粪便检测在乙状结肠镜检查阴性后的应用对结直肠癌死亡率的影响。

The effect of using fecal testing after a negative sigmoidoscopy on the risk of death from colorectal cancer.

机构信息

Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, USA.

Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.

出版信息

J Med Screen. 2021 Jun;28(2):140-147. doi: 10.1177/0969141320921427. Epub 2020 May 21.

DOI:10.1177/0969141320921427

PMID:32438892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7679284/

Abstract

OBJECTIVE

To examine whether receiving a fecal occult blood test after a negative sigmoidoscopy reduced mortality from colorectal cancer.

METHODS

We used a nested case-control design with incidence-density matching in historical cohorts of 1,877,740 50-90-year-old persons during 2006-2012, in an integrated health-system setting. We selected 1758 average risk patients who died from colorectal cancer and 3503 matched colorectal cancer-free persons. Colorectal cancer-specific death was ascertained from cancer and mortality registries. Screening histories were determined from electronic and chart-audit clinical data in the 5- to 10-year period prior to the reference date. We evaluated receipt of subsequent fecal occult blood test within five years of the reference date among patients with negative sigmoidoscopy two to six years before the reference date.

RESULTS

Of the 5261 patients, 831 patients (204 colorectal cancer deaths/627 controls) had either negative sigmoidoscopy only ( = 592) or negative sigmoidoscopy with subsequent screening fecal occult blood test ( = 239). Fifty-six (27.5%) of the 204 patients dying of colorectal cancer and 183 (29.2%) of the 627 colorectal cancer-free patients received fecal occult blood test following a negative sigmoidoscopy. Conditional regressions found no significant association between fecal occult blood test receipt and colorectal cancer death risk, overall (adjusted odds ratio = 0.93, confidence interval: 0.65-1.33), or for right (odds ratio = 1.02, confidence interval: 0.65-1.60) or left-colon/rectum (odds ratio = 0.77, confidence interval: 0.39-1.52) cancers. Similar results were obtained in sensitivity analyses with alternative exposure ascertainment windows or timing of fecal occult blood test.

CONCLUSIONS

Our results suggest that receipt of at least one fecal occult blood test during the several years after a negative sigmoidoscopy did not substantially reduce mortality from colorectal cancer.

摘要

目的

探讨阴性乙状结肠镜检查后行粪便潜血试验是否能降低结直肠癌死亡率。

方法

采用巢式病例对照设计，以 2006 年至 2012 年期间某综合医疗系统中 1877740 名 50-90 岁人群为研究对象，通过发病率密度匹配进行分析。我们选择了 1758 名平均风险的结直肠癌死亡患者和 3503 名匹配的结直肠癌无死亡患者。结直肠癌特异性死亡通过癌症和死亡率登记处确定。筛查史通过参考日期前 5 至 10 年的电子病历和图表审核临床数据确定。我们评估了在参考日期前 2 至 6 年进行阴性乙状结肠镜检查后，在参考日期后 5 年内接受后续粪便潜血试验的情况。

结果

在 5261 名患者中，831 名患者（204 例结直肠癌死亡/627 例对照）仅行阴性乙状结肠镜检查（ = 592）或阴性乙状结肠镜检查加后续筛查粪便潜血试验（ = 239）。204 例结直肠癌死亡患者中有 56 例（27.5%）和 627 例结直肠癌无死亡患者中有 183 例（29.2%）接受了粪便潜血试验。条件回归发现，接受粪便潜血试验与结直肠癌死亡风险之间无显著关联，总体而言（调整比值比 = 0.93，置信区间：0.65-1.33），或对于右（比值比 = 1.02，置信区间：0.65-1.60）或左结肠/直肠（比值比 = 0.77，置信区间：0.39-1.52）癌症。在使用替代暴露确定窗口或粪便潜血试验时间的敏感性分析中，也得到了类似的结果。