Cooper Gregory S, Xu Fang, Schluchter Mark D, Koroukian Siran M, Barnholtz Sloan Jill S
Division of Gastroenterology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Wearn 244, Cleveland, OH, 44106-5066, USA,
Dig Dis Sci. 2014 Nov;59(11):2765-72. doi: 10.1007/s10620-014-3246-8. Epub 2014 Jun 14.
Diverticulosis, a prevalent condition at screening colonoscopy, has been associated with colorectal cancers that develop after a clearing colonoscopy, or interval cancers.
To quantify the overall risk of diverticulosis in the development of interval cancers and examine this association in relevant subgroups.
Using a linked database containing SEER tumor registry data and Medicare claims, we identified patients aged ≥69 years with colorectal cancer who underwent colonoscopy within 6 months of diagnosis. Patients with an additional colonoscopy from 36 to 6 months prior to cancer diagnosis were characterized as having interval cancers. We compared characteristics of patients with interval cancers and detected cancers according to a diagnosis of diverticulosis not associated with a colonoscopy procedure from 1991 through the date of the most recent colonoscopy in both univariate and multivariate models.
A previous diagnosis of diverticulosis was documented in 14,452 (26.9 %) patients with detected cancers compared to 2,905 (69.3 %) patients with interval cancers (p < 0.001); these results were consistent in multivariable analysis. Moreover, the association was found as well in the proximal colon (OR 2.88, 95 % CI 2.66, 3.12), distal colon (OR 3.56, 95 % CI 3.09, 4.11), and rectum (OR 4.07, 95 % CI 3.34, 4.95). The vast majority of diverticulosis diagnoses were without complications such as hemorrhage or diverticulitis.
Diverticulosis was strongly associated with interval colorectal cancers in all segments of the colon. Given its known predominance in the left colon, the findings argue against impaired visualization of lesions at colonoscopy as the only pathogenic factor.
憩室病是结肠镜筛查时的常见病症，与结肠镜检查后发生的结直肠癌（即间隔期癌）有关。
量化憩室病在间隔期癌发生中的总体风险，并在相关亚组中研究这种关联。
利用一个包含监测、流行病学和最终结果（SEER）肿瘤登记数据及医疗保险理赔数据的关联数据库，我们确定了年龄≥69岁、在诊断后6个月内接受结肠镜检查的结直肠癌患者。在癌症诊断前36个月至6个月期间接受过额外结肠镜检查的患者被归类为患有间隔期癌。我们在单变量和多变量模型中，根据1991年至最近一次结肠镜检查日期时与结肠镜检查操作无关的憩室病诊断情况，比较了间隔期癌患者和确诊癌患者的特征。
在确诊癌患者中，有14452例（26.9%）曾被诊断为憩室病，而在间隔期癌患者中为2905例（69.3%）（p<0.001）；这些结果在多变量分析中是一致的。此外，在近端结肠（比值比[OR]2.88，95%置信区间[CI]2.66，3.12）、远端结肠（OR 3.56，95%CI 3.09，4.11）和直肠（OR 4.07，95%CI 3.34，4.95）中也发现了这种关联。绝大多数憩室病诊断并无出血或憩室炎等并发症。
憩室病与结肠各段的间隔期结直肠癌密切相关。鉴于其在左半结肠中占主导地位，这些发现表明结肠镜检查时病变可视化受损并非唯一致病因素。
