Tang Victoria, Boscardin W John, Stijacic-Cenzer Irena, Lee Sei J
San Francisco VA Medical Center, San Francisco, CA 94121, USA
San Francisco VA Medical Center, San Francisco, CA 94121, USA Division of Geriatrics, University of California San Francisco CA, USA.
BMJ. 2015 Apr 16;350:h1662. doi: 10.1136/bmj.h1662.
To determine the time to benefit of using flexible sigmoidoscopy for colorectal cancer screening.
Survival meta-analysis.
A Cochrane Collaboration systematic review published in 2013, Medline, and Cochrane Library databases.
Randomized controlled trials comparing screening flexible sigmoidoscopy with no screening. Trials with fewer than 100 flexible sigmoidoscopy screenings were excluded.
Four studies were eligible (total n = 459,814). They were similar for patients' age (50-74 years), length of follow-up (11.2-11.9 years), and relative risk for colorectal cancer related mortality (0.69-0.78 with flexible sigmoidoscopy screening). For every 1000 people screened at five and 10 years, 0.3 and 1.2 colorectal cancer related deaths, respectively, were prevented. It took 4.3 years (95% confidence interval 2.8 to 5.8) to observe an absolute risk reduction of 0.0002 (one colorectal cancer related death prevented for every 5000 flexible sigmoidoscopy screenings). It took 9.4 years (7.6 to 11.3) to observe an absolute risk reduction of 0.001 (one colorectal cancer related death prevented for every 1000 flexible sigmoidoscopy screenings).
Our findings suggest that screening flexible sigmoidoscopy is most appropriate for older adults with a life expectancy greater than approximately 10 years.
确定使用乙状结肠镜进行结直肠癌筛查的获益时间。
生存荟萃分析。
2013年发表的Cochrane协作系统评价、Medline及Cochrane图书馆数据库。
比较筛查性乙状结肠镜检查与未筛查的随机对照试验。乙状结肠镜检查少于100例的试验被排除。
4项研究符合纳入标准（总计n = 459,814）。这些研究在患者年龄（50 - 74岁）、随访时间（11.2 - 11.9年）以及结直肠癌相关死亡率的相对风险（乙状结肠镜筛查为0.69 - 0.78）方面相似。每1000人在5年和10年接受筛查，分别可预防0.3例和1.2例结直肠癌相关死亡。观察到绝对风险降低0.0002（每5000次乙状结肠镜筛查预防1例结直肠癌相关死亡）需要4.3年（95%置信区间2.8至5.8）。观察到绝对风险降低0.001（每1000次乙状结肠镜筛查预防1例结直肠癌相关死亡）需要9.4年（7.6至11.3）。
我们的研究结果表明，筛查性乙状结肠镜检查最适合预期寿命大于约10年的老年人。
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