Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
Am J Gastroenterol. 2021 May 1;116(5):967-975. doi: 10.14309/ajg.0000000000001146.
A claimed advantage of colonoscopy over sigmoidoscopy in colorectal cancer (CRC) screening is prevention of CRC not only in the distal colon and rectum but also in the proximal colon. We aimed to assess the association of screening colonoscopy use with overall and site-specific CRC incidence and associated mortality.
Information on use of screening colonoscopy as well as potential confounding factors was obtained at baseline in 2000-2002, updated at 2-, 5-, 8-, and 17-year follow-up from 9,207 participants aged 50-75 years without history of CRC in a statewide cohort study in Saarland, Germany. Covariate-adjusted associations of screening colonoscopy with CRC incidence and mortality, which were obtained through record linkage with the Saarland Cancer Registry and mortality statistics up to 2018, were assessed by Cox proportional hazards models with time-varying exposure information.
During a median follow-up of 17.2 years, 268 participants were diagnosed with CRC and 98 died from CRC. Screening colonoscopy was associated with strongly reduced CRC incidence (adjusted hazard ratio [aHR] 0.44, 95% confidence interval [CI] 0.33-0.57) and mortality (aHR 0.34, 95% CI 0.21-0.53), with stronger reduction for distal (aHRs 0.36, 95% CI 0.25-0.51, and 0.33, 95% CI 0.19-0.59, respectively) than for proximal cancer (aHRs 0.69, 95% CI 0.42-1.13, and 0.62, 95% CI 0.26-1.45, respectively). Nevertheless, strong reduction of mortality from proximal cancer was also observed within 10 years after screening colonoscopy (aHR 0.31, 95% CI 0.10-0.96).
In this large prospective cohort study from Germany, screening colonoscopy was associated with strong reduction in CRC incidence and mortality.
与结直肠筛查相比，结肠镜检查在结直肠癌（CRC）筛查方面的一个声称的优势在于，它不仅可以预防远端结肠和直肠的 CRC，还可以预防近端结肠的 CRC。我们旨在评估筛查性结肠镜检查的使用与整体和特定部位 CRC 发病率以及相关死亡率之间的关联。
在德国萨尔州一项全州范围的队列研究中，我们于 2000-2002 年在基线时获取了关于筛查性结肠镜检查的使用情况以及潜在混杂因素的信息，并在 2、5、8 和 17 年随访时进行了更新，共纳入 9207 名年龄在 50-75 岁之间、无结直肠癌病史的参与者。通过与萨尔兰癌症登记处和 2018 年之前的死亡率统计数据的记录链接，使用时变暴露信息的 Cox 比例风险模型评估了筛查性结肠镜检查与 CRC 发病率和死亡率的关联。
在中位随访 17.2 年期间，有 268 名参与者被诊断患有 CRC，98 人死于 CRC。筛查性结肠镜检查与 CRC 发病率（调整后的危险比[aHR]0.44，95%置信区间[CI]0.33-0.57）和死亡率（aHR 0.34，95% CI 0.21-0.53）显著降低相关，远端癌症的降低幅度更大（aHRs 0.36，95% CI 0.25-0.51 和 0.33，95% CI 0.19-0.59），近端癌症的降低幅度较小（aHRs 0.69，95% CI 0.42-1.13 和 0.62，95% CI 0.26-1.45）。然而，在筛查性结肠镜检查后 10 年内，近端癌症的死亡率也明显降低（aHR 0.31，95% CI 0.10-0.96）。
在这项来自德国的大型前瞻性队列研究中，筛查性结肠镜检查与 CRC 发病率和死亡率的显著降低相关。
