Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
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DOI：
10.1056/nejmoa1100370
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发表时间：
2012-02-23
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影响因子：
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通讯作者：
Waye JD
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作者：
Zauber AG;Winawer SJ;O'Brien MJ;Lansdorp-Vogelaar I;van Ballegooijen M;Hankey BF;Shi W;Bond JH;Schapiro M;Panish JF;Stewart ET;Waye JD
在国家息肉研究中，结肠镜切除腺瘤性息肉可以预防结直肠癌。我们在一项关于结直肠癌死亡率的研究中评估了结肠镜息肉切除术的长期效果。我们纳入了所有在1980年至1990年期间前瞻性转诊至各临床中心接受首次结肠镜检查的息肉（腺瘤和非腺瘤）患者。国家死亡指数用于识别死亡和确定死亡原因;随访时间长达23年。将腺瘤切除患者的结直肠癌死亡率与根据监测流行病学和最终结果（SEER）计划估计的一般人群中结直肠癌基于发病率的预期死亡率以及观察到的非腺瘤性息肉患者（内部对照组）结直肠癌死亡率进行比较。在参与研究期间切除腺瘤的2602名患者中，在中位数为15.8年后，1246名患者死于任何原因，12名患者死于结直肠癌。在一般人群中，预计结直肠癌死亡人数为25.4人，结肠镜息肉切除术的标准化基于发病率的死亡率为0.47（95%置信区间[CI]，0.26 - 0.80），表明死亡率降低53%。在息肉切除术后的前10年内，腺瘤和非腺瘤性息肉患者的结直肠癌死亡率相似（相对危险度，1.2; 95%CI，0.1 - 10.6）。这些发现支持了结肠镜下切除腺瘤性息肉可以预防结直肠癌死亡的假设。（由国家癌症研究所和其他机构资助。
In the National Polyp Study (NPS), colorectal cancer was prevented by colonoscopic removal of adenomatous polyps. We evaluated the long-term effect of colonoscopic polypectomy in a study on mortality from colorectal cancer. We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with non-adenomatous polyps (internal control group). Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6). These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.)