C3-Gas, Gastroenterology Section, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101, USA.
J Gen Intern Med. 2012 Oct;27(10):1349-60. doi: 10.1007/s11606-012-2115-4. Epub 2012 Jun 15.
In recent years, colorectal cancer (CRC) screening using computerized tomographic colonography (CTC) has attracted considerable attention. In order to better understand patient preferences for CTC versus colonoscopy, we performed a systematic review and meta-analysis of the available literature. Data sources included published studies, abstracts and book chapters, in any language, with publication dates from 1995 through February 2012, and with prospective or retrospective enrollment of diagnostic or screening patients who had undergone both procedures and explicit assessment of their preference for colonoscopy versus CTC. A predefined algorithm identified eligible studies using computer and hand searches performed by two independent investigators. We used a mixed effects model to pool preference differences (defined as the proportion of subjects who preferred CTC minus the proportion who preferred colonoscopy for each study). Twenty-three studies met inclusion criteria, totaling 5616 subjects. In 16 of these studies, patients preferred CTC over colonoscopy, while colonoscopy was preferred in three studies. Due to the high degree of heterogeneity, an overall pooled preference difference was not calculated. Stratified analysis revealed that studies published in radiology journals (preference difference 0.590 [95 % CI 0.485, 0.694]) seemed more likely than studies in gastroenterology (0.218 [-0.015-0.451]) or general medicine journals (-0.158 [-0.389-0.072]) to report preference for CTC (p<0.001). Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors. Symptomatic patients expressed no preference, but screening patients preferred CTC. There was no difference in preferences between studies using "masked" and "unmasked" preference ascertainment methods. Three studies featuring limited bowel preparations for CTC reported marked preference for CTC. There was no evidence of publication bias, while cumulative and exclusion analysis did not show any temporal trend or dominant study. Limitations included data heterogeneity and preference ascertainment limitations. In conclusion, most included studies reported preference for CTC. On stratified analysis, screening patients preferred CTC while diagnostic patients showed no preference. Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals.
近年来，使用计算机断层结肠成像（CTC）进行结直肠癌（CRC）筛查引起了相当大的关注。为了更好地了解患者对 CTC 与结肠镜检查的偏好，我们对现有的文献进行了系统回顾和荟萃分析。数据来源包括已发表的研究、摘要和书籍章节，语言不限，发表日期为 1995 年至 2012 年 2 月，前瞻性或回顾性纳入接受过两种检查并明确评估其对结肠镜检查与 CTC 偏好的诊断或筛查患者。使用预定义的算法，通过两位独立研究者进行计算机和手工搜索，确定符合条件的研究。我们使用混合效应模型对偏好差异进行汇总（定义为每个研究中更喜欢 CTC 的受试者比例减去更喜欢结肠镜检查的受试者比例）。23 项研究符合纳入标准，共纳入 5616 例患者。在其中 16 项研究中，患者更喜欢 CTC，而在 3 项研究中则更喜欢结肠镜检查。由于高度异质性，未计算总体汇总偏好差异。分层分析显示，发表在放射学杂志上的研究（偏好差异 0.590[95%CI0.485，0.694]）比发表在胃肠病学杂志（0.218[-0.015-0.451]）或普通医学杂志（-0.158[-0.389-0.072]）上的研究更有可能报告对 CTC 的偏好（p<0.001）。放射学作者的研究显示出与胃肠病学作者的研究相比，对 CTC 的偏好更强的趋势。有症状的患者没有表现出偏好，但筛查患者更喜欢 CTC。使用“屏蔽”和“未屏蔽”偏好确定方法的研究之间没有偏好差异。三项 CTC 肠道准备有限的研究报告了对 CTC 的明显偏好。没有证据表明存在发表偏倚，累积分析和排除分析也没有显示出任何时间趋势或主要研究。局限性包括数据异质性和偏好确定的局限性。总之，大多数纳入的研究报告了对 CTC 的偏好。分层分析显示，筛查患者更喜欢 CTC，而诊断患者没有偏好。发表在放射学杂志上的研究与发表在胃肠病学或普通医学杂志上的研究相比，对 CTC 的偏好明显更强。
