Paillot B, Czernichow P, Michel P, Merle V, Queuniet A M, Duval C, Daubert H
Service de Gastro-entérologie et Nutrition, Centre Regional de Lutte Contre le Cancer, Rouen, France.
Gut. 1999 Mar;44(3):372-6. doi: 10.1136/gut.44.3.372.
Subjects without known colorectal adenomas or cancer constitute a large majority of the population where 85% of all cases of colorectal cancer are thought to occur. Consequently these people should be considered for screening to decrease mortality from colorectal cancer in the general population.
To estimate the incidence rate of rectosigmoid adenomas in these subjects.
Subjects without adenomas or cancer at a previous examination which had visualised the rectosigmoid underwent a fibre endoscopy every three years. Endoscopic data and population characteristics were collected prospectively.
A total of 450 subjects fulfilled the selection criteria; 287 (64%) underwent at least two examinations, and 163 had three or more. At the second examination, with a mean delay of 39 months, the incidence rate of rectosigmoïd adenomas was 1.50% per patient year. The rate was 1.75% per patient year (95% CI 0.80-3.33) at the third endoscopy with an additional mean delay of 38 months. The cumulative incidence rate at six years was 7.3% (95% CI 4.3-10.3), representing a mean of 1.2% per patient year. This rate increased with age and was higher for men than for women after age adjustment (p< 0.03).
The incidence rates are very low compared with those of patients with prior adenomas. These results should be considered in establishing rectosigmoid adenoma screening strategies.
在所有结直肠癌病例中，约85%被认为发生在无已知结直肠腺瘤或癌症的人群中，这部分人群占大多数。因此，应考虑对这些人进行筛查，以降低普通人群中结直肠癌的死亡率。
估计这些人群中直肠乙状结肠腺瘤的发病率。
在之前检查中未发现腺瘤或癌症且直肠乙状结肠可视化的受试者，每三年接受一次纤维内镜检查。前瞻性收集内镜检查数据和人群特征。
共有450名受试者符合入选标准；287名（64%）接受了至少两次检查，163名接受了三次或更多次检查。在第二次检查时，平均间隔39个月，直肠乙状结肠腺瘤的发病率为每年每患者1.50%。在第三次内镜检查时，平均间隔增加38个月，发病率为每年每患者1.75%（95%可信区间0.80 - 3.33）。六年时的累积发病率为7.3%（95%可信区间4.3 - 10.3），平均每年每患者1.2%。该发病率随年龄增长而增加，年龄调整后男性高于女性（p < 0.03）。
与先前有腺瘤的患者相比，发病率非常低。在制定直肠乙状结肠腺瘤筛查策略时应考虑这些结果。
