Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies.
Effect of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality: systematic review and meta-analysis of randomised controlled trials and observational studies.
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DOI：
10.1136/bmj.g2467
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发表时间：
2014-04-09
期刊：
影响因子：
--
通讯作者：
Hoffmeister M
中科院分区：
文献类型：
--
作者：
Brenner H;Stock C;Hoffmeister M
目的回顾、总结和比较乙状结肠镜检查和结肠镜检查在预防结直肠癌发生和死亡方面的有效性。设计随机对照试验和观察性研究的系统回顾和荟萃分析。数据来源PubMed、Embase和Web of Science。两名研究者独立地提取了已识别研究的特征和结果，并进行了标准化质量评级。入选标准：随机对照试验和观察性研究（英文），研究一般人群中乙状结肠镜检查和结肠镜检查对结直肠癌发病率和死亡率的影响。结果：对于筛查性乙状结肠镜检查，确定了4项随机对照试验和10项观察性研究，一致发现远端而非近端结直肠癌的发病率和死亡率显著降低。远端结直肠癌发病率和死亡率的总体估计降低了31%（95%置信区间为26%至37%）和46%（33%至57%）在有意筛选分析中，42%在随机对照试验的符合方案分析中为29%-53%和61%（27%-79%），在观察性研究中为64%（50%-74%）和66%（38%-81%）。对于筛查结肠镜检查，证据仅限于6项观察性研究，其结果初步表明远端结直肠癌发病率和死亡率的降低更明显，沿着近端结肠癌死亡率的显著降低。间接比较乙状结肠镜检查和结肠镜检查的观察性研究结果表明，结肠镜检查后结肠直肠癌的发病风险和死亡风险降低了40%至60%，尽管这种增量风险降低仅对近端结肠癌死亡具有统计学意义。结论随机对照试验和观察性研究的有力和一致的证据表明，筛查性乙状结肠镜检查和筛查性结肠镜检查可预防大多数远端结直肠癌死亡。观察性研究表明，结肠镜检查与乙状结肠镜检查相比，可降低近端结肠癌的死亡率。这种附加值应该在进一步的研究中进行检查，并与更高的成本、不适、并发症发生率、所需的能力和依从性的可能差异进行权衡。
Objectives To review, summarise, and compare the evidence for effectiveness of screening sigmoidoscopy and screening colonoscopy in the prevention of colorectal cancer occurrence and deaths. Design Systematic review and meta-analysis of randomised controlled trials and observational studies. Data sources PubMed, Embase, and Web of Science. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings. Eligibility criteria Randomised controlled trials and observational studies in English on the impact of screening sigmoidoscopy and screening colonoscopy on colorectal cancer incidence and mortality in the general population at average risk. Results For screening sigmoidoscopy, four randomised controlled trials and 10 observational studies were identified that consistently found a major reduction in distal but not proximal colorectal cancer incidence and mortality. Summary estimates of reduction in distal colorectal cancer incidence and mortality were 31% (95% confidence intervals 26% to 37%) and 46% (33% to 57%) in intention to screen analysis, 42% (29% to 53%) and 61% (27% to 79%) in per protocol analysis of randomised controlled trials, and 64% (50% to 74%) and 66% (38% to 81%) in observational studies. For screening colonoscopy, evidence was restricted to six observational studies, the results of which suggest tentatively an even stronger reduction in distal colorectal cancer incidence and mortality, along with a significant reduction in mortality from cancer of the proximal colon. Indirect comparisons of results of observational studies on screening sigmoidoscopy and colonoscopy suggest a 40% to 60% lower risk of incident colorectal cancer and death from colorectal cancer after screening colonoscopy even though this incremental risk reduction was statistically significant for deaths from cancer of the proximal colon only. Conclusions Compelling and consistent evidence from randomised controlled trials and observational studies suggests that screening sigmoidoscopy and screening colonoscopy prevent most deaths from distal colorectal cancer. Observational studies suggest that colonoscopy compared with flexible sigmoidoscopy decreases mortality from cancer of the proximal colon. This added value should be examined in further research and weighed against the higher costs, discomfort, complication rates, capacities needed, and possible differences in compliance.
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影响因子：
9.3
作者：
Kaminski MF;Bretthauer M;Zauber AG;Kuipers EJ;Adami HO;van Ballegooijen M;Regula J;van Leerdam M;Stefansson T;Påhlman L;Dekker E;Hernán MA;Garborg K;Hoff G
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