Association Between Colonoscopy and Colorectal Cancer Mortality in a US Cohort According to Site of Cancer and Colonoscopist Specialty
Association Between Colonoscopy and Colorectal Cancer Mortality in a US Cohort According to Site of Cancer and Colonoscopist Specialty
复制标题
DOI：
10.1200/jco.2011.40.4772
复制
发表时间：
2012-07-20
影响因子：
45.3
通讯作者：
Doria-Rose, V. Paul
中科院分区：
文献类型：
--
作者：
Baxter, Nancy N.;Warren, Joan L.;Doria-Rose, V. Paul
PurposeWe设计了这项研究，以评估结肠镜检查与结直肠癌（CRC）的死亡在美国的网站CRC和内镜speciality.MethodsWe设计了一个病例对照研究，使用监测，流行病学和最终结果（SEER）-医疗保险数据。我们确定了1998年1月至2002年12月诊断为CRC的患者（病例），年龄为70至89岁，截至2007年死于CRC。我们为每个病例选择了三个匹配的对照组，没有癌症。对照组被指定一个参考日期（病例诊断日期）。从1991年1月到诊断/参考日期前6个月进行的结肠镜检查是我们的主要暴露。我们通过控制协变量的条件Logistic回归，按结直肠癌部位分层，比较病例组和对照组的结肠镜检查暴露情况。我们通过与美国医学协会（AMA）主文件的链接确定内镜医师专业。我们评估了结肠镜检查和结直肠癌死亡之间的关联是否因内镜医师的专业而异。ResultsWe确定了9，458例病例（3，963例近端[41.9%]，4，685例远端[49.5%]和810例未知部位[8.6%]）和27，641例对照。总的来说，11.3%的病例和23.7%的对照组在诊断前6个月以上接受了结肠镜检查。与对照组相比，病例不太可能接受结肠镜检查（比值比[OR]，0.40; 95%CI，0.37至0.43）;远端（OR，0.24; 95%CI，0.21至0.27）CRC与近端（OR，0.58; 95%CI，0.53至0.64）CRC的相关性更强。该协会的强度与内镜specialty.ConclusionColonoscopy是与CRC的死亡风险降低，与协会相当，并始终强于远端与近端CRC。如果结肠镜检查由胃肠病学家进行，则总体相关性最强。
PurposeWe designed this study to evaluate the association of colonoscopy with colorectal cancer (CRC) death in the United States by site of CRC and endoscopist specialty.MethodsWe designed a case-control study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. We identified patients (cases) diagnosed with CRC age 70 to 89 years from January 1998 through December 2002 who died as a result of CRC by 2007. We selected three matched controls without cancer for each case. Controls were assigned a referent date (date of diagnosis of the case). Colonoscopy performed from January 1991 through 6 months before the diagnosis/referent date was our primary exposure. We compared exposure to colonoscopy in cases and controls by using conditional logistic regression controlling for covariates, stratified by site of CRC. We determined endoscopist specialty by linkage to the American Medical Association (AMA) Masterfile. We assessed whether the association between colonoscopy and CRC death varied with endoscopist specialty.ResultsWe identified 9,458 cases (3,963 proximal [41.9%], 4,685 distal [49.5%], and 810 unknown site [8.6%]) and 27,641 controls. In all, 11.3% of cases and 23.7% of controls underwent colonoscopy more than 6 months before diagnosis. Compared with controls, cases were less likely to have undergone colonoscopy (odds ratio [OR], 0.40; 95% CI, 0.37 to 0.43); the association was stronger for distal (OR, 0.24; 95% CI, 0.21 to 0.27) than proximal (OR, 0.58; 95% CI, 0.53 to 0.64) CRC. The strength of the association varied with endoscopist specialty.ConclusionColonoscopy is associated with a reduced risk of death from CRC, with the association considerably and consistently stronger for distal versus proximal CRC. The overall association was strongest if colonoscopy was performed by a gastroenterologist.