（例/1000例患者：8-30天，30; 2个月，28; 3个月，31; 4-6个月，31; 7-9个月，43）或晚期疾病（每1000例患者的病例数：8-30天，8例; 2个月，7例; 3个月，7例; 4-6个月，9例; 7-9个月，13例）。在10至12个月（n = 748）检查任何结直肠癌的风险显著较高（OR，1.48 [95% CI，1.05-2.08]; 49例/1000例患者）和晚期疾病（OR，1.97 [95% CI，1.14-3.42]; 19例/1000例患者）和任何结直肠癌超过12个月（n = 747）（OR，2.25 [95% CI，1.89-2.68]; 76例/1000例患者）和晚期疾病（OR，3.22 [95% CI，2.44-4.25]; 31例/1000例患者）。结论和相关性在粪便免疫化学试验结果阳性的患者中，与8至30天的随访结肠镜检查相比，10个月后的随访与结直肠癌的高风险和诊断时的晚期疾病相关。需要进一步的研究来评估这种关系是否是因果关系。
IMPORTANCE The fecal immunochemical test (FIT) is commonly used for colorectal cancer screening and positive test results require follow-up colonoscopy. However, follow-up intervals vary, which may result in neoplastic progression.OBJECTIVE To evaluate time to colonoscopy after a positive FIT result and its association with risk of colorectal cancer and advanced-stage disease at diagnosis.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study (January 1, 2010-December 31, 2014) within Kaiser Permanente Northern and Southern California. Participants were 70 124 patients aged 50 through 70 years eligible for colorectal cancer screening with a positive FIT result who had a follow-up colonoscopy.EXPOSURES Time (days) to colonoscopy after a positive FIT result.MAIN OUTCOMES AND MEASURES Risk of any colorectal cancer and advanced-stage disease (defined as stage III and IV cancer). Odds ratios (ORs) and 95% CIs were adjusted for patient demographics and baseline risk factors. RESULTS Of the 70 124 patients with positive FIT results (median age, 61 years [IQR, 55-67 years]; men, 52.7%), there were 2191 cases of any colorectal cancer and 601 cases of advanced-stage disease diagnosed. Compared with colonoscopy follow-up within 8 to 30 days (n = 27 176), there were no significant differences between follow-up at 2 months (n = 24 644), 3 months (n = 8666), 4 to 6 months (n = 5251), or 7 to 9 months (n = 1335) for risk of any colorectal cancer (cases per 1000 patients: 8-30 days, 30; 2 months, 28; 3 months, 31; 4-6 months, 31; and 7-9 months, 43) or advanced-stage disease (cases per 1000 patients: 8-30 days, 8; 2 months, 7; 3 months, 7; 4-6 months, 9; and 7-9 months, 13). Risks were significantly higher for examinations at 10 to 12 months (n = 748) for any colorectal cancer (OR, 1.48 [95% CI, 1.05-2.08]; 49 cases per 1000 patients) and advanced-stage disease (OR, 1.97 [95% CI, 1.14-3.42]; 19 cases per 1000 patients) and more than 12 months (n = 747) for any colorectal cancer (OR, 2.25 [95% CI, 1.89-2.68]; 76 cases per 1000 patients) and advanced-stage disease (OR, 3.22 [95% CI, 2.44-4.25]; 31 cases per 1000 patients).CONCLUSIONS AND RELEVANCE Among patients with a positive fecal immunochemical test result, compared with follow-up colonoscopy at 8 to 30 days, follow-up after 10 months was associated with a higher risk of colorectal cancer and more advanced-stage disease at the time of diagnosis. Further research is needed to assess whether this relationship is causal.