Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.
Gastroenterology. 2020 Jul;159(1):129-138.e9. doi: 10.1053/j.gastro.2020.03.016. Epub 2020 Mar 14.
BACKGROUND & AIMS: Estimates of absolute risk of colorectal cancer (CRC) are needed to facilitate communication and better inform the public about the potentials and limits of cancer prevention.
Using data from a large population-based case-control study in Germany (Darmkrebs: Chancen der Verhütung durch Screening [DACHS] study, which began in 2003) and population registry data, we calculated 30-year absolute risk estimates for development of CRC based on a healthy lifestyle score (derived from 5 modifiable lifestyle factors: smoking, alcohol consumption, diet, physical activity, and body fatness), a polygenic risk score (based on 90 single-nucleotide polymorphisms), and colonoscopy history.
We analyzed data from 4220 patients with CRC and 3338 individuals without CRC. Adherence to a healthy lifestyle and colonoscopy in the preceding 10 years were associated with a reduced relative risk of CRC in men and women. We observed a higher CRC risk in participants with high or intermediate genetic risk scores. For 50-year-old men and women without a colonoscopy, the absolute risk of CRC varied according to the polygenic risk score and the healthy lifestyle score (men, 3.5%-13.4%; women, 2.5%-10.6%). For 50-year-old men and women with a colonoscopy, the absolute risk of developing CRC was much lower but still varied according to the polygenic risk score and the healthy lifestyle score (men, 1.2%-4.8%; women, 0.9%-4.2%). Among all risk factor profiles, the 30-year absolute risk estimates consistently decreased with adherence to a healthy lifestyle.
In a population-based study, we found that a colonoscopy can drastically reduce the absolute risk of CRC and that the genetically predetermined risk of CRC can be further reduced by adherence to a healthy lifestyle. Our results show the magnitude of CRC prevention possible through colonoscopy and lifestyle at a predefined genetic risk. This observational study has been registered in the German Clinical Trials Register (DRKS00011793), which is a primary registry in the World Health Organization Registry Network.
为了便于交流并更好地向公众传达癌症预防的潜力和局限性，需要估计结直肠癌（CRC）的绝对风险。
利用德国一项大型基于人群的病例对照研究（2003 年开始的大肠癌：筛查的机会[DACH]研究）和人口登记数据，我们根据健康生活方式评分（来源于 5 个可改变的生活方式因素：吸烟、饮酒、饮食、身体活动和体脂）、多基因风险评分（基于 90 个单核苷酸多态性）和结肠镜检查史，计算出 30 年 CRC 发病的绝对风险估计值。
我们分析了 4220 例 CRC 患者和 3338 例无 CRC 的个体的数据。在男性和女性中，遵循健康的生活方式和结肠镜检查在前 10 年内与 CRC 的相对风险降低有关。我们观察到高或中遗传风险评分的参与者 CRC 风险更高。对于 50 岁且未进行结肠镜检查的男性和女性，多基因风险评分和健康生活方式评分会影响 CRC 的绝对风险（男性，3.5%-13.4%；女性，2.5%-10.6%）。对于 50 岁且进行了结肠镜检查的男性和女性，CRC 的发病风险要低得多，但仍取决于多基因风险评分和健康生活方式评分（男性，1.2%-4.8%；女性，0.9%-4.2%）。在所有危险因素中，30 年绝对风险估计值随着健康生活方式的依从性而持续降低。
在一项基于人群的研究中，我们发现结肠镜检查可以显著降低 CRC 的绝对风险，并且通过遵循健康的生活方式可以进一步降低 CRC 的遗传风险。我们的结果表明，通过结肠镜检查和生活方式在既定遗传风险下预防 CRC 的幅度。这项观察性研究已在德国临床试验注册处（DRKS00011793）注册，该注册处是世界卫生组织注册网络中的一个主要注册处。
