Screening Colonoscopy and Risk for Incident Late-Stage Colorectal Cancer Diagnosis in Average-Risk Adults
Screening Colonoscopy and Risk for Incident Late-Stage Colorectal Cancer Diagnosis in Average-Risk Adults
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筛查结肠镜检查和平均风险成人晚期结直肠癌诊断事件的风险
DOI：
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发表时间：
2013
影响因子：
39.2
通讯作者：
N. Weiss
中科院分区：
文献类型：
--
作者：
Chyke A Doubeni;S. Weinmann;K. Adams;A. Kamineni;D. Buist;A. Ash;C. Rutter;V. P. Doria;D. Corley;R. Greenlee;Jessica Chubak;A. Williams;A. Kroll;Eric A. Johnson;Joe Webster;K. Richert;T. Levin;R. Fletcher;N. Weiss
背景
结肠镜检查在中等风险成人中的有效性尚不确定，尤其是对右半结肠癌。
客观化
研究筛查结肠镜检查与晚期结直肠癌(CRC)发病风险的关系。
设计
嵌套式病例对照研究。
设置
四项美国医疗计划。
病人
1039名中等风险成年人在其中一项健康计划中登记至少5年。病例患者在2006至2008年间确诊为IIB期或更高(晚期)结直肠癌的日期(参考日期)时年龄为55岁至85岁。为每个病例患者选择一个或两个对照患者，在出生年份、性别、健康计划和先前登记的持续时间上匹配。
测量
在参考日期前3个月至10年收到结直肠癌筛查，通过病历审计确定。病例患者和对照组患者接受结肠镜检查或乙状结肠镜检查的情况通过条件Logistic回归进行比较，条件Logistic回归考虑了病史、社会经济状况和其他筛查暴露。
结果
其中13例(2.8%)和46例对照(9.0%)接受过结肠镜检查，调整后的优势比分别为0.29(95%CI，0.15~0.58)，0.36(CI，0.16~0.80)，0.26(CI，0.06~1.11，P=0.069)。92例患者(19.5%)和173例对照患者(34.0%)接受乙状结肠镜检查，其AOR分别为0.50(CI，0.36~0.70)、0.79(CI，0.51~1.23)和0.26(CI，0.14~0.48)。
限制
筛查结肠镜检查的数量很少，影响了估计的精度。
结论
在中等风险人群中，结肠镜检查与诊断晚期结直肠癌(包括右侧结肠癌)的风险降低相关。对于乙状结肠镜检查，这种关联在左侧结直肠癌中被发现，但与右半结肠癌晚期癌的关联在统计学上并不显著。
BACKGROUND
The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer.
OBJECTIVE
To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC).
DESIGN
Nested case-control study.
SETTING
Four U.S. health plans.
PATIENTS
1039 average-risk adults enrolled for at least 5 years in one of the health plans. Case patients were aged 55 to 85 years on their diagnosis date (reference date) of stage IIB or higher (late-stage) CRC during 2006 to 2008. One or 2 control patients were selected for each case patient, matched on birth year, sex, health plan, and prior enrollment duration.
MEASUREMENTS
Receipt of CRC screening 3 months to 10 years before the reference date, ascertained through medical record audits. Case patients and control patients were compared on receipt of screening colonoscopy or sigmoidoscopy by using conditional logistic regression that accounted for health history, socioeconomic status, and other screening exposures.
RESULTS
In analyses restricted to 471 eligible case patients and their 509 matched control patients, 13 case patients (2.8%) and 46 control patients (9.0%) had undergone screening colonoscopy, which corresponded to an adjusted odds ratio (AOR) of 0.29 (95% CI, 0.15 to 0.58) for any late-stage CRC, 0.36 (CI, 0.16 to 0.80) for right colon cancer, and 0.26 (CI, 0.06 to 1.11; P = 0.069) for left colon/rectum cancer. Ninety-two case patients (19.5%) and 173 control patients (34.0%) had screening sigmoidoscopy, corresponding to an AOR of 0.50 (CI, 0.36 to 0.70) overall, 0.79 (CI, 0.51 to 1.23) for right colon late-stage cancer, and 0.26 (CI, 0.14 to 0.48) for left colon cancer.
LIMITATION
The small number of screening colonoscopies affected the precision of the estimates.
CONCLUSION
Screening with colonoscopy in average-risk persons was associated with reduced risk for diagnosis of incident late-stage CRC, including right-sided colon cancer. For sigmoidoscopy, this association was seen for left CRC, but the association for right colon late-stage cancer was not statistically significant.
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癌症筛查功效的病例对照研究分析：我们应该如何处理对有症状的人进行的检测？
影响因子：
5
作者：
Weiss,NS
通讯作者：
Weiss,NS
旨在预防癌症发病率的筛查测试功效的病例对照研究。
影响因子：
5
作者：
Weiss,NS
通讯作者：
Weiss,NS
影响因子：
158.5
作者：
MANDEL, JS;BOND, JH;EDERER, F
通讯作者：
EDERER, F
DOI：
10.1093/jncimonographs/lgi032
发表时间：
2005-01-01
期刊：
Journal of the National Cancer Institute. Monographs
影响因子：
--
作者：
Wagner, Edward H;Greene, Sarah M;Vogt, Thomas M
通讯作者：
Vogt, Thomas M