Role of Colonoscopy and Polyp Characteristics in Colorectal Cancer After Colonoscopic Polyp Detection A Population-Based Case-Control Study
Role of Colonoscopy and Polyp Characteristics in Colorectal Cancer After Colonoscopic Polyp Detection A Population-Based Case-Control Study
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DOI：
10.7326/0003-4819-157-4-201208210-00002
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发表时间：
2012-08-21
影响因子：
39.2
通讯作者：
Hoffmeister, Michael
中科院分区：
文献类型：
--
作者：
Brenner, Hermann;Chang-Claude, Jenny;Hoffmeister, Michael
背景资料：研究发现结肠镜检查发现的腺瘤特征可预测腺瘤复发。目的：评估结肠镜检查相关因素和息肉特征对结肠镜检查发现息肉后结直肠癌风险的作用。设计：基于人群的病例对照研究（3148例病例参与者和3274例对照参与者）。设置：德国的莱茵-内卡地区。患者：病例组和对照组参与者在过去10年中在以前的结肠镜检查中经医生验证检测到息肉（增生性息肉除外）。测量：通过访谈和医疗记录获得以前结肠镜检查的详细历史和结果。根据结肠镜检查相关因素（不完全性、肠道准备不良、所有息肉未完全切除、5年内未进行结肠镜检查）和息肉特征（>= 1 cm、绒毛成分或高度异型增生、>= 3个息肉和>= 1个近端息肉）对病例和对照参与者进行比较。优势比（OR）和归因分数，通过使用多元Logistic回归和Levin formulation.Results：155例参与者和260名对照参与者与医生验证的息肉检测在过去的10年中确定。以下特征在病例参与者中比在对照参与者中明显更常见：并非所有息肉都被完全切除（29.0% vs. 9.6%; OR，3.73 [95% CI，2.11 - 6.60]），5年内未进行监测结肠镜检查（26.5% vs. 11.5%; OR，2.96 [CI，1.70 - 5.16]），以及检测到3个或更多息肉（14.2% vs. 7.3%; OR，2.21 [CI，1.07 - 4.54]）。所有其他变量的比值比范围为1.12 - 1.42，CI包括1.00。总体而言，41.1%和21.7%的癌症病例统计归因于结肠镜检查相关因素和息肉的特点，分别为，Limitation：这是一项观察性研究与潜在的残余混杂和选择bias.Conclusion：结肠镜检查相关因素比息肉的特点更重要的分层结肠直肠癌的风险后，结肠镜息肉检测在社区设置。
Background: Studies have identified characteristics of adenomas detected on colonoscopy to be predictive of adenoma recurrence.Objective: To assess the role of both colonoscopy-related factors and polyp characteristics on the risk for colorectal cancer after colonoscopic polyp detection.Design: Population-based case-control study (3148 case participants and 3274 control participants).Setting: Rhine-Neckar region of Germany.Patients: Case and control participants with physician-validated detection of polyps (other than hyperplastic polyps) at a previous colonoscopy in the past 10 years.Measurements: Detailed history and results of previous colonoscopies were obtained through interviews and medical records. Case and control participants were compared according to colonoscopy-related factors (incompleteness, poor bowel preparation, incomplete removal of all polyps, and no surveillance colonoscopy within 5 years) and polyp characteristics (>= 1 cm, villous components or high-grade dysplasia, >= 3 polyps, and >= 1 proximal polyp). Odds ratios (ORs) and attributable fractions were derived by using multiple logistic regression and the Levin formula.Results: 155 case participants and 260 control participants with physician-validated polyp detection in the past 10 years were identified. The following characteristics were significantly more common among case participants than among control participants: not all polyps completely removed (29.0% vs. 9.6%; OR, 3.73 [95% CI, 2.11 to 6.60]), no surveillance colonoscopy within 5 years (26.5% vs. 11.5%; OR, 2.96 [CI, 1.70 to 5.16]), and detection of 3 or more polyps (14.2% vs. 7.3%; OR, 2.21 [CI, 1.07 to 4.54]). Odds ratios ranged from 1.12 to 1.42 and CIs included 1.00 for all other variables. Overall, 41.1% and 21.7% of cancer cases were statistically attributable to colonoscopy-related factors and polyp characteristics, respectively.Limitation: This was an observational study with potential for residual confounding and selection bias.Conclusion: Colonoscopy-related factors are more important than polyp characteristics for stratification of colorectal cancer risk after colonoscopic polyp detection in the community setting.