Risk of Developing Proximal Versus Distal Colorectal Cancer After a Negative Colonoscopy: A Population-Based Study
Risk of Developing Proximal Versus Distal Colorectal Cancer After a Negative Colonoscopy: A Population-Based Study
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DOI：
10.1016/j.cgh.2008.05.016
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发表时间：
2008-10-01
影响因子：
12.6
通讯作者：
Rabeneck, Linda
中科院分区：
文献类型：
--
作者：
Lakoff, Josh;Paszat, Lawrence F.;Rabeneck, Linda
背景与目的：结肠镜检查阴性后，结肠直肠癌（CRC）的发病率总体上降低了长达10年。本研究的目的是确定阴性结肠镜检查后近端和远端结直肠癌的发生率。方法：对1992年1月1日至1997年12月31日期间结肠镜检查阴性的安大略省50至80岁居民进行队列研究，并使用相关的管理数据库进行鉴定。队列成员没有既往结直肠癌、炎症性肠病或近期结肠切除术史。每个个体随访至2005年12月31日，并将总体CRC、远端CRC和近端CRC的相对发生率（RR）与其余安大略省人群进行比较。结果：确定了110402例结肠镜检查阴性个体的队列。总体CRC的RR和远端CRC的RR仍显著低于安大略省人群。例如，在第14年，远端CRC的RR为0.21（95%可信区间，0.05-0.36）。近端结直肠癌的RR在一半的随访年份显著低于安大略省人群，主要是在随访7年后。结论：在14年的随访期内，结肠镜检查阴性与随后总体CRC发生率降低以及远端结肠CRC发生率降低相关。然而，近端结直肠癌发病率的降低在幅度和时间上有所不同，并且发生在一半的随访年，主要是在7年随访后。这些结果突出了结肠镜检查在常规临床实践中的一个重要局限性。
Background & Aims: The incidence of colorectal cancer (CRC) overall is reduced for up to 10 years after a negative colonoscopy. The objective of this research was to determine the incidence of proximal and distal CRC after a negative complete colonoscopy. Methods: A cohort of Ontario residents aged 50 to 80 years who had a negative complete colonoscopy between January 1, 1992, and December 31, 1997, was identified by using linked administrative databases. Cohort members had no prior history of CRC, inflammatory bowel disease, or recent colonic resection. Each individual was followed up through December 31, 2005, and the relative rate (RR) of overall CRC, distal CRC, and proximal CRC was compared with the remaining Ontario population. Results: A cohort of 110,402 individuals with a negative complete colonoscopy was identified. The RR of CRC overall and the RR of distal CRC remained significandy lower than the Ontario population. For example, at year 14 the RR of distal CRC was 0.21 (95% confidence interval, 0.05-0.36). The RR of proximal CRC was significantly lower than the Ontario population in half of the follow-up years, mainly after 7 years of follow-up. Conclusions: Over a 14-year follow-up period, negative complete colonoscopy was associated with a subsequent reduced incidence of CRC overall, and of incident CRC in the distal colon. However, the reduction in incidence of proximal CRC differed in magnitude and timing, and occurred in half the follow-up years, mainly after 7 years of follow-up. These results highlight an important limitation of colonoscopy in usual clinical practice.