Kahi Charles J, Azzouz Faouzi, Juliar Beth E, Imperiale Thomas F
Indiana University Medical Center, Roudebush Veterans Affairs Medical Center, Indiana University Department of Biostatistics, Indianapolis, Indiana 46202, USA.
Gastrointest Endosc. 2007 Sep;66(3):544-50. doi: 10.1016/j.gie.2007.01.008.
In the elderly, the increased prevalence of colorectal neoplasia and the protective effect of colonoscopy may be offset by advancing age and comorbidity.
To describe and quantify the endoscopic findings, survival, and predictors of mortality of elderly persons after colonoscopy.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of persons aged>or=75 years who underwent colonoscopy in 1999 and 2000 at a U.S. Veterans Affairs facility and urban county hospital.
Advanced neoplasms were defined as colorectal cancer (CRC), polyp with high-grade dysplasia, villous histologic features, or tubular adenoma>or=1 cm. Comorbidity was measured with the Charlson comorbidity index. Subjects were followed until death or study closure.
Of 469 eligible subjects, 65 were excluded and 404 were included in the study. Fifty-nine of 404 (15%) had an advanced neoplasm, including 8 (2%) with CRC. There were 167 deaths (41%); the mean overall survival was 4.1+/-0.1 years (median 5.95 years). A symptomatic indication for colonoscopy was not predictive of death. Mortality was predicted by age (hazard ratio 1.16 for each year increase beyond age 75 years, 95% CI 1.07-1.3, P=.0003) and Charlson score (hazard ratio 8.3 for each point increase, 95% CI 1.4-48.5, P=.02). The median survival of patients aged 75 to 79 years was >5 years if the Charlson score was <or=4. Among patients aged>or=80 years, the median survival was <5 years regardless of Charlson score.
Retrospective design.
In this cohort of elders, age and comorbidity were predictors of death. The protective effect of younger age lessens as comorbidity increases. These findings may have important implications for CRC screening and surveillance in elders.
在老年人中，结直肠肿瘤患病率的增加以及结肠镜检查的保护作用可能会因年龄增长和合并症而被抵消。
描述并量化老年人结肠镜检查后的内镜检查结果、生存率及死亡预测因素。
设计、地点和患者：对1999年和2000年在美国退伍军人事务机构和城市县医院接受结肠镜检查的年龄≥75岁的人群进行回顾性队列研究。
进展期肿瘤定义为结直肠癌（CRC）、高级别异型增生息肉、绒毛组织学特征或直径≥1 cm的管状腺瘤。采用Charlson合并症指数衡量合并症情况。对研究对象进行随访直至死亡或研究结束。
469名符合条件的受试者中，65名被排除，404名被纳入研究。404名受试者中有59名（15%）患有进展期肿瘤，其中8名（2%）患有CRC。共有167人死亡（41%）；平均总生存期为4.1±0.1年（中位数为5.95年）。结肠镜检查的症状性指征不能预测死亡。死亡率可通过年龄（75岁以后每增加一岁，风险比为1.16，95%可信区间为1.07 - 1.3，P = 0.0003）和Charlson评分（每增加一分，风险比为8.3，95%可信区间为1.4 - 48.5，P = 0.02）预测。如果Charlson评分≤4，75至79岁患者的中位生存期>5年。在年龄≥80岁的患者中，无论Charlson评分如何，中位生存期均<5年。
回顾性设计。
在这一老年人群队列中，年龄和合并症是死亡的预测因素。随着合并症增加，年轻的保护作用减弱。这些发现可能对老年人CRC筛查和监测具有重要意义。
