Kaiser Permanente Washington Health Research Institute, Seattle, Washington.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
Cancer Epidemiol Biomarkers Prev. 2019 Jan;28(1):91-98. doi: 10.1158/1055-9965.EPI-18-0452. Epub 2018 Nov 20.
To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval.
We describe patterns of and factors associated with subsequent colonoscopy among persons with ≥3 adenomas and/or ≥1 adenoma with villous/tubulovillous histology in four U.S. integrated healthcare delivery systems. We report Kaplan-Meier estimators of the cumulative percentage of patients undergoing colonoscopy 6 months to 3.5 years after an index colonoscopy with high-risk findings. Combining data from three healthcare systems, we used multivariable logistic regression with inverse probability of censoring weights to estimate ORs and 95% confidence intervals (CI) for associations between patient characteristics and receipt of subsequent colonoscopy.
Among 6,909 persons with advanced adenomas, the percent receiving a subsequent colonoscopy 6 months to 3.5 years later ranged from 18.3% (95% CI: 11.7%-27.8%) to 59.5% (95% CI: 53.8%-65.2%) across healthcare systems. Differences remained significant in the multivariable model. Patients with ≥3 adenomas were more likely than those with 1 to 2 villous/tubulovillous adenomas to undergo subsequent colonoscopy. Subsequent colonoscopy was also more common for patients ages 60-74 and less common for patients ages 80 to 89 compared with those ages 50 to 54 years at their index colonoscopy. Sex, race/ethnicity, and comorbidity index score were generally not associated with subsequent colonoscopy receipt.
Colonoscopy within the recommended interval following advanced adenoma was underutilized and varied by healthcare system, age, and number of adenomas.
Strategies to improve adherence to surveillance colonoscopy following advanced adenomas are needed.
为降低结直肠癌的发病率和死亡率，专家建议在高级别腺瘤切除后 3 年内进行监测结肠镜检查。目前对于该间隔时间的依从性知之甚少。
我们描述了在美国四个综合医疗服务系统中，具有≥3 个腺瘤和/或≥1 个具有绒毛/管状绒毛状组织学特征的腺瘤的患者在高级别腺瘤切除后进行后续结肠镜检查的模式和相关因素。我们报告了在具有高危特征的索引结肠镜检查后 6 个月至 3.5 年内接受结肠镜检查的患者百分比的累积 Kaplan-Meier 估计值。通过合并来自三个医疗保健系统的数据，我们使用逆概率 censoring 加权的多变量逻辑回归来估计患者特征与接受后续结肠镜检查之间的关联的比值比（OR）和 95%置信区间（CI）。
在 6909 名高级别腺瘤患者中，在不同医疗服务系统中，在高级别腺瘤切除后 6 个月至 3.5 年内接受后续结肠镜检查的患者比例范围为 18.3%（95%CI：11.7%-27.8%）至 59.5%（95%CI：53.8%-65.2%）。在多变量模型中差异仍然显著。与 1 至 2 个绒毛/管状绒毛状腺瘤相比，具有≥3 个腺瘤的患者更有可能进行后续结肠镜检查。与在索引结肠镜检查时年龄为 50-54 岁的患者相比，年龄为 60-74 岁的患者以及年龄为 80-89 岁的患者进行后续结肠镜检查的可能性更高。性别、种族/族裔和合并症指数评分通常与接受后续结肠镜检查的可能性无关。
在高级别腺瘤切除后推荐的间隔内进行结肠镜检查的情况并未得到充分利用，并且因医疗服务系统、年龄和腺瘤数量而异。
需要采取策略来提高对高级别腺瘤监测结肠镜检查的依从性。
