Jayasekara Harindra, Reece Jeanette C, Buchanan Daniel D, Rosty Christophe, Dashti S Ghazaleh, Ait Ouakrim Driss, Winship Ingrid M, Macrae Finlay A, Boussioutas Alex, Giles Graham G, Ahnen Dennis J, Lowery Jan, Casey Graham, Haile Robert W, Gallinger Steven, Le Marchand Loic, Newcomb Polly A, Lindor Noralane M, Hopper John L, Parry Susan, Jenkins Mark A, Win Aung Ko
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia.
Int J Cancer. 2016 Sep 1;139(5):1081-90. doi: 10.1002/ijc.30153. Epub 2016 May 9.
Individuals diagnosed with colorectal cancer (CRC) are at risk of developing a metachronous CRC. We examined the associations between personal, tumour-related and lifestyle risk factors, and risk of metachronous CRC. A total of 7,863 participants with incident colon or rectal cancer who were recruited in the USA, Canada and Australia to the Colon Cancer Family Registry during 1997-2012, except those identified as high-risk, for example, Lynch syndrome, were followed up approximately every 5 years. We estimated the risk of metachronous CRC, defined as the first new primary CRC following an interval of at least one year after the initial CRC diagnosis. Observation time started at the age at diagnosis of the initial CRC and ended at the age at diagnosis of the metachronous CRC, last contact or death whichever occurred earliest, or were censored at the age at diagnosis of any metachronous colorectal adenoma. Cox regression was used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). During a mean follow-up of 6.6 years, 142 (1.81%) metachronous CRCs were diagnosed (mean age at diagnosis 59.8; incidence 2.7/1,000 person-years). An increased risk of metachronous CRC was associated with the presence of a synchronous CRC (HR = 2.73; 95% CI: 1.30-5.72) and the location of cancer in the proximal colon at initial diagnosis (compared with distal colon or rectum, HR = 4.16; 95% CI: 2.80-6.18). The presence of a synchronous CRC and the location of the initial CRC might be useful for deciding the intensity of surveillance colonoscopy for individuals diagnosed with CRC.
被诊断患有结直肠癌（CRC）的个体有发生异时性结直肠癌的风险。我们研究了个人、肿瘤相关和生活方式风险因素与异时性结直肠癌风险之间的关联。1997年至2012年期间，在美国、加拿大和澳大利亚，共有7863名罹患结肠癌或直肠癌的参与者被纳入结肠癌家族登记处，但那些被确定为高危人群，如林奇综合征患者除外，这些参与者大约每5年接受一次随访。我们估计了异时性结直肠癌的风险，其定义为在初次结直肠癌诊断后至少间隔一年出现的首个新的原发性结直肠癌。观察时间从初次结直肠癌诊断时的年龄开始，到异时性结直肠癌诊断时的年龄、最后一次接触或死亡（以最早发生者为准）结束，或者在任何异时性结直肠腺瘤诊断时的年龄被截尾。采用Cox回归得出风险比（HRs）和95%置信区间（CIs）。在平均6.6年的随访期间，诊断出142例（1.81%）异时性结直肠癌（诊断时的平均年龄为59.8岁；发病率为2.7/1000人年）。异时性结直肠癌风险增加与同时性结直肠癌的存在（HR = 2.73；95% CI：1.30 - 5.72）以及初次诊断时癌症位于近端结肠有关（与远端结肠或直肠相比，HR = 4.16；95% CI：2.80 - 6.18）。同时性结直肠癌的存在以及初次结直肠癌的位置可能有助于确定被诊断为结直肠癌的个体进行结肠镜监测的强度。
