Department of Gastroenterological Oncology, Maria-Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Cancer Prevention, Maria-Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Department of Gastroenterological Oncology, Maria-Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Department of Cancer Prevention, Maria-Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Gastroenterology. 2017 Jul;153(1):98-105. doi: 10.1053/j.gastro.2017.04.006. Epub 2017 Apr 17.
BACKGROUND & AIMS: The quality of endoscopists' colonoscopy performance is measured by adenoma detection rate (ADR). Although ADR is associated inversely with interval colorectal cancer and colorectal cancer death, the effects of an increasing ADR have not been shown. We investigated whether increasing ADRs from individual endoscopists is associated with reduced risks of interval colorectal cancer and subsequent death.
We performed a prospective cohort study of individuals who underwent a screening colonoscopy within the National Colorectal Cancer Screening Program in Poland, from January 1, 2004, through December 31, 2008. We collected data from 146,860 colonoscopies performed by 294 endoscopists, with each endoscopist having participated at least twice in annual editions of primary colonoscopy screening. We used annual feedback and quality benchmark indicators to improve colonoscopy performance. We used ADR quintiles in the whole data set to categorize the annual ADRs for each endoscopist. An increased ADR was defined as an increase by at least 1 quintile category, or the maintenance of the highest category in subsequent screening years. Multivariate frailty models were used to evaluate the effects of increased ADR on the risk of interval colorectal cancer and death.
Throughout the enrollment period, 219 endoscopists (74.5%) increased their annual ADR category. During 895,916 person-years of follow-up evaluation through the National Cancer Registry, we identified 168 interval colorectal cancers and 44 interval cancer deaths. An increased ADR was associated with an adjusted hazard ratio for interval colorectal cancer of 0.63 (95% confidence interval [CI], 0.45-0.88; P = .006), and for cancer death of 0.50 (95% CI, 0.27-0.95; P = .035). Compared with no increase in ADR, reaching or maintaining the highest quintile ADR category (such as an ADR > 24.56%) decreased the adjusted hazard ratios for interval colorectal cancer to 0.27 (95% CI, 0.12-0.63; P = .003), and 0.18 (95% CI, 0.06-0.56; P = .003), respectively.
In a prospective study of individuals who underwent screening colonoscopy within a National Colorectal Cancer Screening Program, we associated increased ADR with a reduced risk of interval colorectal cancer and death.
结直肠腺瘤检出率（ADR）是衡量内镜医生结肠镜检查质量的指标。虽然 ADR 与结直肠间期癌和结直肠癌死亡风险呈负相关，但尚未证实 ADR 增加的效果。我们研究了个体内镜医生的 ADR 增加是否与结直肠间期癌和随后死亡风险的降低相关。
我们对 2004 年 1 月 1 日至 2008 年 12 月 31 日期间在波兰国家结直肠癌筛查计划中接受筛查性结肠镜检查的个体进行了前瞻性队列研究。我们收集了 294 名内镜医生进行的 146860 例结肠镜检查的数据，每位内镜医生至少参加过两次年度初级结肠镜筛查。我们使用年度反馈和质量基准指标来提高结肠镜检查的性能。我们使用整个数据集的 ADR 五分位数来对每个内镜医生的年度 ADR 进行分类。ADR 增加定义为至少增加一个五分位类别，或在随后的筛查年度维持最高类别。使用多因素脆弱性模型评估 ADR 增加对结直肠间期癌和死亡风险的影响。
在整个入组期间，74.5%的 219 名内镜医生增加了他们的年度 ADR 类别。在通过国家癌症登记处进行的 895916 人年随访评估期间，我们发现了 168 例结直肠间期癌和 44 例结直肠间期癌死亡。ADR 增加与结直肠间期癌的校正风险比相关，为 0.63（95%置信区间[CI]，0.45-0.88；P=.006），癌症死亡的校正风险比为 0.50（95%CI，0.27-0.95；P=.035）。与 ADR 无增加相比，达到或维持最高五分位 ADR 类别（如 ADR > 24.56%）使结直肠间期癌的校正风险比分别降至 0.27（95%CI，0.12-0.63；P=.003）和 0.18（95%CI，0.06-0.56；P=.003）。
在一项对国家结直肠癌筛查计划中接受筛查性结肠镜检查的个体的前瞻性研究中，我们发现 ADR 增加与结直肠间期癌和死亡风险降低相关。
