Imperiale Thomas F, Myers Laura J, Barker Barry C, Larson Jason, Stump Timothy E, Daggy Joanne K
Center of Innovation, Health Services Research and Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Cancer Prev Res (Phila). 2023 Sep 1;16(9):513-522. doi: 10.1158/1940-6207.CAPR-22-0506.
Identifying risk factors for early-onset colorectal cancer (EOCRC) could help reverse its rising incidence through risk factor reduction and/or early screening. We sought to identify EOCRC risk factors that could be used for decisions about early screening. Using electronic databases and medical record review, we compared male veterans ages 35 to 49 years diagnosed with sporadic EOCRC (2008-2015) matched 1:4 to clinic and colonoscopy controls without colorectal cancer, excluding those with established inflammatory bowel disease, high-risk polyposis, and nonpolyposis syndromes, prior bowel resection, and high-risk family history. We ascertained sociodemographic and lifestyle factors, family and personal medical history, physical measures, vital signs, medications, and laboratory values 6 to 18 months prior to case diagnosis. In the derivation cohort (75% of the total sample), univariate and multivariate logistic regression models were used to derive a full model and a more parsimonious model. Both models were tested using a validation cohort. Among 600 cases of sporadic EOCRC [mean (SD) age 45.2 (3.5) years; 66% White], 1,200 primary care clinic controls [43.4 (4.2) years; 68% White], and 1,200 colonoscopy controls [44.7 (3.8) years; 63% White], independent risk factors included age, cohabitation and employment status, body mass index (BMI), comorbidity, colorectal cancer, or other visceral cancer in a first- or second-degree relative (FDR or SDR), alcohol use, exercise, hyperlipidemia, use of statins, NSAIDs, and multivitamins. Validation c-statistics were 0.75-0.76 for the full model and 0.74-0.75 for the parsimonious model, respectively. These independent risk factors for EOCRC may identify veterans for whom colorectal cancer screening prior to age 45 or 50 years should be considered.
Screening 45- to 49-year-olds for colorectal cancer is relatively new with uncertain uptake thus far. Furthermore, half of EOCRC occurs in persons < 45 years old. Using risk factors may help 45- to 49-year-olds accept screening and may identify younger persons for whom earlier screening should be considered. See related Spotlight, p. 479.
识别早发性结直肠癌（EOCRC）的风险因素有助于通过降低风险因素和/或早期筛查来扭转其发病率上升的趋势。我们试图确定可用于早期筛查决策的EOCRC风险因素。通过电子数据库和病历回顾，我们对2008年至2015年诊断为散发性EOCRC的35至49岁男性退伍军人与无结直肠癌的诊所和结肠镜检查对照进行了1:4匹配，排除了患有确诊的炎症性肠病、高危息肉病和非息肉病综合征、既往肠道切除术以及高危家族史的患者。我们确定了病例诊断前6至18个月的社会人口统计学和生活方式因素、家族和个人病史、体格测量、生命体征、药物使用情况以及实验室检查值。在推导队列（占总样本的75%）中，使用单变量和多变量逻辑回归模型推导出一个完整模型和一个更简约的模型。两个模型均在验证队列中进行了检验。在600例散发性EOCRC病例中[平均（标准差）年龄45.2（3.5）岁；66%为白人]，1200例初级保健诊所对照[43.4（4.2）岁；68%为白人]，以及1200例结肠镜检查对照[44.7（3.8）岁；63%为白人]中，独立风险因素包括年龄、同居和就业状况、体重指数（BMI）、合并症、一级或二级亲属（FDR或SDR）中患有结直肠癌或其他内脏癌、饮酒、运动、高脂血症、使用他汀类药物、非甾体抗炎药（NSAIDs）以及多种维生素。完整模型的验证c统计量分别为0.75 - 0.76，简约模型为0.74 - 0.75。这些EOCRC的独立风险因素可能有助于确定应考虑在45岁或50岁之前进行结直肠癌筛查的退伍军人。
对45至49岁人群进行结直肠癌筛查相对较新，目前其接受程度尚不确定。此外，一半的EOCRC发生在45岁以下的人群中。使用风险因素可能有助于45至49岁人群接受筛查，并可能识别出应考虑更早进行筛查的更年轻人群。见相关聚焦内容，第479页。
