Family history and the risk of colorectal cancer: The importance of patients' history of colonoscopy
Family history and the risk of colorectal cancer: The importance of patients' history of colonoscopy
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DOI：
10.1002/ijc.30284
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发表时间：
2016-11-15
影响因子：
6.4
通讯作者：
Brenner, Hermann
中科院分区：
文献类型：
--
作者：
Weigl, Korbinian;Jansen, Lina;Brenner, Hermann
有家族病史(FH)的人患结直肠癌(CRC)风险的登记研究通常不控制重要的协变量，如结肠镜检查史。我们的目标是量化FH和CRC风险之间的联系，仔细考虑潜在的混杂因素。我们在德国进行了一项以人群为基础的病例对照研究。从2003年到2014年，共有4313名首次诊断为结直肠癌的患者(病例)和3153名对照纳入其中。我们使用多元Logistic回归分析来评估FH与结直肠癌风险之间的关联，以及优势比(OR)和由此产生的95%可信区间(95%CI)。共有582例患者(13.5%)和321例对照(10.2%)报告了一级亲属的结直肠癌病史，在调整性别和年龄因素后，结直肠癌的风险增加了41%(OR：1.41，95%可信区间1.22-1.63)。经综合调整(包括既往结肠镜检查)后，OR值为1.73(95%CI，1.48~2.03)。无论FH状态如何，有结肠镜检查史的患者与无FH病史的患者相比，其结直肠癌风险较低(无FH患者的OR：0.25，95%CI，0.22~0.28；FH患者的OR：0.45，95%CI，0.36~0.56)。因此，在广泛使用结肠镜检查的时代，调整以前的结肠镜检查对于得出FH相关CRC风险的有效估计至关重要。结肠镜检查可降低FH患者发生结直肠癌的风险，远低于无FH患者和未行结肠镜检查的患者。
Registry-based studies on the risk of colorectal cancer (CRC) for persons with a family history (FH) typically did not control for important covariates, such as history of colonoscopy. We aimed to quantify the association between FH and CRC risk, carefully accounting for potential confounders. We conducted a population-based case-control study in Germany. A total of 4,313 patients with a first diagnosis of CRC (cases) and 3,153 controls recruited from 2003 to 2014 were included. We used multiple logistic regression analyses to assess the association between FH and risk of CRC with odds ratios (OR) and the resulting 95% confidence intervals (95% CI). A total of 582 cases (13.5%) and 321 (10.2%) controls reported a history of CRC in a first-degree relative, which was associated with a 41% increase in risk of CRC (OR: 1.41, 95% CI 1.22-1.63) after adjustment for sex and age. The OR substantially increased to 1.73 (95% CI, 1.48-2.03) after comprehensive adjustment including previous colonoscopies. Irrespective of their FH status, persons with history of colonoscopies had a lower CRC risk compared with persons without previous colonoscopies and without family history (OR: 0.25, 95% CI, 0.22-0.28 for persons without FH and OR 0.45, 95% CI, 0.36-0.56 for persons with FH). In an era of widespread use of colonoscopy, adjusting for previous colonoscopy is therefore crucial for deriving valid estimates of FH-related CRC risk. Colonoscopy reduces the risk of CRC among those with FH far below levels of people with no FH and no colonoscopy.