Low Risk of Colorectal Cancer and Advanced Adenomas More Than 10 Years After Negative Colonoscopy
Low Risk of Colorectal Cancer and Advanced Adenomas More Than 10 Years After Negative Colonoscopy
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DOI：
10.1053/j.gastro.2009.10.054
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发表时间：
2010-03-01
期刊：
影响因子：
29.4
通讯作者：
Hoffmeister, Michael
中科院分区：
文献类型：
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作者：
Brenner, Hermann;Haug, Ulrike;Hoffmeister, Michael
背景与目的：结肠镜筛查是降低结直肠癌发病率和死亡率的有效方法。关于筛查的最佳间隔时间几乎没有经验证据，这是一个争论的主题。我们将晚期结直肠肿瘤的患病率与结肠镜检查阴性后的时间相关联。方法：在一项针对德国结肠镜筛查项目参与者的研究中，我们确定了既往接受过结肠镜检查但未检测到息肉（结肠镜检查阴性）的受试者在筛查结肠镜检查时检测到的结直肠肿瘤的患病率。将数据与未接受结肠镜检查的受试者的数据进行比较。研究结果：在平均11.9年前结肠镜检查阴性的参与者中没有检测到CRC（n = 553），相比之下，根据未接受结肠镜检查的参与者的年龄和性别特异性患病率，预期有8.4例CRC病例（n = 2701;标准化患病率[SPR] = 0.00; 95%置信区间[CI]：0.00-0.55）。在既往接受过结肠镜检查的受试者中，晚期腺瘤的患病率也要低得多（SPR = 0.42; 95% CI：0.25-0.68）。检测晚期腺瘤的校正患病率比（95%CI）为0.38（95% CI：0.16-0.90），0.34（95% CI：0.15-0.74），0.38（95% CI：0.16-0.90）和0.53（95%置信区间：0.27-1.04）分别在1-5年、6-10年、11- 1 - 5年和>16年前进行结肠镜检查阴性的参与者中，与之前没有结肠镜检查的参与者相比。结论：结肠镜检查阴性后结直肠癌和晚期腺瘤的低风险支持了将筛查间隔延长至>= 10年的建议。
BACKGROUND & AIMS: Screening colonoscopy is an effective method to reduce the incidence of and mortality from colorectal cancer (CRC). There is little empirical evidence available about the optimal interval for screening, making this a subject of debate. We associated the prevalence of advanced colorectal neoplasms with time since negative colonoscopies. METHODS: In a study of participants in the German colonoscopy screening program, we determined the prevalence of colorectal neoplasias detected at screening colonoscopy among subjects who had undergone a previous colonoscopy without detection of polyps (negative colonoscopy). Data were compared with that from subjects who had not received colonoscopies. RESULTS: No CRCs were detected in participants who had a previous negative colonoscopy an average of 11.9 years previously (n = 553), compared with the 8.4 CRC cases expected based on age- and gender-specific prevalences among participants who had not received a colonoscopy (n = 2701; standardized prevalence ratio [SPR] = 0.00; 95% confidence interval [CI]: 0.00-0.55). Prevalence of advanced adenoma was also much lower among subjects who had previous colonoscopies (SPR = 0.42; 95% CI: 0.25-0.68). Adjusted prevalence ratios (95% CIs) for detecting an advanced adenoma were 0.38 (95% CI: 0.16-0.90), 0.34 (95% CI: 0.15-0.74), 0.38 (95% CI: 0.16-0.90), and 0.53 (95% CI: 0.27-1.04) among participants with a negative colonoscopy conducted 1-5, 6-10, 11-15, and >16 years ago, respectively, compared to participants with no previous colonoscopy. CONCLUSIONS: The low risk of CRC and advanced adenomas after a negative colonoscopy supports suggestions that screening intervals be extended to >= 10 years.