Flexible sigmoidoscopy in the randomized prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial: added yield from a second screening examination.
Flexible sigmoidoscopy in the randomized prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial: added yield from a second screening examination.
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随机前列腺癌、肺癌、结直肠癌和卵巢癌 (PLCO) 癌症筛查试验中的柔性乙状结肠镜检查：第二次筛查检查的产量增加。
DOI：
10.1093/jnci/djr549
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发表时间：
2012
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Weissfeld,JoelL;Schoen,RobertE;Pinsky,PaulF;Bresalier,RobertS;Doria-Rose,VPaul;Laiyemo,AdeyinkaO;Church,Timothy;Yokochi,LanceA;Yurgalevitch,Susan;Rathmell,Joshua;Andriole,GeraldL;Buys,Saundra;Crawford,EDavid;Fouad,Mona;
在评估柔性乙状结肠镜（FSG）对结直肠癌死亡率影响的随机试验中，只有前列腺、肺、结直肠和卵巢（PLCO）癌症筛查试验对参与者进行了一次以上的筛查。我们报告了PLCO筛选FSG项目的结果，并评估了第二个FSG产生的产量增加。方法在研究开始时和3年或5年后，根据随机分配的时间，在10个区域筛查中心对参与者进行60厘米FSG筛查。随后诊断干预的结果以标准化的方式进行跟踪和记录，并根据性别和年龄对结果进行比较。该方案不鼓励在首次FSG后诊断为结直肠癌或腺瘤的患者重复FSG。结果77 447例入组患者中，67 073例（86.6%）至少有1例FSG， 39 443例（50.9%）有2例FSG。74.9%的患者在首次FSG阳性后进行诊断干预，78.7%的患者在再次FSG阳性后进行诊断干预。第二次FSG使筛查率提高了32%：在第一次筛查后，每1000人中有37.8人检出结直肠癌或晚期腺瘤，在所有筛查后，每1000人中有49.8人检出结直肠癌或晚期腺瘤。第二种FSG使癌症或晚期腺瘤的发生率在女性中增加26%，在男性中增加34%。在FSG阳性的一年内被诊断为结直肠癌的223名受试者中，64.6%为I期，17.5%为II期。结论重复FSG对女性结直肠癌或晚期腺瘤的检出率提高了1 / 4，对男性提高了1 / 3。在超过80%的筛查人群中，筛查检测到的癌症是早期的（I期或II期）。作为最终终点，来自PLCO的结直肠癌死亡率数据将在以后的出版物中公布。
BackgroundAmong randomized trials evaluating flexible sigmoidoscopy (FSG) for its effect on colorectal cancer mortality, only the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial screened its participants more than one time. We report outcomes from the PLCO screening FSG program and evaluate the increased yield produced by a second FSG.MethodsParticipants were screened by 60-cm FSG in 10 regional screening centers at study entry and 3 or 5 years later, depending on the time of random assignment. Results from subsequent diagnostic intervention were tracked and recorded in a standardized fashion, and outcomes were compared according to sex and age. The protocol discouraged repeat FSG in persons with colorectal cancer or adenoma diagnosed after the initial FSG.ResultsOf 77 447 enrollees, 67 073 (86.6%) had at least one FSG and 39 443 (50.9%) had two FSGs. Diagnostic intervention occurred in 74.9% after a positive first FSG and in 78.7% after a positive repeat FSG. The second FSG increased the screening yield by 32%: Colorectal cancer or advanced adenoma was detected in 37.8 per 1000 persons after first screening and in 49.8 per 1000 persons after all screenings. The second FSG increased the yield of cancer or advanced adenoma by 26% in women and by 34% in men. Of 223 subjects who received a diagnosis of colorectal carcinoma within 1 year of a positive FSG, 64.6% had stage I and 17.5% had stage II disease.ConclusionsRepeat FSG increased the detection of colorectal cancer or advanced adenoma in women by one-fourth and in men by one-third. Screen-detected carcinomas were early stage (stage I or II) in greater than 80% of screened persons. Colorectal cancer mortality data from the PLCO, as the definitive endpoint, will follow in later publications.