Department of Medicine, Richard L. Roudebush Veterans Affairs (VA) Medical Center, Indianapolis, Indiana.
Department of Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
JAMA Netw Open. 2023 Apr 3;6(4):e236693. doi: 10.1001/jamanetworkopen.2023.6693.
Postcolonoscopy colorectal cancer (PCCRC) refers to colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer was found and is reflective of colonoscopy quality at the individual and system levels. Colonoscopy is widely performed in the Veterans Affairs (VA) health care system, but the prevalence of PCCRC and its associated mortality are unknown.
To examine PCCRC prevalence and its all-cause mortality (ACM) and CRC-specific mortality (CSM) within the VA health care system.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used VA-Medicare administrative data to identify 29 877 veterans aged 50 to 85 years with newly diagnosed CRC between January 1, 2003, and December 31, 2013. Patients whose colonoscopy occurred less than 6 months before CRC diagnosis with no other colonoscopy within the previous 36 months were categorized as having detected CRC (DCRC). Those who had a colonoscopy that did not detect CRC between 6 and 36 months before CRC diagnosis were categorized as having postcolonoscopy CRC (PCCRC-3y). A third group included patients with CRC and no colonoscopy within the prior 36 months. The final analysis of the data was performed in September 2022.
Prior receipt of colonoscopy.
Cox proportional hazards regression (with censoring, last follow-up December 31, 2018) analyses were conducted to compare PCCRC-3y and DCRC for 5-year ACM and CSM after CRC diagnosis.
Of 29 877 patients with CRC (median [IQR] age, 67 [60-75] years; 29 353 [98%] male; 5284 [18%] Black, 23 971 [80%] White, and 622 [2%] other), 1785 (6%) were classified as having PCCRC-3y and 21 811 (73%) as having DCRC. The 5-year ACM rates were 46% vs 42% for patients with PCCRC-3y vs patients with DCRC. The 5-year CSM rates were 26% vs 25% for patients with PCCRC-3y vs patients with DCRC. In multivariable Cox proportional hazards regression analysis, there was no significant difference in ACM and CSM between patients with PCCRC-3y (adjusted hazard ratio [aHR], 1.04; 95% CI, 0.98-1.11; P = .18) and patients with DCRC (aHR, 1.04; 95% CI, 0.95-1.13; P = .42). However, compared with patients with DCRC, patients with no prior colonoscopy had significantly higher ACM (aHR, 1.76; 95% CI, 1.70-1.82; P < .001) and CSM (aHR, 2.22; 95% CI, 2.12-2.32; P < .001). Compared with patients with DCRC, patients with PCCRC-3y had significantly lower odds of having undergone colonoscopy performed by a gastroenterologist (odds ratio, 0.48; 95% CI, 0.43-0.53; P < .001).
This study found that PCCRC-3y constituted 6% of CRCs in the VA system, which is similar to other settings. Compared with patients with CRC detected by colonoscopy, those with PCCRC-3y have comparable ACM and CSM.
结肠镜检查后结直肠癌（PCCRC）是指在结肠镜检查中未发现癌症但反映个体和系统水平结肠镜检查质量的结直肠癌。结肠镜检查在退伍军人事务部（VA）医疗保健系统中广泛开展，但 PCCRC 的流行情况及其相关死亡率尚不清楚。
检查退伍军人事务部医疗保健系统中 PCCRC 的患病率及其全因死亡率（ACM）和结直肠癌特异性死亡率（CSM）。
设计、设置和参与者：这项回顾性队列研究使用 VA-医疗保险行政数据来确定 2003 年 1 月 1 日至 2013 年 12 月 31 日期间年龄在 50 岁至 85 岁之间的 29877 名新诊断为 CRC 的退伍军人。结肠镜检查发生在 CRC 诊断前不到 6 个月且在之前的 36 个月内没有进行其他结肠镜检查的患者被归类为发现 CRC（DCRC）。那些在 CRC 诊断前 6 至 36 个月进行的结肠镜检查未发现 CRC 的患者被归类为 PCCRC-3y。第三组包括在之前的 36 个月内没有进行 CRC 且没有进行结肠镜检查的患者。最终数据分析于 2022 年 9 月进行。
先前接受过结肠镜检查。
使用 Cox 比例风险回归（带有删失，最后一次随访至 2018 年 12 月 31 日）分析比较了 PCCRC-3y 和 DCRC 在 CRC 诊断后 5 年的 ACM 和 CSM。
在 29877 名 CRC 患者（中位数[IQR]年龄，67[60-75]岁；29353 名[98%]男性；5284 名[18%]黑人，23971 名[80%]白人，622 名[2%]其他）中，1785 名（6%）被归类为 PCCRC-3y，21811 名（73%）被归类为 DCRC。PCCRC-3y 患者的 5 年 ACM 率为 46%，DCRC 患者为 42%。PCCRC-3y 患者的 5 年 CSM 率为 26%，DCRC 患者为 25%。在多变量 Cox 比例风险回归分析中，PCCRC-3y 患者（调整后危险比 [aHR]，1.04；95%CI，0.98-1.11；P=0.18）和 DCRC 患者（aHR，1.04；95%CI，0.95-1.13；P=0.42）之间的 ACM 和 CSM 无显著差异。然而，与 DCRC 患者相比，没有接受过结肠镜检查的患者 ACM（aHR，1.76；95%CI，1.70-1.82；P<0.001）和 CSM（aHR，2.22；95%CI，2.12-2.32；P<0.001）显著更高。与 DCRC 患者相比，PCCRC-3y 患者接受胃肠病学家进行的结肠镜检查的可能性显著降低（比值比，0.48；95%CI，0.43-0.53；P<0.001）。
这项研究发现，VA 系统中 PCCRC-3y 占 CRC 的 6%，与其他环境相似。与通过结肠镜检查发现的 CRC 患者相比，PCCRC-3y 患者的 ACM 和 CSM 相似。
