根据个体风险状况进行结肠镜筛查后的结直肠癌长期发病率和死亡率。
Long-Term Colorectal Cancer Incidence and Mortality After Colonoscopy Screening According to Individuals' Risk Profiles.
机构信息
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
出版信息
J Natl Cancer Inst. 2021 Sep 4;113(9):1177-1185. doi: 10.1093/jnci/djab041.
BACKGROUND
It remains unknown whether the benefit of colonoscopy screening against colorectal cancer (CRC) and the optimal age to start screening differ by CRC risk profile.
METHODS
Among 75 873 women and 42 875 men, we defined a CRC risk score (0-8) based on family history, aspirin, height, body mass index, smoking, physical activity, alcohol, and diet. We calculated colonoscopy screening-associated hazard ratios and absolute risk reductions (ARRs) for CRC incidence and mortality and age-specific CRC cumulative incidence according to risk score. All statistical tests were 2-sided.
RESULTS
During a median of 26 years of follow-up, we documented 2407 CRC cases and 874 CRC deaths. Although the screening-associated hazard ratio did not vary by risk score, the ARRs in multivariable-adjusted 10-year CRC incidence more than doubled for individuals with scores 6-8 (ARR = 0.34%, 95% confidence interval [CI] = 0.26% to 0.42%) compared with 0-2 (ARR = 0.15%, 95% CI = 0.12% to 0.18%, Ptrend < .001). Similar results were found for CRC mortality (ARR = 0.22%, 95% CI = 0.21% to 0.24% vs 0.08%, 95% CI = 0.07% to 0.08%, Ptrend < .001). The ARR in mortality of distal colon and rectal cancers was fourfold higher for scores 6-8 than 0-2 (distal colon cancer: ARR = 0.08%, 95% CI = 0.07% to 0.08% vs 0.02%, 95% CI = 0.02% to 0.02%, Ptrend < .001; rectal cancer: ARR = 0.08%, 95% CI = 0.08% to 0.09% vs 0.02%, 95% CI = 0.02% to 0.03%, Ptrend < .001). When using age 45 years as the benchmark to start screening, individuals with risk scores of 0-2, 3, 4, 5, and 6-8 attained the threshold CRC risk level (10-year cumulative risk of 0.47%) at age 51 years, 48 years, 45 years, 42 years, and 38 years, respectively.
CONCLUSIONS
The absolute benefit of colonoscopy screening is more than twice higher for individuals with the highest than lowest CRC risk profile. Individuals with a high- and low-risk profile may start screening up to 6-7 years earlier and later, respectively, than the recommended age of 45 years.
背景
目前尚不清楚针对结直肠癌（CRC）的结肠镜筛查的获益以及开始筛查的最佳年龄是否因 CRC 风险特征而有所不同。
方法
在 75873 名女性和 42875 名男性中，我们基于家族史、阿司匹林使用、身高、体重指数、吸烟、身体活动、饮酒和饮食，定义了 CRC 风险评分（0-8 分）。我们计算了根据风险评分的 CRC 发病率和死亡率的结肠镜筛查相关风险比和绝对风险降低（ARR），以及特定年龄的 CRC 累积发病率。所有统计检验均为双侧检验。
结果
在中位随访 26 年期间，我们记录了 2407 例 CRC 病例和 874 例 CRC 死亡病例。尽管筛查相关风险比不因风险评分而变化，但多变量调整后的 10 年 CRC 发病率的 ARR 在评分 6-8 分的个体中增加了一倍以上（ARR=0.34%，95%置信区间[CI]为 0.26%至 0.42%），而评分 0-2 分的个体（ARR=0.15%，95%CI=0.12%至 0.18%，Ptrend<.001）。CRC 死亡率也有类似的结果（ARR=0.22%，95%CI=0.21%至 0.24%vs 0.08%，95%CI=0.07%至 0.08%，Ptrend<.001）。评分 6-8 分的个体的远端结肠癌和直肠癌的 ARR 比评分 0-2 分的个体高四倍（远端结肠癌：ARR=0.08%，95%CI=0.07%至 0.08%vs 0.02%，95%CI=0.02%至 0.02%，Ptrend<.001；直肠癌：ARR=0.08%，95%CI=0.08%至 0.09%vs 0.02%，95%CI=0.02%至 0.03%，Ptrend<.001）。当以 45 岁作为开始筛查的基准时，评分 0-2、3、4、5 和 6-8 的个体分别在 51 岁、48 岁、45 岁、42 岁和 38 岁达到 CRC 风险水平（10 年累积风险为 0.47%）。
结论
对于 CRC 风险最高和最低的个体，结肠镜筛查的绝对获益分别高出两倍以上。高风险和低风险个体开始筛查的时间可能比建议的 45 岁分别早 6-7 年和晚 6-7 年。
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