Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
J Gastroenterol Hepatol. 2019 Mar;34(3):532-536. doi: 10.1111/jgh.14517. Epub 2018 Nov 18.
Because the risk of colorectal cancer has not been well examined in fecal immunochemistry test (FIT)-positive patients who previously underwent colonoscopy, this study aimed to investigate this topic.
This was a single-center, observational study of prospectively collected data in Japan. FIT-positive, average-risk patients who underwent colonoscopy were divided into groups as follows: those who never underwent colonoscopy in the past (no colonoscopy group), those with a history of colonoscopy between 6 months and 5 years (0.5- to 5-year colonoscopy group), and those with a history of colonoscopy more than 5 years ago (> 5-year colonoscopy group). We investigated the prevalence of advanced neoplasia and invasive cancer among these groups using multiple logistic regression analysis.
Detection rates of advanced neoplasia in the no colonoscopy group, 0.5- to 5-year colonoscopy group, and > 5-year colonoscopy group were 14.8% (240/1626), 3.9% (13/330), and 6.9% (17/248), respectively. Detection rates of invasive cancer in each aforementioned group were 5.7% (92/1,626), 0.3% (1/330), and 1.2% (3/248), respectively. Odds ratios of advanced neoplasia in the 0.5- to 5-year colonoscopy group and > 5-year colonoscopy were 0.23 (95% confidence interval [CI]: 0.13-0.42) and 0.40 (95% CI: 0.24-0.68), respectively, in multivariate analysis. The odds ratios of invasive cancer in each aforementioned group were 0.05 (95% CI: 0.01-0.37) and 0.19 (95% CI: 0.06-0.61), respectively.
Re-screening with the FIT should not be recommended for at least 5 years for average-risk patients after colonoscopy without high-risk neoplasms, because the risks of colorectal cancer are low in such patients.
由于粪便免疫化学检测（FIT）阳性的患者既往行结肠镜检查后结直肠癌的风险尚未得到充分研究，本研究旨在对此进行探讨。
这是一项在日本进行的前瞻性收集数据的单中心观察性研究。将既往行 FIT 阳性、平均风险结肠镜检查的患者分为以下几组：既往从未行结肠镜检查者（无结肠镜检查组）、既往 6 个月至 5 年内行结肠镜检查者（0.5-5 年结肠镜检查组）和既往 5 年以上行结肠镜检查者（>5 年结肠镜检查组）。我们通过多因素逻辑回归分析，调查了这些组中高级别腺瘤和侵袭性癌的检出率。
无结肠镜检查组、0.5-5 年结肠镜检查组和>5 年结肠镜检查组的高级别腺瘤检出率分别为 14.8%（240/1626）、3.9%（13/330）和 6.9%（17/248）；侵袭性癌的检出率分别为 5.7%（92/1626）、0.3%（1/330）和 1.2%（3/248）。多因素分析显示，0.5-5 年结肠镜检查组和>5 年结肠镜检查组高级别腺瘤的比值比（OR）分别为 0.23（95%置信区间[CI]：0.13-0.42）和 0.40（95% CI：0.24-0.68）；各上述组侵袭性癌的 OR 分别为 0.05（95% CI：0.01-0.37）和 0.19（95% CI：0.06-0.61）。
对于无高危腺瘤的平均风险患者，结肠镜检查后至少 5 年内无需再次进行 FIT 筛查，因为此类患者结直肠癌的风险较低。
