用于结直肠癌筛查的晚期结直肠肿瘤的预测指标。

Predictors of advanced colorectal neoplasia for colorectal cancer screening.

作者信息

Wong Martin C S, Lam Thomas Y T, Tsoi Kelvin K F, Chan Victor C W, Hirai Hoyee W, Ching Jessica Y L, Sung Joseph J Y

机构信息

Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong; School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong.

Institute of Digestive Disease, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong.

出版信息

Am J Prev Med. 2014 May;46(5):433-9. doi: 10.1016/j.amepre.2013.12.008.

DOI:10.1016/j.amepre.2013.12.008

PMID:24745632

Abstract

BACKGROUND

The Asia-Pacific Colorectal Screening (APCS) score based on age, gender, family history, and smoking is useful to predict advanced colorectal neoplasia (ACN) in asymptomatic Asian subjects.

PURPOSE

To evaluate the factors in addition to those of APCS associated with ACN colonoscopic findings.

METHODS

Data from 5,220 asymptomatic subjects aged between 50 and 70 years who underwent screening colonoscopy in a community center between 2008 and 2012 were analyzed. One binary logistic regression analysis was conducted in 2013 with the presence of ACN or cancer as the outcome, controlling for APCS score, alcohol consumption, BMI, hypertension, and other chronic diseases as independent variables.

RESULTS

The average participant age was 57.7 years (SD=4.9) and 47.5% were men. Advanced neoplasms or cancers were identified at colonoscopy in 5.6% of all screening participants. From multivariate regression analysis, APCS score≥4 (adjusted OR [AOR]=1.74, 95% CI=1.34, 2.25, p<0.001); overweight (BMI=23-24.9, AOR=1.52, 95% CI=1.12, 2.07, p=0.007); obesity (BMI≥25, AOR=1.56, 95% CI=1.15, 2.10, p=0.004); hypertension (AOR=1.58, 95% CI=1.21, 2.06, p=0.001); and alcohol consumption (AOR=1.47, 95% CI=1.05, 2.06, p=0.025) were associated with ACN. The c-statistic of APCS score alone was 0.560 (95% CI=0.524, 0.595, p=0.001) and that of APCS score plus BMI, hypertension, and alcohol consumption was 0.613 (95% CI=0.578, 0.648, p<0.001).

CONCLUSIONS

Alcohol consumption, hypertension, and BMI are independent predictors of ACN, which could be incorporated into the APCS for prioritizing Asian asymptomatic subjects for colorectal cancer screening.

摘要

背景

基于年龄、性别、家族史和吸烟情况的亚太地区结直肠癌筛查（APCS）评分有助于预测无症状亚洲人群中的晚期结直肠肿瘤（ACN）。

目的

评估除APCS因素外与ACN结肠镜检查结果相关的因素。

方法

分析了2008年至2012年期间在社区中心接受筛查结肠镜检查的5220名年龄在50至70岁之间的无症状受试者的数据。2013年进行了一项二元逻辑回归分析，以是否存在ACN或癌症作为结果，将APCS评分、饮酒量、体重指数（BMI）、高血压和其他慢性疾病作为自变量进行控制。

结果

参与者的平均年龄为57.7岁（标准差=4.9），男性占47.5%。在所有筛查参与者中，5.6%在结肠镜检查中发现了晚期肿瘤或癌症。多因素回归分析显示，APCS评分≥4（调整优势比[AOR]=1.74，95%置信区间=1.34，2.25，p<0.001）；超重（BMI=23 - 24.9，AOR=1.52，95%置信区间=1.12，2.07，p=0.007）；肥胖（BMI≥25，AOR=1.56，95%置信区间=1.15，2.10，p=0.004）；高血压（AOR=1.58，95%置信区间=1.21，2.06，p=0.001）；以及饮酒（AOR=1.47，95%置信区间=1.05，2.06，p=0.025）与ACN相关。仅APCS评分的c统计量为0.560（95%置信区间=0.524，0.595，p=0.001），APCS评分加上BMI、高血压和饮酒量的c统计量为0.613（95%置信区间=0.578，0.648，p<0.001）。