Adenoma detection rate and risk of colorectal cancer and death.
Adenoma detection rate and risk of colorectal cancer and death.
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DOI：
10.1056/nejmoa1309086
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发表时间：
2014-04-03
期刊：
影响因子：
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通讯作者：
Quesenberry CP
中科院分区：
文献类型：
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作者：
Corley DA;Jensen CD;Marks AR;Zhao WK;Lee JK;Doubeni CA;Zauber AG;de Boer J;Fireman BH;Schottinger JE;Quinn VP;Ghai NR;Levin TR;Quesenberry CP
由医生进行的筛查性结肠镜检查检出一个或多个腺瘤的比例（腺瘤检出率）是推荐的质量指标。然而，关于这一比率与患者随后患结直肠癌（间隔癌）和死亡的风险之间的关系知之甚少。使用来自综合医疗保健提供组织的数据，我们评估了腺瘤检出率与结肠镜检查后6个月至10年诊断的结直肠癌风险以及癌症相关死亡风险之间的关系。通过使用考克斯回归，我们对归因风险的估计根据患者的人口统计学特征、结肠镜检查的适应症和共存疾病进行了调整。我们评估了136名胃肠病学家进行的314，872次结肠镜检查;腺瘤检出率范围为7.4%至52.5%。在随访期间，我们确定了712例间隔期结直肠腺癌，包括255例晚期癌症，147例死于间隔期结直肠癌。根据腺瘤检出率的五分位数，从最低到最高，间隔期癌症的未校正风险分别为9.8、8.6、8.0、7.0和4.8例/10，000人-年随访。在腺瘤检出率最高的五分之一的医生的患者中，与检出率最低的五分之一的医生的患者相比，任何时间段癌症的校正风险比为0.52（95%置信区间[CI]，0.39 - 0.69），晚期间隔期癌症，0.43（95% CI，0.29至0.64），致死性间隔期癌症为0.38（95% CI，0.22至0.65）。腺瘤检出率每增加1.0%，癌症风险降低3.0%（风险比，0.97; 95%CI，0.96 - 0.98）。腺瘤检出率与间歇期结直肠癌、晚期间歇期癌和致死性间歇期癌的风险呈负相关。（由凯撒永久社区福利计划和国家癌症研究所资助。
The proportion of screening colonoscopic examinations performed by a physician that detect one or more adenomas (the adenoma detection rate) is a recommended quality measure. However, little is known about the association between this rate and patients’ risks of a subsequent colorectal cancer (interval cancer) and death. Using data from an integrated health care delivery organization, we evaluated the associations between the adenoma detection rate and the risks of colorectal cancer diagnosed 6 months to 10 years after colonoscopy and of cancer-related death. With the use of Cox regression, our estimates of attributable risk were adjusted for the demographic characteristics of the patients, indications for colonoscopy, and coexisting conditions. We evaluated 314,872 colonoscopies performed by 136 gastroenterologists; the adenoma detection rates ranged from 7.4 to 52.5%. During the follow-up period, we identified 712 interval colorectal adenocarcinomas, including 255 advanced-stage cancers, and 147 deaths from interval colorectal cancer. The unadjusted risks of interval cancer according to quintiles of adenoma detection rates, from lowest to highest, were 9.8, 8.6, 8.0, 7.0, and 4.8 cases per 10,000 person-years of follow-up, respectively. Among patients of physicians with adenoma detection rates in the highest quintile, as compared with patients of physicians with detection rates in the lowest quintile, the adjusted hazard ratio for any interval cancer was 0.52 (95% confidence interval [CI], 0.39 to 0.69), for advanced-stage interval cancer, 0.43 (95% CI, 0.29 to 0.64), and for fatal interval cancer, 0.38 (95% CI, 0.22 to 0.65). Each 1.0% increase in the adenoma detection rate was associated with a 3.0% decrease in the risk of cancer (hazard ratio, 0.97; 95% CI, 0.96 to 0.98). The adenoma detection rate was inversely associated with the risks of interval colorectal cancer, advanced-stage interval cancer, and fatal interval cancer. (Funded by the Kaiser Permanente Community Benefit program and the National Cancer Institute.)