Sjöström Olle, Lindholm Lars, Tavelin Björn, Melin Beatrice
Department of Radiation Sciences, Oncology, Unit of Research, Education and Development-Östersund, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Fam Cancer. 2016 Oct;15(4):543-51. doi: 10.1007/s10689-016-9867-7.
Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012-0.5299) and 0.11 (CI 95 % 0.0014-0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.
尽管对于已知遗传性结直肠癌（HCRC）综合征的个体以及有中度家族性结直肠癌（FCRC）病史的个体都推荐进行结肠镜监测，但监测益处的证据有限且监测实践各不相同。本研究评估了在癌症预防诊所的指导下进行分散式结肠镜监测对有结直肠癌家族史个体的预防效果。我们对瑞典于默奥大学医院癌症遗传学诊所结肠镜监测登记处记录的261例HCRC或FCRC患者进行了一项基于人群的前瞻性研究。在瑞典北部的当地医院，每两年（HCRC）或每五年（FCRC）进行一次结肠镜监测。主要结局指标为高危腺瘤（HRA）或结直肠癌的发现情况以及患者对监测的依从性。对未进行监测时结直肠癌的预期病例数进行了估计。在总共1256人年的随访期间，发现了1例结直肠癌。未进行监测时癌症的预期病例数在9.5至10.5之间，导致结直肠癌的标准化发病率（观察到的与预期病例数之比）在0.10（95%CI 0.0012 - 0.5299）至0.11（95%CI 0.0014 - 0.5857）之间。未报告结直肠癌死亡病例，但有3例患者需要手术干预。在初次结肠镜检查中，5.9%（14/237）发现了HRA，在后续结肠镜检查中，3.4%（12/356）发现了HRA。由于计划的662次结肠镜检查中有597次完成，患者对监测计划的依从性为90%。该研究得出结论，在癌症预防诊所的指导下采用分散式结肠镜监测方法且患者对该计划依从性高时，结肠镜监测对预防结直肠癌是有效的。
