Colonoscopy Reduces Colorectal Cancer Incidence and Mortality in Patients With Non-Malignant Findings: A Meta-Analysis.
Colonoscopy Reduces Colorectal Cancer Incidence and Mortality in Patients With Non-Malignant Findings: A Meta-Analysis.
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DOI：
10.1038/ajg.2015.418
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发表时间：
2016-03
期刊：
影响因子：
--
通讯作者：
Li ZS
中科院分区：
文献类型：
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作者：
Pan J;Xin L;Ma YF;Hu LH;Li ZS
观察性研究表明，结肠镜检查可降低一般人群中结直肠癌（CRC）的发病率和死亡率。我们的目的是进行一项荟萃分析，量化具有筛查和诊断指征的结肠镜检查对非恶性发现的CRC患者的保护程度，并证明筛查比诊断性结肠镜检查的潜在更显著的效果。检索截止到2015年4月30日的PubMed、EMBASE和会议摘要。主要结局是总CRC发病率和死亡率。采用随机效应模型计算合并相对风险（rr）和95%置信区间（ci）。11项观察性研究共纳入1499521人。合并分析显示，结肠镜检查与非恶性发现的患者CRC发病率降低61%的RR （RR: 0.39; 95% CI: 0.26-0.60; I2=93.6%）和CRC死亡率降低61% （RR: 0.39; 95% CI: 0.35-0.43; I2=12.0%）相关，尽管CRC发病率的结果存在高度异质性。在排除一项异常研究后，发病率结局的异质性较低（I2=44.7%）。亚组分析显示，筛查性结肠镜检查的效果更为突出，与诊断性结肠镜检查相比，CRC发病率降低89% (RR: 0.11; 95% CI: 0.08-0.15) （RR: 0.51; 95% CI: 0.43-0.59； P<0.001）。在这项观察性研究的荟萃分析的基础上，结肠镜检查后非恶性发现的CRC患者的发病率和死亡率显著降低。筛查性结肠镜检查对结直肠癌发病率的影响比诊断性结肠镜检查更显著。
Observational studies have shown that colonoscopy reduces colorectal cancer (CRC) incidence and mortality in the general population. We aimed to conduct a meta-analysis quantifying the magnitude of protection by colonoscopy, with screening and diagnostic indications, against CRC in patients with non-malignant findings and demonstrating the potentially more marked effect of screening over diagnostic colonoscopy. PubMed, EMBASE, and conference abstracts were searched through 30 April 2015. The primary outcomes were overall CRC incidence and mortality. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effect models. Eleven observational studies with a total of 1,499,521 individuals were included. Pooled analysis showed that colonoscopy was associated with a 61% RR reduction in CRC incidence (RR: 0.39; 95% CI: 0.26–0.60; I2=93.6%) and a 61% reduction in CRC mortality (RR: 0.39; 95% CI: 0.35–0.43; I2=12.0%) in patients with non-malignant findings, although there was high heterogeneity for the outcome of CRC incidence. After excluding one outlier study, there was low heterogeneity for the outcome of incidence (I2=44.7%). Subgroup analysis showed that the effect of screening colonoscopy was more prominent, corresponding to an 89% reduction in CRC incidence (RR: 0.11; 95% CI: 0.08–0.15), in comparison with settings involving diagnostic colonoscopy (RR: 0.51; 95% CI: 0.43–0.59; P<0.001). On the basis of this meta-analysis of observational studies, CRC incidence and mortality in patients with non-malignant findings are significantly reduced after colonoscopy. The effect of screening colonoscopy on CRC incidence is more marked than diagnostic colonoscopy.