Gonçalves Margarida Gomes, Silva Joana, Carvalho Tânia, Costa Dalila, Gonçalves Raquel, Rebelo Ana
Gastroenterology Department, Braga Hospital, Braga, Portugal.
School of Medicine, University of Minho, Braga, Portugal.
GE Port J Gastroenterol. 2022 Sep 6;30(5):359-367. doi: 10.1159/000526126. eCollection 2023 Oct.
Colonoscopy is effective to detect and remove colorectal lesions. However, after a negative colonoscopy, cancers could be detected during the interval follow-up. This study was designed to identify characteristics and risk factors for postcolonoscopy colorectal cancer - interval type.
Medical records of individuals who were newly diagnosed with colorectal cancer between January 2018 and December 2019 were reviewed. Clinical, demographic, and endoscopic variables were analyzed. Those with the diagnosis of colorectal cancer between two consecutive colonoscopies performed within the appropriated surveillance range were considered to have postcolonoscopy colorectal cancer - interval type. A comparison between the group of patients with non-postcolonoscopy colorectal cancer - interval type and the group of patients with postcolonoscopy colorectal cancer - interval type was then performed.
During the study period, 491 patients were newly diagnosed with colorectal cancer. Among them, 61 (12.4%) had postcolonoscopy colorectal cancer - interval subtype. Postcolonoscopy colorectal cancer - interval type was three times more prevalent on the proximal colon ( = 0.014) and was associated with the presence of two or more cardiovascular risk factors (aOR = 4.25; = 0.016), cholecystectomy in the past (aOR = 10.09; = 0.019), and family history of colorectal cancer on a first-degree relative (aOR = 4.25; = 0.006). Moreover, isolated cardiovascular risk factors revealed a protective effect for the absence of all cardiovascular risk factors (aOR = 20; = 0.034). The ROC curve associated with the multivariate model revealed a predictive power of 77.8% ( < 0.001).
Postcolonoscopy colorectal cancer - interval type is more common in the proximal colon and in patients with a family history (first-degree relative) of colorectal cancer, two or more cardiovascular risk factors, and a history of cholecystectomy. All of these are easily detectable in clinical practice and may be of extreme importance in the control of postcolonoscopy colorectal cancer in the near future.
结肠镜检查对于检测和切除结直肠病变有效。然而，在结肠镜检查结果为阴性后，仍可能在随访期间发现癌症。本研究旨在确定结肠镜检查后结直肠癌（间隔型）的特征和危险因素。
回顾了2018年1月至2019年12月期间新诊断为结直肠癌的患者的病历。分析了临床、人口统计学和内镜变量。在适当监测范围内连续两次结肠镜检查之间被诊断为结直肠癌的患者被视为患有结肠镜检查后结直肠癌（间隔型）。然后对非结肠镜检查后结直肠癌（间隔型）患者组和结肠镜检查后结直肠癌（间隔型）患者组进行比较。
在研究期间，491例患者新诊断为结直肠癌。其中，61例（12.4%）患有结肠镜检查后结直肠癌（间隔亚型）。结肠镜检查后结直肠癌（间隔型）在近端结肠的发生率高3倍（P = 0.014），并且与存在两种或更多种心血管危险因素相关（调整后比值比[aOR]=4.25；P = 0.016）、既往胆囊切除术（aOR = 10.09；P = 0.019）以及一级亲属的结直肠癌家族史（aOR = 4.25；P = 0.006）。此外，单独的心血管危险因素显示出对不存在所有心血管危险因素具有保护作用（aOR = 20；P = 0.034）。与多变量模型相关的ROC曲线显示预测能力为77.8%（P < 0.001）。
结肠镜检查后结直肠癌（间隔型）在近端结肠以及有结直肠癌家族史（一级亲属）、两种或更多种心血管危险因素和胆囊切除史的患者中更为常见。所有这些在临床实践中都易于检测，并且在不久的将来对控制结肠镜检查后结直肠癌可能极为重要。
