Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center and Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California.
Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California.
Gastroenterology. 2021 May;160(6):1997-2005.e3. doi: 10.1053/j.gastro.2021.01.219. Epub 2021 Feb 2.
The optimal time interval for diagnostic colonoscopy completion after an abnormal stool-based colorectal cancer (CRC) screening test is uncertain. We examined the association between time to colonoscopy and CRC outcomes among individuals who underwent diagnostic colonoscopy after abnormal stool-based screening.
We performed a retrospective cohort study of veterans age 50 to 75 years with an abnormal fecal occult blood test (FOBT) or fecal immunochemical test (FIT) between 1999 and 2010. We used multivariable Cox proportional hazards to generate CRC-specific incidence and mortality hazard ratios (HRs) and 95% confidence intervals (CI) for 3-month colonoscopy intervals, with 1 to 3 months as the reference group. Association of time to colonoscopy with late-stage CRC diagnosis was also examined.
Our cohort included 204,733 patients. Mean age was 61 years (SD 6.9). Compared with patients who received a colonoscopy at 1 to 3 months, there was an increased CRC risk for patients who received a colonoscopy at 13 to 15 months (HR 1.13; 95% CI 1.00-1.27), 16 to 18 months (HR 1.25; 95% CI 1.10-1.43), 19 to 21 months (HR 1.28; 95% CI: 1.11-1.48), and 22 to 24 months (HR 1.26; 95% CI 1.07-1.47). Compared with patients who received a colonoscopy at 1 to 3 months, mortality risk was higher in groups who received a colonoscopy at 19 to 21 months (HR 1.52; 95% CI 1.51-1.99) and 22 to 24 months (HR 1.39; 95% CI 1.03-1.88). Odds for late-stage CRC increased at 16 months.
Increased time to colonoscopy is associated with higher risk of CRC incidence, death, and late-stage CRC after abnormal FIT/FOBT. Interventions to improve CRC outcomes should emphasize diagnostic follow-up within 1 year of an abnormal FIT/FOBT result.
在异常粪便结直肠癌（CRC）筛查试验后，诊断性结肠镜检查完成的最佳时间间隔尚不确定。我们研究了接受诊断性结肠镜检查后异常粪便筛查个体的结肠镜检查时间与 CRC 结局之间的关系。
我们对年龄在 50 至 75 岁之间的退伍军人进行了回顾性队列研究，这些退伍军人在 1999 年至 2010 年期间进行了异常粪便潜血试验（FOBT）或粪便免疫化学试验（FIT）。我们使用多变量 Cox 比例风险来生成 3 个月结肠镜检查间隔的 CRC 特异性发生率和死亡率风险比（HR）和 95％置信区间（CI），以 1 至 3 个月为参考组。还检查了结肠镜检查时间与晚期 CRC 诊断之间的关系。
我们的队列包括 204733 名患者。平均年龄为 61 岁（SD 6.9）。与 1 至 3 个月接受结肠镜检查的患者相比，13 至 15 个月（HR 1.13；95％CI 1.00-1.27），16 至 18 个月（HR 1.25；95％CI 1.10-1.43），19 至 21 个月（HR 1.28；95％CI：1.11-1.48）和 22 至 24 个月（HR 1.26；95％CI 1.07-1.47）接受结肠镜检查的 CRC 风险增加。与 1 至 3 个月接受结肠镜检查的患者相比，19 至 21 个月（HR 1.52；95％CI 1.51-1.99）和 22 至 24 个月（HR 1.39；95％CI 1.03-1.88）接受结肠镜检查的患者死亡率风险更高。
结肠镜检查时间的延长与异常 FIT/FOBT 后 CRC 发病率，死亡率和晚期 CRC 的风险增加有关。改善 CRC 结局的干预措施应强调在异常 FIT/FOBT 结果后 1 年内进行诊断性随访。
