Department of Medicine, Columbia University Medical Center.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
J Clin Gastroenterol. 2019 Sep;53(8):e334-e340. doi: 10.1097/MCG.0000000000001099.
Colonoscopy is effective for colorectal cancer (CRC) prevention, yet patients may develop CRC despite adhering to screening/surveillance intervals. There are limited data on predictive factors associated with these postcolonoscopy CRCs (PCCRCs). We aimed to measure PCCRC rates and identify risk factors for PCCRC.
We performed a case-control study, comparing patients with PCCRCs to spontaneous CRCs diagnosed during a 12.5-year period at an academic medical center. PCCRCs were defined as CRCs diagnosed in between guideline-recommended screening/surveillance intervals.
During the 12.5-year period, of 1266 CRCs diagnosed, 122 (10%) were PCCRCs. 70% of PCCRCs were diagnosed within 5 years of a prior colonoscopy. There was an increasing trend for PCCRC rates in recent years [odds ratio (OR), 2.78; 95% confidence interval (CI), 1.51-5.09], with PCCRCs comprising 13.6% of cancers diagnosed in 2016 as compared with 5.7% of cancers diagnosed in 2005. Older age (OR per year, 1.02; 95% CI, 1.01-1.04), proximal colonic location (OR, 1.99; 95% CI, 1.20-3.33) and early stage (OR, 2.57; 95% CI, 1.34-4.95) were associated with PCCRCs. In total, 41% of PCCRCs were diagnosed by a different physician from the physician who did the prior colonoscopy, and 42% of physicians did not diagnose any of their PCCRC cases.
PCCRC rates are rising in recent years, likely reflecting the widespread adoption of colonoscopy as a primary screening tool, and are more common in older patients and those with proximal, early-stage tumors. The finding that a large proportion of PCCRCs are diagnosed by a different physician raises the concern that physicians are unaware of their own patients' PCCRCs.
结肠镜检查可有效预防结直肠癌（CRC），但即使患者遵循筛查/监测间隔，仍可能发生 CRC。与这些结肠镜检查后 CRC（PCCRC）相关的预测因素数据有限。我们旨在测量 PCCRC 发生率并确定 PCCRC 的危险因素。
我们进行了一项病例对照研究，将 PCCRC 患者与在学术医疗中心 12.5 年内诊断出的自发性 CRC 患者进行比较。PCCRC 定义为在指南推荐的筛查/监测间隔内诊断出的 CRC。
在 12.5 年期间，在诊断出的 1266 例 CRC 中，有 122 例（10%）为 PCCRC。70%的 PCCRC 是在前一次结肠镜检查后 5 年内诊断出的。近年来，PCCRC 发生率呈上升趋势[比值比（OR），2.78；95%置信区间（CI），1.51-5.09]，2016 年诊断出的 PCCRC 占癌症的 13.6%，而 2005 年诊断出的癌症占 5.7%。年龄较大（每年 OR，1.02；95%CI，1.01-1.04）、结肠近端位置（OR，1.99；95%CI，1.20-3.33）和早期阶段（OR，2.57；95%CI，1.34-4.95）与 PCCRC 相关。总共，41%的 PCCRC 是由与进行前一次结肠镜检查的医生不同的医生诊断的，而 42%的医生没有诊断出他们的任何 PCCRC 病例。
近年来，PCCRC 发生率呈上升趋势，这可能反映了结肠镜检查作为主要筛查工具的广泛采用，并且在年龄较大的患者和具有近端、早期肿瘤的患者中更为常见。发现很大一部分 PCCRC 是由不同的医生诊断出来的，这引发了人们对医生不知道自己患者的 PCCRC 的担忧。
