Salimzadeh Hamideh, Bishehsari Faraz, Amani Mohammad, Ansari Reza, Sotoudeh Masoud, Delavari Alireza, Malekzadeh Reza
Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Masoud Gastroenterology and Hepatology Clinic, Sasan Alborz Biomedical Research Center, Tehran, Iran.
Int J Cancer. 2016 Nov 15;139(10):2243-51. doi: 10.1002/ijc.30366. Epub 2016 Aug 10.
We aimed to determine the risk of advanced neoplasms among a cohort of asymptomatic first degree relatives (FDRs) of patients with sporadic colorectal cancer (CRC) compared with matched controls. Data for patients with a diagnosis of CRC made between September 2013 and August 2014 were obtained from a population-based cancer registry system in Tehran. Screening colonoscopies were done for 342 FDRs and the findings were compared to those from 342 age- and gender-matched healthy controls without a family history of CRC. We reported the association as conditional Odds Ratio (OR) using Mantel Hazel and Logistic regression. The prevalence of advanced neoplasia was 13.2% among FDRs and 3.8% in controls (matched OR [mOR], 4.0, 95% confidence interval [CI], 2.1 - 7.6; p < 0.001). In FDRs aged 40-49 years, the prevalence of advanced neoplasia was significantly higher than in their matched controls (mOR, 6.8, 95% CI, 1.5-31.4; p = 0.01). Family history of CRC in at least one FDR was the strongest predictor of advanced neoplasia (adjusted OR, 4.0, 95% CI: 2.1-7.6; p < 0.001). The age of the index case at diagnosis did not predict the presence of advanced colonic neoplasms in their FDRs. Our study indicates a high risk of advanced neoplasia in FDRs of CRC cases, where only eight colonoscopies are needed to detect one advanced neoplasia. Our data suggest that all FDRs, regardless of the age of CRC diagnosis in their index case, should be considered for a targeted early screening.
我们旨在确定散发性结直肠癌（CRC）患者的无症状一级亲属（FDRs）队列中晚期肿瘤的风险，并与匹配的对照组进行比较。2013年9月至2014年8月期间诊断为CRC的患者数据来自德黑兰的一个基于人群的癌症登记系统。对342名FDRs进行了筛查结肠镜检查，并将结果与342名年龄和性别匹配、无CRC家族史的健康对照者的结果进行比较。我们使用Mantel Hazel和逻辑回归将关联报告为条件比值比（OR）。FDRs中晚期瘤变的患病率为13.2%，对照组为3.8%（匹配OR [mOR]，4.0，95%置信区间 [CI]，2.1 - 7.6；p < 0.001）。在40 - 49岁的FDRs中，晚期瘤变的患病率显著高于其匹配的对照组（mOR，6.8，95% CI，1.5 - 31.4；p = 0.01）。至少一名FDR有CRC家族史是晚期瘤变的最强预测因素（调整后OR，4.0，95% CI：2.1 - 7.6；p < 0.001）。索引病例诊断时的年龄不能预测其FDRs中晚期结肠肿瘤的存在。我们的研究表明，CRC病例的FDRs中晚期瘤变风险很高，仅需8次结肠镜检查就能检测出1例晚期瘤变。我们的数据表明，所有FDRs，无论其索引病例的CRC诊断年龄如何，都应考虑进行有针对性的早期筛查。
