筛查时腺瘤检出率较高与结直肠癌发病率和死亡率的长期降低相关。
Higher Adenoma Detection Rates at Screening Associated With Lower Long-Term Colorectal Cancer Incidence and Mortality.
机构信息
Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
出版信息
Clin Gastroenterol Hepatol. 2022 Feb;20(2):e148-e167. doi: 10.1016/j.cgh.2020.09.020. Epub 2020 Sep 12.
BACKGROUND & AIMS: Detection and removal of adenomas reduces colorectal cancer (CRC) risk. The impact of adenoma detection rates (ADRs) on long-term CRC incidence and mortality is unknown. We investigated this using data from the UK Flexible Sigmoidoscopy Screening Trial.
METHODS
Of 167,882 UK Flexible Sigmoidoscopy Screening Trial participants, 40,085 were in the intervention arm and underwent flexible sigmoidoscopy screening at 13 trial centers. The median follow-up time was 17 years. At each center, 1 endoscopist performed most flexible sigmoidoscopies. Multivariable logistic regression was used to classify centers into high-, intermediate-, and low-detector groups based on their main endoscopist's ADR. We calculated the incidence and mortality of distal and all-site CRC, and estimated hazard ratios (HRs) with 95% CIs using Cox regression.
RESULTS
Five, 4, and 4 centers, respectively, were classified into the high-detector, intermediate-detector, and low-detector groups. The average ADRs in each respective group were 15%, 12%, and 9%. Distal CRC incidence and mortality were reduced among those screened compared with controls in all groups, and effects of screening varied significantly by detector ranking, with larger reductions in incidence and mortality seen in the high-detector group (incidence: HR, 0.34; 95% CI, 0.27-0.42; mortality: HR, 0.22, 95% CI, 0.13-0.37) than in the low-detector group (incidence: HR, 0.55; 95% CI, 0.44-0.68; mortality: HR, 0.54; 95% CI, 0.34-0.86). Similar results were observed for all-site CRC, with larger effects seen in the high-detector (incidence: HR, 0.58; 95% CI, 0.50-0.67; mortality: HR, 0.52; 95% CI, 0.39-0.69) than in the low-detector group (incidence: HR, 0.72; 95% CI, 0.61-0.85; mortality: HR, 0.68; 95% CI, 0.51-0.92), although the heterogeneity was not statistically significant.
CONCLUSIONS
Higher ADRs at screening provide greater long-term protection against CRC incidence and mortality. Isrctn.org, number: ISRCTN28352761.
背景与目的
腺瘤的检测和去除可降低结直肠癌（CRC）的风险。腺瘤检出率（ADR）对长期 CRC 发病率和死亡率的影响尚不清楚。我们使用来自英国柔性乙状结肠镜筛查试验的数据对此进行了研究。
方法
在 167882 名英国柔性乙状结肠镜筛查试验参与者中，40085 名参与者在干预组中，并在 13 个试验中心接受了柔性乙状结肠镜筛查。中位随访时间为 17 年。在每个中心，1 名内镜医生进行了大多数的柔性乙状结肠镜检查。使用多变量逻辑回归根据主要内镜医生的 ADR 将中心分为高、中、低检出组。我们计算了远端和所有部位 CRC 的发病率和死亡率，并使用 Cox 回归估计了 95%CI 的风险比（HR）。
结果
分别有 5、4 和 4 个中心被归类为高检出组、中检出组和低检出组。在每个相应组中，ADR 的平均值分别为 15%、12%和 9%。与对照组相比，所有组中接受筛查的人群远端 CRC 的发病率和死亡率均降低，且筛查效果随检出器排名显著变化，高检出组的发病率和死亡率降低幅度更大（发病率：HR，0.34；95%CI，0.27-0.42；死亡率：HR，0.22，95%CI，0.13-0.37），而低检出组的发病率和死亡率降低幅度较小（发病率：HR，0.55；95%CI，0.44-0.68；死亡率：HR，0.54；95%CI，0.34-0.86）。所有部位 CRC 的结果相似，高检出组（发病率：HR，0.58；95%CI，0.50-0.67；死亡率：HR，0.52；95%CI，0.39-0.69）的效果大于低检出组（发病率：HR，0.72；95%CI，0.61-0.85；死亡率：HR，0.68；95%CI，0.51-0.92），尽管异质性无统计学意义。
结论
筛查时更高的 ADR 可提供更大的长期 CRC 发病率和死亡率保护。ISRCTN.org，编号：ISRCTN28352761。
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