Forsberg Anna, Widman Linnea, Bottai Matteo, Ekbom Anders, Hultcrantz Rolf
Department of Medicine, Karolinska Institutet, Solna (MedS), Stockholm, Sweden.
Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Clin Gastroenterol Hepatol. 2020 Nov;18(12):2724-2733.e3. doi: 10.1016/j.cgh.2020.06.010. Epub 2020 Jun 15.
BACKGROUND & AIMS: The rate of postcolonoscopy colorectal cancer (PCCRC) is a measure of colonoscopy quality, but there are conflicting results from studies of survival times of patients with PCCRC. We assessed survival times of patients with PCCRC and characterized the microscopic and macroscopic features of postcolonoscopy colorectal tumors.
We performed a population-based cohort study using data from a database in Sweden, on 458,937 colonoscopies (54.0% women) performed from 2003 through 2012. Rates of colorectal cancer within 3 years of a colonoscopy were calculated based on the World Endoscopy Organization guidelines. Risk factors were evaluated using Poisson regression analysis. We used Cox regression models and Kaplan-Meier analyses, stratified by sex, to assess conditional survival. Logistic regression models were used to evaluate features of postcolonoscopy colorectal tumors, including stage location (right, left, or rectum) differentiation grade (high or low), synchronous tumors, perineural growth, resection margins, and mucinous and vessel characteristics.
Within 36 months after a colonoscopy, there were 19,184 individuals who had received a diagnosis of CRC; 1384 of these were PCCRCs (7.2%). The proportion of individuals with PCCRC decreased from 9.4% in 2003 to 6.1% in 2012. The largest risk factors for PCCRC were a prior diagnosis of CRC (relative risk [RR], 3.31; 95% CI, 2.71-4.04), ulcerative colitis (RR, 5.44; 95% CI, 4.75-6.23), Crohn's disease (RR, 3.81; 95% CI, 2.98-4.87), and prior polypectomy (RR, 2.32; 95% CI, 1.97-2.72). Individuals with PCCRCs had shorter survival times than individuals with CRCs detected during the index colonoscopy. Multivariate hazard ratios for PCCRC were 2.75 for men (95% CI, 2.21-3.42) and 2.00 for women (95% CI, 1.59-2.52), respectively. Individuals with left-side PCCRC had shorter survival times than patients with CRC detected during the index colonoscopy. Postcolonoscopy colorectal tumors had increased odds of low differentiation grade (odds ratio, 1.27; 95% CI, 1.09-1.49) compared with colorectal tumors detected during the index colonoscopy.
In an analysis of colonoscopies in Sweden, the rate of PCCRCs decreased from 9.4% in 2003 to 6.1% in 2012. Diseases that require surveillance (such as prior colorectal neoplasms and inflammatory bowel diseases) are the largest risk factors for PCCRC. Patients with PCCRC have shorter survival times than patients with CRC detected during their initial colonoscopy-especially women and patients with left-side tumors.
结肠镜检查后结直肠癌（PCCRC）发生率是衡量结肠镜检查质量的一项指标，但关于PCCRC患者生存时间的研究结果存在矛盾。我们评估了PCCRC患者的生存时间，并对结肠镜检查后结直肠肿瘤的微观和宏观特征进行了描述。
我们利用瑞典一个数据库中的数据进行了一项基于人群的队列研究，纳入了2003年至2012年期间进行的458,937例结肠镜检查（女性占54.0%）。根据世界内镜组织指南计算结肠镜检查后3年内的结直肠癌发生率。使用泊松回归分析评估危险因素。我们使用Cox回归模型和Kaplan-Meier分析，并按性别分层，以评估条件生存情况。使用逻辑回归模型评估结肠镜检查后结直肠肿瘤的特征，包括分期部位（右半、左半或直肠）、分化程度（高或低）、同步肿瘤、神经周围生长、切缘以及黏液和血管特征。
在结肠镜检查后的36个月内，有19,184人被诊断为结直肠癌；其中1384例为PCCRC（7.2%）。PCCRC患者的比例从2003年的9.4%降至2012年的6.1%。PCCRC的最大危险因素是先前诊断为结直肠癌（相对风险[RR]，3.31；95%CI，2.71 - 4.04）、溃疡性结肠炎（RR，5.44；95%CI，4.75 - 6.23）、克罗恩病（RR，3.81；95%CI，2.98 - 4.87）以及先前的息肉切除术（RR，2.32；95%CI，1.97 - 2.72）。PCCRC患者的生存时间比在首次结肠镜检查时发现的结直肠癌患者短。PCCRC的多因素风险比男性为2.75（95%CI，2.21 - 3.42），女性为2.00（95%CI，1.59 - 2.52）。左侧PCCRC患者的生存时间比在首次结肠镜检查时发现的结直肠癌患者短。与在首次结肠镜检查时发现的结直肠肿瘤相比，结肠镜检查后结直肠肿瘤低分化程度的几率增加（优势比，1.27；95%CI，1.09 - 1.49）。
在对瑞典结肠镜检查的分析中，PCCRC发生率从2003年的9.4%降至2012年的6.1%。需要进行监测的疾病（如先前的结直肠肿瘤和炎症性肠病）是PCCRC的最大危险因素。PCCRC患者的生存时间比在首次结肠镜检查时发现的结直肠癌患者短，尤其是女性和左侧肿瘤患者。
