Stevens Tyler, Burke Carol A
Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Am J Gastroenterol. 2003 Aug;98(8):1881-5. doi: 10.1111/j.1572-0241.2003.07576.x.
The age to begin colorectal cancer (CRC) screening is based on the risk of neoplasia and is published in screening guidelines. The age to stop screening is unknown but should be based, in part, on the same principle. The purpose of this study was to establish whether the prevalence of neoplasia detected by colonoscopy diminished with advancing age, to warrant ceasing colonoscopic screening.
The endoscopic and pathology reports of all asymptomatic subjects undergoing colonoscopy for the purpose of CRC screening or an evaluation of abdominal pain or change in bowel habits between 1997 and 2000 were reviewed. A multivariate logistic regression analysis was used to assess the effect of age, gender, and indication for examination on the prevalence of neoplasia, as well as on having more than two adenomas, advanced adenomas (tubulovillous, villous, severe dysplasia, or size > or = 1 cm), and invasive cancers.
A total of 915 patients were included. Of these, 50% were male, with a mean age of 65 yr (range 50-100). Neoplasia peaked in the seventh decade, with a fall thereafter (p = 0.009). Numerous adenomas, advanced adenomas, and invasive cancers increased with age. The yield for overall neoplasia, advanced adenomas, and more than two adenomas was higher in the screening group than in the symptomatic group. More invasive cancers were found in the symptomatic group compared with the asymptomatic group, but this did not achieve statistical significance (4 vs 1, p = 0.44).
The prevalence of advanced neoplasia continues to increase with age. Subjects undergoing colonoscopy for screening had a greater risk for neoplasia than did subjects with symptoms. There is no decline in yield of advanced neoplasia to justify stopping screening colonoscopy in the elderly.
开始结直肠癌（CRC）筛查的年龄是基于瘤变风险确定的，并已在筛查指南中公布。停止筛查的年龄尚不清楚，但部分也应基于相同原则。本研究的目的是确定结肠镜检查发现的瘤变患病率是否会随着年龄增长而降低，从而证明应停止结肠镜筛查。
回顾了1997年至2000年间所有因CRC筛查或评估腹痛或排便习惯改变而接受结肠镜检查的无症状受试者的内镜和病理报告。采用多因素逻辑回归分析来评估年龄、性别和检查指征对瘤变患病率以及对有两个以上腺瘤、高级别腺瘤（管状绒毛状、绒毛状、重度不典型增生或大小≥1 cm）和浸润性癌的影响。
共纳入915例患者。其中，50%为男性，平均年龄65岁（范围50 - 100岁）。瘤变在七十岁时达到峰值，此后下降（p = 0.009）。多个腺瘤、高级别腺瘤和浸润性癌随年龄增加。筛查组总体瘤变、高级别腺瘤和两个以上腺瘤的检出率高于有症状组。与无症状组相比，有症状组发现更多浸润性癌，但未达到统计学意义（4例对1例，p = 0.44）。
高级别瘤变的患病率继续随年龄增加。接受结肠镜筛查的受试者比有症状的受试者发生瘤变的风险更高。高级别瘤变的检出率没有下降，不足以证明应停止对老年人进行结肠镜筛查。
