Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan.
Clin Gastroenterol Hepatol. 2019 Jun;17(7):1332-1340.e3. doi: 10.1016/j.cgh.2018.10.041. Epub 2018 Nov 1.
BACKGROUND & AIMS: In patients with positive results from a fecal immunochemical test (FIT), failure to receive a timely follow-up colonoscopy may be associated with higher risks of colorectal cancer (CRC) and advanced-stage CRC. We evaluated the prevalence of any CRC and advanced-stage CRC associated with delays in follow-up colonoscopies for patients with positive results from a FIT.
We collected data from 39,346 patients (age, 50-69 years) who participated in the Taiwanese Nationwide Screening Program from 2004 through 2012 and had completed a colonoscopy more than 1 month after a positive result from a FIT. Risks of any CRC and advanced-stage CRC (stage III-IV) were evaluated using logistic regression models and results expressed as adjusted odds ratios (aORs) and corresponding 95% CIs.
In our cohort, 2003 patients received a diagnosis of any CRC and 445 patients were found to have advanced-stage disease. Compared with colonoscopy within 1-3 months (cases per 1000 patients: 50 for any CRC and 11 for advanced-stage disease), risks were significantly higher when colonoscopy was delayed by more than 6 months for any CRC (aOR, 1.31; 95% CI, 1.04-1.64; 68 cases per 1000 patients) and advanced-stage disease (aOR, 2.09; 95% CI, 1.43-3.06; 24 cases per 1000 patients). The risks continuously increased when colonoscopy was delayed by more than 12 months for any CRC (aOR, 2.17; 95% CI, 1.44-3.26; 98 cases per 1000 patients) and advanced-stage disease (aOR, 2.84; 95% CI, 1.43-5.64; 31 cases per 1000 patients). There were no significant differences for colonoscopy follow up at 3-6 months for risk of any CRC (aOR, 0.98; 95% CI, 0.86-1.12; 49 cases per 1000 patients) or advanced-stage disease (aOR, 0.95; 95% CI, 0.72-1.25; 10 cases per 1000 patients).
In an analysis of data from the Taiwanese Nationwide Screening Program, we found that among patients with positive results from a FIT, risks of CRC and advanced-stage disease increase with time. These findings indicate the importance of timely colonoscopy after a positive result from a FIT.
在粪便免疫化学检测（FIT）结果阳性的患者中，如果未能及时进行随访结肠镜检查，可能会增加结直肠癌（CRC）和晚期 CRC 的风险。我们评估了与 FIT 阳性患者的随访结肠镜检查延迟相关的任何 CRC 和晚期 CRC（III-IV 期）的发生率。
我们收集了 2004 年至 2012 年期间参加台湾全国筛查计划的 39346 名（年龄 50-69 岁）患者的数据，这些患者在 FIT 阳性后 1 个月以上进行了结肠镜检查。使用逻辑回归模型评估任何 CRC 和晚期 CRC（III-IV 期）的风险，并以校正比值比（aOR）和相应的 95%置信区间（CI）表示结果。
在我们的队列中，有 2003 例患者被诊断为任何 CRC，445 例患者被诊断为晚期疾病。与结肠镜检查在 1-3 个月内进行相比（每 1000 例患者的病例数：任何 CRC 为 50 例，晚期疾病为 11 例），当结肠镜检查延迟超过 6 个月时，任何 CRC（aOR，1.31；95%CI，1.04-1.64；每 1000 例患者中 68 例）和晚期疾病（aOR，2.09；95%CI，1.43-3.06；每 1000 例患者中 24 例）的风险显著增加。当结肠镜检查延迟超过 12 个月时，任何 CRC（aOR，2.17；95%CI，1.44-3.26；每 1000 例患者中 98 例）和晚期疾病（aOR，2.84；95%CI，1.43-5.64；每 1000 例患者中 31 例）的风险持续增加。对于结肠镜检查在 3-6 个月之间的任何 CRC（aOR，0.98；95%CI，0.86-1.12；每 1000 例患者中 49 例）或晚期疾病（aOR，0.95；95%CI，0.72-1.25；每 1000 例患者中 10 例），随访结肠镜检查的风险没有显著差异。
在对来自台湾全国筛查计划的数据进行分析时，我们发现，在 FIT 阳性的患者中，CRC 和晚期疾病的风险随时间而增加。这些发现表明，在 FIT 阳性后及时进行结肠镜检查非常重要。
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