Wong John C T, Lau James Y W, Suen Bing Y, Ng Siew C, Wong Martin C S, Tang Raymond S Y, Wong Sunny H, Wu Justin C Y, Chan Francis K L, Sung Joseph J Y
The Chinese University of Hong Kong, Institute of Digestive Disease, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
J Gastroenterol Hepatol. 2017 Jan;32(1):92-97. doi: 10.1111/jgh.13450.
Colorectal cancer (CRC) incidence is rising among <50-year olds. The objective of this study was to determine screening colonoscopy outcomes among 40- to 49-year olds, which are currently limited.
Asymptomatic 40- to 49-year olds underwent one time CRC screening colonoscopy at The Chinese University of Hong Kong between 2007 and 2011. Screening outcomes, including prevalence, distribution, and predictive factors for overall and specifically proximal colorectal neoplasia were determined.
Among 1133 ethnic Chinese, colorectal neoplasia prevalence was 20.5%. In men, distal adenomas were associated with proximal colorectal neoplasia. Men, advancing age, a first degree relative (FDR) with CRC, and diabetes mellitus were independently associated with colorectal neoplasia. A colorectal neoplasia was three times more likely to be found in a 45- to 49-year-old man with FDR of CRC compared with a 40- to 44-year-old woman without a FDR of CRC. The numbers needed to screen one colorectal neoplasia, and one advanced neoplasm in the highest risk group of 45- to 49-year-old men with FDR with CRC were 2.8 (95% CI: 2.2-4.4) and 18.5 (95% CI: 8.9-39.2), respectively.
Colorectal neoplasia prevalence in this 40- to 49-year-old Chinese cohort was higher than previous studies. Men, advancing age, FDR with CRC, and diabetes mellitus, can be used to risk stratify for neoplasia development. Men 45-49 years old with FDR with CRC represented the highest risk subgroup, with the lowest number needed to screen.
50岁以下人群的结直肠癌（CRC）发病率正在上升。本研究的目的是确定40至49岁人群的结肠镜筛查结果，目前这方面的数据有限。
2007年至2011年期间，无症状的40至49岁人群在香港中文大学接受了一次CRC筛查结肠镜检查。确定了筛查结果，包括总体及特定近端结直肠肿瘤的患病率、分布情况和预测因素。
在1133名华裔中，结直肠肿瘤患病率为20.5%。在男性中，远端腺瘤与近端结直肠肿瘤相关。男性、年龄增长、有CRC的一级亲属（FDR）以及糖尿病与结直肠肿瘤独立相关。与无CRC的FDR的40至44岁女性相比，有CRC的FDR的45至49岁男性发现结直肠肿瘤的可能性高出三倍。在有CRC的FDR的45至49岁男性这一最高风险组中，筛查出一例结直肠肿瘤和一例进展期肿瘤所需的人数分别为2.8（95%CI：2.2 - 4.4）和18.5（95%CI：8.9 - 39.2）。
该40至49岁中国队列中的结直肠肿瘤患病率高于以往研究。男性、年龄增长、有CRC的FDR以及糖尿病可用于对肿瘤发生风险进行分层。有CRC的FDR的45 - 49岁男性代表最高风险亚组，筛查所需人数最少。
