Risk of Advanced Colorectal Neoplasia According to Age and Gender
Risk of Advanced Colorectal Neoplasia According to Age and Gender
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DOI：
10.1371/journal.pone.0020076
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发表时间：
2011-05-24
期刊：
影响因子：
3.7
通讯作者：
Goeke, Burkhard
中科院分区：
文献类型：
--
作者：
Kolligs, Frank T.;Crispin, Alexander;Goeke, Burkhard
背景：结直肠癌（CRC）是癌症相关发病和死亡的主要原因之一。尽管男性诊断结直肠癌的平均年龄较低，但结肠镜检查或粪便潜血试验（FOBT）筛查在男女中都是在相同年龄开始的。常见的结直肠癌前体病变，晚期腺瘤的患病率仅在筛查人群中有很好的记录。本研究的目的是评估低于筛查年龄的晚期腺瘤的风险。方法和发现：我们分析了2006年至2008年间巴伐利亚州625,918例成人门诊结肠镜检查的普查数据。建立了一个逻辑回归模型来确定晚期肿瘤的性别和年龄特异性风险。晚期肿瘤在16,740名女性（4.6%）和22,684名男性（8.6%）中发现。男性与晚期肿瘤的总体风险增加相关（优势比1.95；95%可信区间CI， 1.91 ~ 2.00）。在任何年龄和任何适应症组中，女性比男性更需要结肠镜检查来检测晚期腺瘤或癌症。在75岁时，发现晚期腺瘤需要14.8次（95% CI, 14.4-15.2）筛查，18.2次（95% CI, 17.7-18.7）诊断和7.9次（95% CI, 7.6-8.2）结肠镜检查以随访FOBT阳性（FOBT结肠镜检查）。在50岁时，需要39.0 （95% CI, 38.0-40.0）和16.3 （95% CI, 15.7-16.9）的FOBT结肠镜检查。男性比女性分别早20年和10年达到相同的年龄。结论：在任何年龄，独立于结肠镜检查的适应症，男性结肠镜检查诊断出晚期肿瘤的风险高于女性。这表明，男性比女性更早开始筛查可能会导致无症状的肿瘤前病变和肿瘤性结肠病变的检测相关增加。
Background: Colorectal cancer (CRC) is one of the leading causes of cancer related morbidity and death. Despite the fact that the mean age at diagnosis of CRC is lower in men, screening by colonoscopy or fecal occult blood test (FOBT) is initiated at same age in both genders. The prevalence of the common CRC precursor lesion, advanced adenoma, is well documented only in the screening population. The purpose of this study was to assess the risk of advanced adenoma at ages below screening age.Methods and Findings: We analyzed data from a census of 625,918 outpatient colonoscopies performed in adults in Bavaria between 2006 and 2008. A logistic regression model to determine gender-and age-specific risk of advanced neoplasia was developed. Advanced neoplasia was found in 16,740 women (4.6%) and 22,684 men (8.6%). Male sex was associated with an overall increased risk of advanced neoplasia (odds ratio 1.95; 95% confidence interval, CI, 1.91 to 2.00). At any age and in any indication group, more colonoscopies were needed in women than in men to detect advanced adenoma or cancer. At age 75 14.8 (95% CI, 14.4-15.2) screening, 18.2 (95% CI, 17.7-18.7) diagnostic, and 7.9 (95% CI, 7.6-8.2) colonoscopies to follow up on a positive FOBT (FOBT colonoscopies) were needed to find advanced adenoma in women. At age 50 39.0 (95% CI, 38.0-40.0) diagnostic, and 16.3 (95% CI, 15.7-16.9) FOBT colonoscopies were needed. Comparable numbers were reached 20 and 10 years earlier in men than in women, respectively.Conclusions: At any age and independent of the indication for colonoscopy, men are at higher risk of having advanced neoplasia diagnosed upon colonoscopy than women. This suggests that starting screening earlier in life in men than in women might result in a relevant increase in the detection of asymptomatic preneoplastic and neoplastic colonic lesions.