Impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
Impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
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DOI：
10.1001/jamasurg.2013.8
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发表时间：
2013-08-01
期刊：
影响因子：
16.9
通讯作者：
Berger, David L.
中科院分区：
文献类型：
--
作者：
Amri, Ramzi;Bordeianou, Liliana G.;Berger, David L.
在美国，结肠镜检查似乎可以降低结直肠癌的发病率。除了去除良性病变和防止进展为恶性肿瘤，筛查结肠镜检查理论上确定早期疾病的无症状患者，可能导致更高的存活率。和生存率，并确定是否通过筛查诊断改善长期预后独立分期。设计回顾性审查前瞻性维持，机构审查委员会-从1月1日起在马萨诸塞州总医院接受结肠癌手术的所有患者，干预结肠癌手术.主要结果和指标术后分期、死亡和复发，以发病率和事件发生时间为指标.结果共纳入1071例患者，其中217例通过筛查确诊。未通过筛查确诊的患者有发生侵袭性更强的肿瘤（>= T3：相对危险度[RR] = 1.96; P < .001）、淋巴结疾病（RR = 1.92; P < .001）和转移性疾病（RR = 3.37; P < .001）的风险。在随访中，这些患者有较高的死亡率（RR = 3.02; P <0.001）和复发率（RR = 2.19; P = 0.004），以及较短的生存期（P <0.001）和无病期（P <0.001）。控制分期和基线特征的考克斯和logistic回归显示，死亡率（P = .02）和生存期（P = .01）是通过筛选诊断的分期的更好分期。在无淋巴结或转移性扩散的肿瘤中，死亡率和转移率也显著较低（P均< .001）。结论和相关性结肠镜检查发现的结肠癌患者不仅表现为较低的疾病分期，而且与分期无关，预后也较好。遵守筛查结肠镜检查指南可以通过早期发现结肠癌在延长寿命，提高生活质量和降低医疗费用方面发挥重要作用。
IMPORTANCE Screening colonoscopy seemingly decreases colorectal cancer rates in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early-stage disease, potentially leading to higher survival rates.OBJECTIVES To assess the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence, and survival and to identify whether diagnosis through screening improves long-term outcomes independent of staging.DESIGN Retrospective review of prospectively maintained, institutional review board-approved database.SETTING Tertiary care center with high patient volume.PATIENTS All patients who underwent colon cancer surgery at Massachusetts General Hospital from January 1, 2004, through December 31, 2011.INTERVENTION Colon cancer surgery.MAIN OUTCOMES AND MEASURES Postoperative staging, death, and recurrence, measured as incidence and time to event.RESULTS A total of 1071 patients were included, with 217 diagnosed through screening. Patients not diagnosed through screening were at risk for a more invasive tumor (>= T3: relative risk [RR] = 1.96; P < .001), nodal disease (RR = 1.92; P < .001), and metastatic disease on presentation (RR = 3.37; P < .001). In follow-up, these patients had higher death rates (RR = 3.02; P < .001) and recurrence rates (RR = 2.19; P = .004) as well as shorter survival (P < .001) and disease-free intervals (P < .001). Cox and logistic regression controlling for staging and baseline characteristics revealed that death rate (P = .02) and survival duration (P = .01) were better stage for stage with diagnosis through screening. Death and metastasis rates also remained significantly lower in tumors without nodal or metastatic spread (all P < .001).CONCLUSIONS AND RELEVANCE Patients with colon cancer identified on screening colonoscopy not only have lower-stage disease on presentation but also have better outcomes independent of their staging. Compliance to screening colonoscopy guidelines can play an important role in prolonging longevity, improving quality of life, and reducing health care costs through early detection of colon cancer.