Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study.
Adenoma surveillance and colorectal cancer incidence: a retrospective, multicentre, cohort study.
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DOI：
10.1016/s1470-2045(17)30187-0
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Cross AJ
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文献类型：
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作者：
Atkin W;Wooldrage K;Brenner A;Martin J;Shah U;Perera S;Lucas F;Brown JP;Kralj-Hans I;Greliak P;Pack K;Wood J;Thomson A;Veitch A;Duffy SW;Cross AJ
切除腺瘤可降低结直肠癌的发病率和死亡率；然而，监测结肠镜检查对结直肠癌风险的益处尚不清楚。我们研究了中危患者结直肠癌发病率的异质性以及监测对结直肠癌发病率的影响。我们在1990年1月1日至2010年12月31日期间在英国17家医院进行了这项回顾性、多中心、队列研究，使用常规下消化道内窥镜检查和病理数据，这些患者在基线结肠镜检查和息肉切除术后被诊断为中等风险腺瘤（>99%）。这些患者目前每隔3年接受一次结肠镜检查。随访至2014年12月31日。我们使用Cox回归评估了监测对结直肠癌发病率的影响，并调整了患者、手术和息肉特征。我们根据确定为结直肠癌危险因素的息肉和手术特征定义了低风险和高风险亚组。我们以2007年英国普通人群为标准，估计结直肠癌发病率和标准化发病率（SIRs）。本试验已注册，注册号为ISRCTN15213649。253 798例患者接受了结肠内窥镜检查，其中11 944例中危性腺瘤纳入本分析。中位随访7.9年（IQR 5.6 - 11.1）后，210例结直肠癌确诊。5019例（42%）患者未参加监测，6925例（58%）患者参加了一次或多次监测访问。与无监测相比，1次或2次监测访问与结直肠癌发病率的显著降低相关（1次访问调整后的风险比为0.57,95% CI为0.40 - 0.80；2次访问调整后的风险比为0.51,95% CI为0.31 - 0.84）。在没有监测的情况下，基线时结肠镜检查质量不佳、近端息肉或高级别或较大腺瘤（≥20 mm）的患者（8865例[74%]）的结直肠癌发病率显著高于普通人群（SIR 1.30, 95% CI 1.06 - 1.57）。相比之下，在没有这些特征的患者中，结直肠癌的发病率低于一般人群（SIR 0.51, 95% CI 0.29 - 0.84）。结肠镜检查对大多数中危性腺瘤患者有益。然而，一些患者在基线结肠镜检查后已经处于低风险，对他们进行监测的价值尚不清楚。英国癌症研究所，国家健康研究所，健康技术评估。
Removal of adenomas reduces colorectal cancer incidence and mortality; however, the benefit of surveillance colonoscopy on colorectal cancer risk remains unclear. We examined heterogeneity in colorectal cancer incidence in intermediate-risk patients and the effect of surveillance on colorectal cancer incidence. We did this retrospective, multicentre, cohort study using routine lower gastrointestinal endoscopy and pathology data from patients who, after baseline colonoscopy and polypectomy, were diagnosed with intermediate-risk adenomas mostly (>99%) between Jan 1, 1990, and Dec 31, 2010, at 17 hospitals in the UK. These patients are currently offered surveillance colonoscopy at intervals of 3 years. Patients were followed up through to Dec 31, 2014.We assessed the effect of surveillance on colorectal cancer incidence using Cox regression with adjustment for patient, procedural, and polyp characteristics. We defined lower-risk and higher-risk subgroups on the basis of polyp and procedural characteristics identified as colorectal cancer risk factors. We estimated colorectal cancer incidence and standardised incidence ratios (SIRs) using as standard the general population of England in 2007. This trial is registered, number ISRCTN15213649. 253 798 patients who underwent colonic endoscopy were identified, of whom 11 944 with intermediate-risk adenomas were included in this analysis. After a median follow-up of 7·9 years (IQR 5·6–11·1), 210 colorectal cancers were diagnosed. 5019 (42%) patients did not attend surveillance and 6925 (58%) attended one or more surveillance visits. Compared to no surveillance, one or two surveillance visits were associated with a significant reduction in colorectal cancer incidence rate (adjusted hazard ratio 0·57, 95% CI 0·40–0·80 for one visit; 0·51, 0·31–0·84 for two visits). Without surveillance, colorectal cancer incidence in patients with a suboptimal quality colonoscopy, proximal polyps, or a high-grade or large adenoma (≥20 mm) at baseline (8865 [74%] patients) was significantly higher than in the general population (SIR 1·30, 95% CI 1·06–1·57). By contrast, in patients without these features, colorectal cancer incidence was lower than that of the general population (SIR 0·51, 95% CI 0·29–0·84). Colonoscopy surveillance benefits most patients with intermediate-risk adenomas. However, some patients are already at low risk after baseline colonoscopy and the value of surveillance for them is unclear. National Institute for Health Research Health Technology Assessment, Cancer Research UK.