Hoffmeister Michael, Chang-Claude Jenny, Brenner Hermann
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Am J Epidemiol. 2007 Jul 15;166(2):130-6. doi: 10.1093/aje/kwm062. Epub 2007 Apr 23.
Large-bowel endoscopy with removal of polyps strongly reduces colorectal cancer risk. In epidemiologic studies, ascertainment of large-bowel endoscopies often relies on self-reports and might be prone to imperfect recall. In 2003-2004, the authors assessed the validity of self-reported colorectal endoscopies in a population-based case-control study including 540 cases and 614 controls from southwest Germany and calculated odds ratios of colorectal cancer risk according to self-reports and medical records. They sought to obtain all medical records for the last self-reported endoscopy and for a subsample of 100 subjects reporting no previous endoscopy. In total, 377 of 483 records could be obtained (78%). Sensitivity of self-reports was 100%, and specificity ranged from 93% to 98% among subgroups defined by age, gender, education, family history of colorectal cancer, and case-control status. The odds ratios for colorectal cancer risk after previous colonoscopy were 0.31 (95% confidence interval: 0.21, 0.45) using self-reports and 0.31 (95% confidence interval: 0.20, 0.47) using medical records. However, agreement between self-reports and medical records was poor regarding type of endoscopy (colonoscopy, sigmoidoscopy, or rectoscopy; kappa = 0.22), moderate concerning polypectomy (kappa = 0.58), and reasonable for year of examination (kappa = 0.70). Self-reports of previous colorectal endoscopies agreed well with medical records, but validation appears to be essential with respect to details of the examination.
通过切除息肉进行的大肠内镜检查可显著降低结直肠癌风险。在流行病学研究中，大肠内镜检查的确定往往依赖于自我报告，可能容易出现回忆不完整的情况。2003年至2004年，作者在一项基于人群的病例对照研究中评估了自我报告的大肠内镜检查的有效性，该研究包括来自德国西南部的540例病例和614例对照，并根据自我报告和医疗记录计算了结直肠癌风险的比值比。他们试图获取上次自我报告的内镜检查的所有医疗记录，以及100名报告未曾进行过内镜检查的受试者的子样本记录。总共获得了483份记录中的377份（78%）。自我报告的敏感性为100%，在按年龄、性别、教育程度、结直肠癌家族史和病例对照状态定义的亚组中，特异性范围为93%至98%。使用自我报告时，先前结肠镜检查后结直肠癌风险的比值比为0.31（95%置信区间：0.21，0.45），使用医疗记录时为0.31（95%置信区间：0.20，0.47）。然而，在结肠镜检查类型（结肠镜检查、乙状结肠镜检查或直肠镜检查；kappa = 0.22）方面，自我报告与医疗记录之间的一致性较差，在息肉切除术方面为中等（kappa = 0.58），在检查年份方面较为合理（kappa = 0.70）。先前大肠内镜检查的自我报告与医疗记录吻合良好，但就检查细节而言，验证似乎至关重要。
