Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
JAMA Intern Med. 2023 Jun 1;183(6):513-519. doi: 10.1001/jamainternmed.2023.0435.
The benefits from colorectal cancer (CRC) screening may take 10 to 15 years to accrue. Therefore, screening is recommended for older adults who are in good health.
To determine the number of screening colonoscopies done in patients older than 75 years with a life expectancy of fewer than 10 years, diagnostic yield, and associated adverse events within 10 days and 30 days of the procedure.
This cross-sectional study with a nested cohort between January 2009 and January 2022 in an integrated health system assessed asymptomatic patients older than 75 years who underwent screening colonoscopy in the outpatient setting. Reports with incomplete data, any indication other than screening, patients who had a colonoscopy within the previous 5 years, and patients with a personal history of inflammatory bowel disease or CRC were excluded.
Life expectancy based on a prediction model from previous literature.
The primary outcome was the percentage of screened patients who had limited (<10 years) life expectancy. Other outcomes included colonoscopy findings and adverse events that developed within 10 days and 30 days of the procedure.
A total of 7067 patients older than 75 years were included. The median (IQR) age was 78 (77-79) years, 3967 (56%) were women, and 5431 (77%) were White with an average of 2 comorbidities (taken from a select group of comorbidities). The proportion of colonoscopies performed on patients with a life expectancy of fewer than 10 years aged 76 to 80 years was 30% in both sexes and increased with age-82% of men and 61% of women aged 81 to 85 years (71% total), and 100% of patients beyond the age of 85 years. Adverse events requiring hospitalizations were common at 10 days (13.58 per 1000) and increased with age, particularly among patients older than 85 years. The detection of advanced neoplasia varied from 5.4% among patients aged 76 to 80 years to 6.2% in those aged 81 to 85 years and 9.5% among patients older than 85 years (P = .02). Of the total population, 15 patients (0.2%) had invasive adenocarcinoma; among patients with a life expectancy of fewer than 10 years, 1 of 9 was treated, whereas 4 of 6 patients with a life expectancy of greater than or equal to 10 years were treated.
In this cross-sectional study with a nested cohort, most screening colonoscopies performed in patients older than 75 years were in patients with limited life expectancy and associated with increased risk of complications. Colorectal cancer was exceedingly rare.
结直肠癌（CRC）筛查的益处可能需要 10 到 15 年才能累积。因此，建议身体健康的老年患者进行筛查。
确定在预期寿命不足 10 年的 75 岁以上患者中进行的筛查结肠镜检查数量、诊断收益以及与该程序后 10 天和 30 天内相关不良事件。
这项横截面研究在一个综合医疗系统中，于 2009 年 1 月至 2022 年 1 月期间进行了嵌套队列研究，评估了在门诊环境中接受筛查结肠镜检查的无症状 75 岁以上的老年患者。排除了数据不完整的报告、除筛查外的任何其他指征、在过去 5 年内进行过结肠镜检查以及有炎症性肠病或 CRC 个人病史的患者。
基于既往文献预测模型的预期寿命。
主要结局是预计寿命有限（<10 年）的筛查患者的百分比。其他结局包括结肠镜检查结果以及该程序后 10 天和 30 天内发生的不良事件。
共纳入 7067 名 75 岁以上的患者。中位（IQR）年龄为 78（77-79）岁，3967 名（56%）为女性，5431 名（77%）为白人，平均有 2 种合并症（选自一组特定的合并症）。预期寿命不足 10 年的 76 至 80 岁患者的结肠镜检查比例在男女两性中均为 30%，且随着年龄的增长而增加-82%的男性和 61%的女性 81 至 85 岁（总共 71%），超过 85 岁的所有患者均为 100%。在 10 天内需要住院治疗的不良事件很常见（每 1000 例中有 13.58 例），且随着年龄的增长而增加，尤其是在 85 岁以上的患者中。高级别瘤变的检出率从 76 至 80 岁患者的 5.4%变化至 81 至 85 岁患者的 6.2%和 85 岁以上患者的 9.5%（P=0.02）。在总人群中，有 15 名患者（0.2%）患有侵袭性腺癌；在预计寿命不足 10 年的患者中，1 例得到治疗，而预计寿命大于或等于 10 年的 6 例患者中有 4 例得到治疗。
在这项具有嵌套队列的横截面研究中，大多数在 75 岁以上患者中进行的筛查结肠镜检查是针对预期寿命有限的患者进行的，并且与并发症风险增加相关。结直肠癌极为罕见。
