PREVENTION OF COLORECTAL-CANCER BY FLEXIBLE ENDOSCOPY AND POLYPECTOMY - A CASE-CONTROL STUDY OF 32702 VETERANS
PREVENTION OF COLORECTAL-CANCER BY FLEXIBLE ENDOSCOPY AND POLYPECTOMY - A CASE-CONTROL STUDY OF 32702 VETERANS
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DOI：
10.7326/0003-4819-123-12-199512150-00002
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发表时间：
1995-12-15
影响因子：
39.2
通讯作者：
SONNENBERG, A
中科院分区：
文献类型：
--
作者：
MULLER, AD;SONNENBERG, A
目的：确定结直肠癌患者是否比未受影响的对照组更不可能接受一次或多次内窥镜手术设计：病例对照研究。设置：退伍军人事务部医院。患者：8722例结肠癌和7629例直肠癌患者，以及与相应病例患者同时出院的年龄、性别、种族匹配的对照组。从1981年到每例结直肠癌患者中进行的大肠内窥镜手术的数量和类型。结果：与对照组相比，结直肠癌患者在被诊断为癌症之前较少接受过大肠内镜检查（结肠癌的比值比为0.51 [95%CI，0.44至0.58];直肠癌的比值比为0.55 [CI，0.47至0.64]）。在接受乙状结肠镜检查、结肠镜检查和息肉切除术的患者中，优势比甚至更小。当按单独的1年间隔进行分析时，癌症患者在癌症发作前长达6年的时间内手术次数明显减少。同样，较少的住院和门诊手术的患者比controls.Conclusions：大肠内窥镜手术的发展结肠癌和直肠癌的风险降低了50%，其保护性影响持续6年。
Objective: To determine whether patients with colorectal cancer are less likely than unaffected controls to have had one or more endoscopic procedures (flexible sigmoidoscopy, colonoscopy, or polypectomy) before being diagnosed with cancer.Design: Case-control study.Setting: Hospitals of the Department of Veterans Affairs.Patients: 8722 and 7629 case-patients with colon and rectal cancer, respectively, and age-, sex-, race-matched controls who were discharged at the same time as the corresponding case-patients.Measurements: Number and type of endoscopic procedures of the large bowel done from 1981 until the development of colorectal cancer in each case-patient. The influence of endoscopic procedures on the development of colorectal cancer was tested by conditional multiple logistic regression analysis.Results: Compared with controls, patients with colorectal cancer were less likely to have had an endoscopic procedure of the large bowel before being diagnosed with cancer (odds ratio for colon cancer, 0.51 [95% CI, 0.44 to 0.58]; odds ratio for rectal cancer, 0.55 [CI, 0.47 to 0.64]). In patients who had flexible sigmoidoscopy, colonoscopy, and polypectomy, the odds ratios were even smaller. When analyzed by separate 1-year intervals, patients with cancer had significantly fewer procedures during periods of up to 6 years before the onset of their cancer. Similarly, fewer inpatient and outpatient procedures were done in patients than in controls.Conclusions: Endoscopic procedures of the large bowel reduce the risk for developing colon and rectal cancer by 50%, their protective influence lasting 6 years.