Wong Martin C S, Ching Jessica Y L, Chiu Han-Mo, Wu Kai Chun, Rerknimitr Rungsun, Li Jingnan, Wu Deng-Chiang, Goh Khean Lee, Matsuda Takahisa, Kim Hyun-Soo, Leong Rupert, Yeoh Khay Guan, Chong Vui Heng, Sollano Jose D, Ahmed Furqaan, Menon Jayaram, Ng Siew C, Wu Justin C Y, Chan Francis K L, Sung Joseph J Y
CUHK JC Bowel Cancer Education Centre, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Faculty of Medicine, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Am J Gastroenterol. 2016 Nov;111(11):1621-1629. doi: 10.1038/ajg.2016.52. Epub 2016 Mar 15.
We tested the hypothesis that the risk of colorectal cancer (CRC), advanced colorectal neoplasia (ACN), and colorectal adenoma among screening participants with different first-degree relatives (FDRs) affected by CRC was similar.
A multi-center, prospective colonoscopy study involving 16 Asia-Pacific regions was performed from 2008 to 2015. Consecutive self-referred CRC screening participants aged 40-70 years were recruited, and each subject received one direct optical colonoscopy. The prevalence of CRC, ACN, and colorectal adenoma was compared among subjects with different FDRs affected using Pearson's χ tests. Binary logistic regression analyses were performed to evaluate the risk of these lesions, controlling for recognized risk factors including age, gender, smoking habits, alcohol drinking, body mass index, and the presence of diabetes mellitus.
Among 11,797 asymptomatic subjects, the prevalence of CRC was 0.6% (none: 0.6%; siblings: 1.1%; mother: 0.5%; father: 1.2%; ≥2 members: 3.1%, P<0.001), that of ACN was 6.5% (none: 6.1%; siblings: 8.3%; mother: 7.7%; father: 8.7%; ≥2 members: 9.3%, P<0.001), and that of colorectal adenoma was 29.3% (none: 28.6%; siblings: 33.5%; mother: 31.8%; father: 31.1%; ≥2 members: 38.1%, P<0.001). In multivariate regression analyses, subjects with at least one FDR affected were significantly more likely to have CRC (adjusted odds ratio (AOR)=2.02-7.89), ACN (AOR=1.55-2.06), and colorectal adenoma (AOR=1.31-1.92) than those without a family history. The risk of CRC (AOR=0.90, 95% confidence interval (CI) 0.34-2.35, P=0.830), ACN (AOR=1.07, 95% CI 0.75-1.52, P=0.714), and colorectal adenoma (AOR=0.96, 95% CI 0.78-1.19, P=0.718) in subjects with either parent affected was similar to that of subjects with their siblings affected.
The risk of colorectal neoplasia was similar among subjects with different FDRs affected. These findings do not support the need to discriminate proband identity in screening participants with affected FDRs when their risks of colorectal neoplasia were estimated.
我们检验了这样一个假设，即在不同的一级亲属（FDRs）患有结直肠癌的筛查参与者中，患结直肠癌（CRC）、进展期结直肠肿瘤（ACN）和结直肠腺瘤的风险是相似的。
2008年至2015年进行了一项涉及16个亚太地区的多中心前瞻性结肠镜检查研究。招募了年龄在40 - 70岁的连续自我推荐的CRC筛查参与者，每位受试者接受一次直接光学结肠镜检查。使用Pearson卡方检验比较不同FDRs受影响的受试者中CRC、ACN和结直肠腺瘤的患病率。进行二元逻辑回归分析以评估这些病变的风险，并对包括年龄、性别、吸烟习惯、饮酒、体重指数和糖尿病存在情况等公认的风险因素进行控制。
在11797名无症状受试者中，CRC的患病率为0.6%（无：0.6%；兄弟姐妹：1.1%；母亲：0.5%；父亲：1.2%；≥2名成员：3.1%，P<0.001），ACN的患病率为6.5%（无：6.1%；兄弟姐妹：8.3%；母亲：7.7%；父亲：8.7%；≥2名成员：9.3%，P<0.001），结直肠腺瘤的患病率为29.3%（无：28.6%；兄弟姐妹：33.5%；母亲：31.8%；父亲：31.1%；≥2名成员：38.1%，P<0.001）。在多变量回归分析中，至少有一名FDR受影响的受试者患CRC（调整后的优势比（AOR）=2.02 - 7.89）、ACN（AOR=1.55 - 2.06）和结直肠腺瘤（AOR=1.31 - 1.92）的可能性显著高于无家族史的受试者。父母一方受影响的受试者患CRC（AOR=0.90，95%置信区间（CI）0.34 - 2.
