基于韩国全国人群的研究：粪便免疫化学检测阳性后的结肠镜检查间期结直肠癌的风险和特征。
Risk and Characteristics of Postcolonoscopy Interval Colorectal Cancer after a Positive Fecal Test: A Nationwide Population-Based Study in Korea.
机构信息
Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
出版信息
Cancer Res Treat. 2018 Jan;50(1):50-59. doi: 10.4143/crt.2017.027. Epub 2017 Feb 24.
PURPOSE
Fecal tests remain a mainstay of population-based colorectal cancer (CRC) screening programs worldwide. However, data on interval CRC (iCRC) arising after follow-up colonoscopy of a positive fecal test are scarce. We conducted a nationwide population-based study to reveal the risk and characteristics of iCRC in this setting.
MATERIALS AND METHODS
We searched the National Cancer Screening Program for CRC database in Korea (2005-2010). Incidence of iCRC within the program was estimated, then Cox proportional-hazards regression analysis was performed to determine the independent predictors of iCRC. The clinical characteristics of iCRC were compared with screen-detected CRC (sCRC).
RESULTS
We identified 280 iCRC among 150,660 negative colonoscopies as a follow-up exam to a positive fecal immunochemical test (FIT), and 2,427 sCRC. The overall incidence of iCRC was 0.49/1,000 person-years (95% confidence interval [CI], 0.48 to 0.51). iCRC was more likely to occur in men (adjusted hazard ratio [aHR], 1.79; 95% CI, 1.39 to 2.30) and elderly patients (aHR, 1.77; 95% CI, 1.38 to 2.28 in 65-74 years; aHR, 3.13, 95% CI, 2.13 to 4.60 in ≥ 75 years). The National Quality Improvement Program for colonoscopy reduced a short-term risk of iCRC (aHR, 0.48; 95% CI, 0.27 to 0.87). Compared with sCRC, iCRC was more likely to occur in the proximal colon, be diagnosed at the localized stage, and have a lower CRC mortality (32.7 vs. 17.4%, 56.8 vs. 34.1%, and 12.5 vs. 17.7%, respectively; all p < 0.05).
CONCLUSION
In a population-based CRC screening program with FIT, the burden of iCRC after follow-up colonoscopy was substantial. Men and elderly patients possess a significantly higher risk of iCRC.
目的
粪便检测仍然是全球基于人群的结直肠癌（CRC）筛查计划的主要手段。然而，关于阳性粪便检测后随访结肠镜检查中出现的间隔 CRC（iCRC）的数据却很少。我们进行了一项全国性的基于人群的研究，以揭示这种情况下 iCRC 的风险和特征。
材料和方法
我们在韩国国家癌症筛查计划 CRC 数据库（2005-2010 年）中进行了搜索。估计了该计划中 iCRC 的发生率，然后进行 Cox 比例风险回归分析，以确定 iCRC 的独立预测因素。比较了 iCRC 与筛查发现的 CRC（sCRC）的临床特征。
结果
我们在对阳性免疫化学粪便检测（FIT）进行阴性结肠镜检查的 150660 例随访检查中发现了 280 例 iCRC，而 2427 例 sCRC。iCRC 的总发生率为 0.49/1000 人年（95%置信区间 [CI]，0.48 至 0.51）。iCRC 更可能发生在男性（调整后的危险比[aHR]，1.79；95%CI，1.39 至 2.30）和老年患者（65-74 岁的 aHR，1.77；95%CI，1.38 至 2.28；≥75 岁的 aHR，3.13，95%CI，2.13 至 4.60）。结肠镜检查的国家质量改进计划降低了 iCRC 的短期风险（aHR，0.48；95%CI，0.27 至 0.87）。与 sCRC 相比，iCRC 更可能发生在近端结肠，诊断为局部期，CRC 死亡率更低（32.7%比 17.4%，56.8%比 34.1%，12.5%比 17.7%；均<0.05）。
结论
在基于人群的 FIT 筛查计划中，随访结肠镜检查后 iCRC 的负担很大。男性和老年患者 iCRC 的风险显著更高。
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