Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
BMJ Open. 2019 Jun 21;9(6):e026138. doi: 10.1136/bmjopen-2018-026138.
Post-colonoscopy colorectal cancers (PCCRCs) are recognised as a critical quality indicator. Benchmarking of PCCRC rate has been hampered by the strong influence of different definitions and methodologies. We adopted a rigorous methodology with high-detail individual data to determine PCCRC rates in a prospective cohort representing a single jurisdiction.
We performed a cohort study of individuals who underwent colonoscopy between 2001 and 2008 at a single centre serving Australian Capital Territory (ACT) and enclaving New South Wales (NSW) region. These individuals were linked to subsequent colorectal cancer (CRC) diagnosis, within 5 years of a negative colonoscopy, through regional cancer registries and hospital records using probabilistic and deterministic record linkage. All cases were verified by pathology review. Predictors of PCCRCs were extracted.
7818 individuals had a colonoscopy in the cohort. Linkage to cancer registries detected 384 and 98 CRCs for notification dates of 2001-2013 (ACT) and 2001-2010 (NSW). A further 55 CRCs were identified from a search of electronic medical records using International Classification of Diseases-10 diagnosis codes. After verification and exclusions, 385/537 CRCs (58% male) were included.
PCCRC rates.
There were 15 PCCRCs in our cohort. The PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was estimated as 0.192% (95% CI 0.095 to 0.289). The index colonoscopy prior to PCCRC was more likely to show diverticulosis (p=0.017 for association, OR 3.56, p=0.014) and have poor bowel preparation (p=0.017 for association, OR 4.19, p=0.009).
In this population-based cohort study, the PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was 0.192%. These data show the 'real world' accuracy of colonoscopy for CRC exclusion.
结直肠镜检查后的结直肠癌（PCCRC）被认为是一个关键的质量指标。由于不同定义和方法的强烈影响，PCCRC 率的基准测试受到了阻碍。我们采用了严格的方法，使用详细的个人数据，在代表单一司法管辖区的前瞻性队列中确定 PCCRC 率。
我们对 2001 年至 2008 年期间在单一中心进行结肠镜检查的个体进行了队列研究，该中心服务于澳大利亚首都领地（ACT）和新南威尔士州（NSW）地区。通过区域癌症登记处和医院记录，使用概率和确定性记录链接，将这些个体与 5 年内阴性结肠镜检查后的随后结直肠癌（CRC）诊断联系起来。所有病例均通过病理检查进行验证。提取 PCCRC 的预测因素。
7818 人在队列中进行了结肠镜检查。与癌症登记处的联系发现，2001-2013 年（ACT）和 2001-2010 年（NSW）的通知日期有 384 例和 98 例 CRC。使用国际疾病分类-10 诊断代码从电子病历搜索中又发现了 55 例 CRC。经过验证和排除后，385/537 例 CRC（58%为男性）被纳入。
PCCRC 率。
我们的队列中有 15 例 PCCRC。PCCRC 发生率为 0.384/1000 人年，5 年 PCCRC 风险估计为 0.192%（95%CI 0.095 至 0.289）。PCCRC 前的索引结肠镜检查更可能显示憩室病（关联 p=0.017，OR 3.56，p=0.014）和肠道准备不良（关联 p=0.017，OR 4.19，p=0.009）。
在这项基于人群的队列研究中，PCCRC 的发病率为 0.384/1000 人年，5 年 PCCRC 风险为 0.192%。这些数据显示了结肠镜检查排除 CRC 的“真实世界”准确性。
