Zhang Xinrong, Wong Vincent Wai-Sun, Yip Terry Cheuk-Fung, Tse Yee-Kit, Liang Lilian Yan, Hui Vicki Wing-Ki, Li Guan-Lin, Chan Henry Lik-Yuen, Wong Grace Lai-Hung
Department of Medicine and TherapeuticsThe Chinese University of Hong KongHong KongChina.
Medical Data Analytic CenterThe Chinese University of Hong KongHong KongChina.
Hepatol Commun. 2021 Mar 21;5(7):1212-1223. doi: 10.1002/hep4.1705. eCollection 2021 Jul.
The benefit of colonoscopy and/or polypectomy for colorectal cancer (CRC) prevention in patients with nonalcoholic fatty liver disease (NAFLD) remains unclear. We aimed to estimate the incidence rate of CRC in patients with NAFLD who had and had not undergone colonoscopy. We conducted a retrospective territory-wide cohort study for patients aged over 40 years with NAFLD identified with the International Classification of Diseases, Ninth Revision, Clinical Modification codes between January 1, 2000, and December 31, 2014. Patients were followed until CRC diagnosis, death, or December 31, 2017. We estimated CRC incidence and standardized incidence ratio (SIR) using the general population of Hong Kong as reference. We included 8,351 patients with NAFLD in the final analysis (median age, 56.2 years; interquartile ratio [IQR], 49.2-65.3 years; 45.4% male; median follow-up, 7.4 years; IQR, 5.4-9.6 years). Compared with the general population, patients with NAFLD who had not undergone colonoscopy had a higher incidence of CRC (SIR, 2.20; 95% confidence interval [CI], 1.64-2.88; < 0.001). Patients with NAFLD who had undergone colonoscopy had a lower incidence of CRC (SIR, 0.54; 95% CI, 0.37-0.75; < 0.001), especially among those aged above 50 years or with diabetes mellitus (DM). Patients with NAFLD with a high fibrosis-4 (FIB-4) score (>2.67) had a significantly higher risk of CRC after adjusting for demographic and metabolic factors. Patients with NAFLD who had undergone colonoscopy had a lower incidence of CRC than the general population, especially among those aged ≥50 years or with DM. A high FIB-4 index was associated with a higher risk of CRC.
结肠镜检查和/或息肉切除术对非酒精性脂肪性肝病（NAFLD）患者预防结直肠癌（CRC）的益处仍不明确。我们旨在评估接受和未接受结肠镜检查的NAFLD患者的结直肠癌发病率。我们对2000年1月1日至2014年12月31日期间，使用国际疾病分类第九版临床修订本编码识别出的40岁以上NAFLD患者进行了一项全地区范围的回顾性队列研究。对患者进行随访直至结直肠癌诊断、死亡或2017年12月31日。我们以香港普通人群为参照，估算结直肠癌发病率和标准化发病率（SIR）。最终分析纳入了8351例NAFLD患者（中位年龄56.2岁；四分位数间距[IQR]，49.2 - 65.3岁；45.4%为男性；中位随访时间7.4年；IQR，5.4 - 9.6年）。与普通人群相比，未接受结肠镜检查的NAFLD患者结直肠癌发病率更高（SIR，2.20；95%置信区间[CI]，1.64 - 2.88；P < 0.001）。接受结肠镜检查的NAFLD患者结直肠癌发病率较低（SIR，0.54；95% CI，0.37 - 0.75；P < 0.001），尤其是在50岁以上或患有糖尿病（DM）的患者中。在校正人口统计学和代谢因素后，纤维化-4（FIB-4）评分高（>2.67）的NAFLD患者患结直肠癌的风险显著更高。接受结肠镜检查的NAFLD患者结直肠癌发病率低于普通人群，尤其是在年龄≥50岁或患有DM的患者中。高FIB-4指数与结直肠癌风险较高相关。
