Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah.
Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah.
Gastroenterology. 2014 Apr;146(4):950-60. doi: 10.1053/j.gastro.2014.01.013. Epub 2014 Jan 11.
BACKGROUND & AIMS: Colorectal cancers (CRCs) diagnosed within a few years after an index colonoscopy can arise from missed lesions or the development of a new tumor. We investigated the proportion, characteristics, and factors that predict interval CRCs that develop within 6-60 months of colonoscopy.
We performed a population-based cohort study of Utah residents who underwent colonoscopy examinations from 1995 through 2009 at Intermountain Healthcare or the University of Utah Health System, which provide care to more than 85% of state residents. Colonoscopy results were linked with cancer histories from the Utah Population Database to identify patients who underwent colonoscopy 6-60 months before a diagnosis of CRC (interval cancer). Logistic regression was performed to identify risk factors associated with interval cancers.
Of 126,851 patients who underwent colonoscopies, 2659 were diagnosed with CRC; 6% of these CRCs (159 of 2659) developed within 6 to 60 months of a colonoscopy. Sex and age were not associated with interval CRCs. A higher percentage of patients with interval CRC were found to have adenomas at their index colonoscopy (57.2%), compared with patients found to have CRC detected at colonoscopy (36%) or patients who did not develop cancer (26%) (P < .001). Interval CRCs tended to be earlier-stage tumors than those detected at index colonoscopy, and to be proximally located (odds ratio, 2.24; P < .001). Patients with interval CRC were more likely to have a family history of CRC (odds ratio, 2.27; P = .008) and had a lower risk of death than patients found to have CRC at their index colonoscopy (hazard ratio, 0.63; P < .001).
In a population-based study in Utah, 6% of all patients with CRC had interval cancers (cancer that developed within 6 to 60 months of a colonoscopy). Interval CRCs were associated with the proximal colon, earlier-stage cancer, lower risk of death, higher rate of adenoma, and family history of CRC. These findings indicate that interval colorectal tumors may arise as the result of distinct biologic features and/or suboptimal management of polyps at colonoscopy.
在索引结肠镜检查后几年内诊断出的结直肠癌（CRC）可能是由遗漏的病变或新肿瘤的发展引起的。我们调查了在结肠镜检查后 6-60 个月内发展为结直肠癌的间隔 CRC 的比例、特征和预测因素。
我们对在 1995 年至 2009 年间在 Intermountain Healthcare 或犹他大学健康系统进行结肠镜检查的犹他州居民进行了一项基于人群的队列研究，这两个机构为该州超过 85%的居民提供医疗服务。将结肠镜检查结果与犹他州人口数据库中的癌症史进行关联，以确定在 CRC（间隔癌）诊断前 6-60 个月接受结肠镜检查的患者。采用逻辑回归分析鉴定与间隔癌相关的危险因素。
在接受结肠镜检查的 126851 名患者中，有 2659 名被诊断患有 CRC；这些 CRC 中有 6%（159 例）在结肠镜检查后 6 至 60 个月内发展为 CRC。性别和年龄与间隔 CRC 无关。在指数结肠镜检查时发现间隔 CRC 的患者中，腺瘤的比例更高（57.2%），而在指数结肠镜检查时发现 CRC 的患者（36%）或未发生癌症的患者（26%）（P<.001）。间隔 CRC 倾向于比指数结肠镜检查时发现的肿瘤更早，并且位于近端（比值比，2.24；P<.001）。间隔 CRC 患者更有可能有 CRC 家族史（比值比，2.27；P=0.008），并且比在指数结肠镜检查时发现 CRC 的患者死亡风险更低（风险比，0.63；P<.001）。
在犹他州的一项基于人群的研究中，所有 CRC 患者中有 6%患有间隔 CRC（结肠镜检查后 6-60 个月内发生的癌症）。间隔 CRC 与近端结肠、早期癌症、较低的死亡率、更高的腺瘤发生率和 CRC 家族史相关。这些发现表明，间隔结直肠肿瘤可能是由于不同的生物学特征和/或结肠镜检查时息肉管理不当而产生的。
