Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Gut Liver. 2018 Nov 15;12(6):655-663. doi: 10.5009/gnl17514.
BACKGROUND/AIMS: The association between metabolic syndrome and colorectal cancer (CRC) has been suggested as one of causes for the increasing incidence of CRC, particularly in younger age groups. The present study examined whether the current age threshold (50 years) for CRC screening in Korea requires modification when considering increased metabolic syndrome.
We analyzed data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was evaluated with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension).
A total of 51,612,316 subjects enrolled during 2014 to 2015 were analyzed. Among them, 19.3% had diabetes, hypertension, dyslipidemia, or some combination thereof. This population had a higher incidence of CRC than did those without these conditions, and this was more prominent in subjects ＜40 years of age. The optimal cutoff age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension. Individuals with at least one of these components of metabolic syndrome had the highest Youden index at 62 years old, but the value was only 0.2. Resetting the cutoff age from 50 years to 45 years achieved a 6% increase in sensitivity for CRC detection among the total population.
Starting CRC screening earlier, namely, at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.
背景/目的：代谢综合征与结直肠癌（CRC）之间的关联被认为是 CRC 发病率上升的原因之一，尤其是在年轻人群中。本研究旨在探讨在考虑代谢综合征发病率增加的情况下，韩国现行的 CRC 筛查年龄阈值（50 岁）是否需要修改。
我们分析了国家健康保险财团数据库的数据，该数据库覆盖了韩国约 97%的人口。CRC 风险根据年龄和相关代谢综合征成分（糖尿病、血脂异常和高血压）的存在与否进行分层评估。
共分析了 2014 年至 2015 年期间的 51612316 名受试者。其中，19.3%患有糖尿病、高血压、血脂异常或这些疾病的组合。与无这些疾病的人群相比，该人群 CRC 的发病率更高，且这在＜40 岁的人群中更为显著。基于最高 Youden 指数，在无糖尿病、血脂异常和高血压的个体中，检测 CRC 的最佳截止年龄为 45 岁。至少有一种代谢综合征成分的个体的截止年龄为 62 岁，但指数仅为 0.2。将截止年龄从 50 岁重置为 45 岁可使总体人群的 CRC 检测灵敏度提高 6%。
在韩国，更早开始 CRC 筛查，即从 45 岁而非 50 岁开始，可能会改善 CRC 的二级预防。
