诊断前结肠镜检查可降低癌症死亡率——来自南澳大利亚基于人群的关联数据的结果。
Pre-diagnostic colonoscopies reduce cancer mortality - results from linked population-based data in South Australia.
机构信息
Cancer Research Institute, University of South Australia, Adelaide, Australia.
SA Cancer Service, South Australian Department for Health and Wellbeing, Adelaide, Australia.
出版信息
BMC Cancer. 2019 Aug 29;19(1):856. doi: 10.1186/s12885-019-6092-4.
BACKGROUND
To investigate the association between pre-diagnostic colonoscopy and colorectal cancer mortality in South Australia.
METHODS
Colonoscopy histories were obtained for colorectal cancer patients diagnosed in 2003-2013 using linked Medical Benefits Schedule (MBS) claims, hospital-inpatient and cancer-registry data. Colonoscopy histories included the year of colonoscopy, numbers of examinations, and the time from first colonoscopy to diagnosis. Histories of multiple exposures to colonoscopies, and exposures of greater than a year from initial colonoscopy to diagnosis, were regarded as indicators of screening or surveillance activity. Colonoscopies occurring within one year of diagnosis were regarded as more likely to be a response to cancer symptoms than those occurring > 1 year before diagnosis. Associations between colonoscopy history and post-diagnostic survival were analysed using sub-hazard ratios (SHRs) from competing risk regression adjusted for socio-demographic and cancer characteristics.
RESULTS
Having pre-diagnostic colonoscopy was associated with an unadjusted reduction in risk of colorectal cancer death of 17% (SHR: 0.83, 95% CI 0.78-0.89). After adjusting for time period and sociodemographic characteristics, the risk of colorectal cancer death reduced by 17% for one pre-diagnostic colonoscopy examination; 27% for two pre-diagnostic colonoscopy examinations; and 45% for three or more pre-diagnostic colonoscopy examinations. Those with a time of over one year from first colonoscopy in the study window to diagnosis, when compared with less than one year, had a 17% lower risk of colorectal cancer death in this adjusted analysis. These reductions were substantially reduced or eliminated when also adjusting for less advanced stage.
CONCLUSIONS
Pre-diagnostic colonoscopy, and more so, multiple colonoscopies and first colonoscopy occurring over one year from initial colonoscopy to diagnosis, were associated with longer survival post diagnosis. This was largely explained by less advanced cancer stage at the time of diagnosis.
背景
本研究旨在调查南澳大利亚地区结肠镜检查与结直肠癌死亡率之间的关联。
方法
利用关联的医疗福利计划（MBS）报销、住院和癌症登记数据，获取 2003 年至 2013 年间诊断为结直肠癌患者的结肠镜检查史。结肠镜检查史包括结肠镜检查的年份、检查次数以及首次结肠镜检查与诊断之间的时间。多次接受结肠镜检查或首次结肠镜检查至诊断的时间超过一年，被视为筛查或监测活动的指标。诊断一年内进行的结肠镜检查被认为更可能是对癌症症状的反应，而不是在诊断前一年以上进行的检查。使用竞争风险回归分析调整社会人口学和癌症特征后的亚危险比（SHR）分析结肠镜检查史与诊断后生存之间的关联。
结果
在未调整的情况下，有结肠镜检查史的患者结直肠癌死亡风险降低了 17%（SHR：0.83，95%CI 0.78-0.89）。在调整了时间区间和社会人口学特征后，一次结肠镜检查使结直肠癌死亡风险降低了 17%；两次结肠镜检查使风险降低了 27%；三次或更多次结肠镜检查使风险降低了 45%。与首次结肠镜检查至诊断的时间不足一年相比，在研究窗口中首次结肠镜检查至诊断的时间超过一年的患者，其结直肠癌死亡风险在调整后分析中降低了 17%。当同时调整为癌症分期较晚时，这些降低幅度显著减小或消除。
结论
在诊断前进行结肠镜检查，尤其是多次结肠镜检查，以及首次结肠镜检查至初始结肠镜检查的时间超过一年，与诊断后更长的生存时间相关。这主要是由于诊断时癌症分期较晚。
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