Rabeneck Linda, Paszat Lawrence F, Hilsden Robert J, McGregor S Elizabeth, Hsieh Eugene, M Tinmouth Jill, Baxter Nancy N, Saskin Refik, Ruco Arlinda, Stock David
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Gastrointest Endosc. 2014 Oct;80(4):660-667. doi: 10.1016/j.gie.2014.02.001. Epub 2014 Mar 27.
Estimating risk for advanced proximal neoplasia (APN) based on distal colon findings can help identify asymptomatic persons who should undergo examination of the proximal colon after flexible sigmoidoscopy (FS) screening.
We aimed to determine the risk of APN by most advanced distal finding among an average-risk screening population.
Prospective, cross-sectional study.
Teaching hospital and colorectal cancer screening center.
A total of 4651 asymptomatic persons at average risk for colorectal cancer aged 50 to 74 years (54.4% women [n = 2529] with a mean [± standard deviation] age of 58.4 ± 6.2 years).
All participants underwent a complete colonoscopy, including endoscopic removal of all polyps.
We explored associations between several risk factors and APN. Logistic regression was used to identify independent predictors of APN.
A total of 142 persons (3.1%) had APN, of whom 85 (1.8%) had isolated APN (with no distal findings). APN was associated with older age, a BMI >27 kg/m(2), smoking, distal advanced adenoma and/or cancer, and distal non-advanced tubular adenoma. Those with a distal advanced neoplasm were more than twice as likely to have APN compared with those without distal lesions.
Distal findings used to estimate risk of APN were derived from colonoscopy rather than FS itself.
In persons at average risk for colorectal cancer, the prevalence of isolated APN was low (1.8%). Use of distal findings to predict APN may not be the most effective strategy. However, incorporating factors such as age (>65 years), sex, BMI (>27 kg/m(2)), and smoking status, in addition to distal findings, should be considered for tailoring colonoscopy recommendations. Further evaluation of risk stratification approaches in other asymptomatic screening populations is warranted.
基于远端结肠检查结果估计进展期近端肿瘤（APN）风险，有助于识别在柔性乙状结肠镜检查（FS）筛查后应接受近端结肠检查的无症状人群。
我们旨在确定平均风险筛查人群中最严重远端检查结果对应的APN风险。
前瞻性横断面研究。
教学医院和结直肠癌筛查中心。
共4651名年龄在50至74岁的结直肠癌平均风险无症状人群（女性占54.4%[n = 2529]，平均[±标准差]年龄为58.4 ± 6.2岁）。
所有参与者均接受了完整的结肠镜检查，包括内镜下切除所有息肉。
我们探讨了几种风险因素与APN之间的关联。采用逻辑回归确定APN的独立预测因素。
共有142人（3.1%）患有APN，其中85人（1.8%）为孤立性APN（无远端检查结果）。APN与年龄较大、体重指数>27 kg/m²、吸烟、远端进展性腺瘤和/或癌症以及远端非进展性管状腺瘤有关。与无远端病变者相比，有远端进展性肿瘤者发生APN的可能性高出两倍多。
用于估计APN风险的远端检查结果来自结肠镜检查而非FS本身。
在结直肠癌平均风险人群中，孤立性APN的患病率较低（1.8%）。利用远端检查结果预测APN可能不是最有效的策略。然而，除了远端检查结果外，还应考虑纳入年龄（>65岁）、性别、体重指数（>27 kg/m²）和吸烟状况等因素，以制定结肠镜检查建议。有必要对其他无症状筛查人群的风险分层方法进行进一步评估。
