Agaciak Madelyn, Wassie Molla M, Simpson Kalindra, Cock Charles, Bampton Peter, Fraser Robert, Symonds Erin L
Department of Medicine, College of Medicine and Public Health Flinders University Bedford Park South Australia Australia.
Flinders University, College of Medicine and Public Health Flinders Health and Medical Research Institute, Adelaide Bedford Park South Australia Australia.
JGH Open. 2024 May 1;8(5):e13071. doi: 10.1002/jgh3.13071. eCollection 2024 May.
Surveillance colonoscopy for colorectal cancer (CRC) is generally not recommended beyond 75 years of age. The study determined incidence and predictors of advanced adenoma and CRC in older individuals undergoing surveillance colonoscopy.
This was a retrospective cohort study of asymptomatic older participants (≥75 years), enrolled in a South Australian CRC surveillance program who underwent colonoscopy (2015-2020). Clinical records were extracted for demographics, personal or family history of CRC, comorbidities, polypharmacy, and colonoscopy findings. The associations between clinical variables and advanced adenoma or CRC at surveillance were assessed with multivariable Poisson regression analysis.
Totally 698 surveillance colonoscopies were analyzed from 574 participants aged 75-91 years (55.6% male). The incidence of CRC was 1.6% (11/698), while 37.9% (260/698) of procedures had advanced adenoma detected. Previous CRC (incidence rate ratio [IRR] 5.9, 95% CI 1.5-22.5), age ≥85 years (IRR 5.8, 95% CI 1.6-20.1) and active smoking (IRR 4.9, 95% CI 1.0-24.4) were independently associated with CRC diagnosis, while advanced adenoma at immediately preceding colonoscopy (IRR 1.6, 95% CI 1.3-2.0) and polypharmacy (IRR 1.2, 95% CI 1.0-1.5) were associated with advanced adenoma at surveillance colonoscopy in asymptomatic older participants (≥75 years).
Advanced neoplasia was found in more than one third of the surveillance procedures completed in this cohort. Continuation of surveillance beyond age 75 yeasrs may be considered in participants who have previous CRC or are active smokers (provided they are fit to undergo colonoscopy). In other cases, such as past advanced adenoma only, the need for ongoing surveillance should be considered alongside participant preference and health status.
一般不建议75岁以上人群进行结直肠癌（CRC）监测性结肠镜检查。本研究确定了接受监测性结肠镜检查的老年个体中进展性腺瘤和CRC的发生率及预测因素。
这是一项对南澳大利亚CRC监测项目中无症状老年参与者（≥75岁）进行的回顾性队列研究，这些参与者在2015年至2020年期间接受了结肠镜检查。提取临床记录中的人口统计学信息、CRC个人或家族史、合并症、多种药物治疗情况以及结肠镜检查结果。采用多变量泊松回归分析评估临床变量与监测时进展性腺瘤或CRC之间的关联。
共分析了574名年龄在75至91岁（男性占55.6%）参与者的698次监测性结肠镜检查。CRC的发生率为1.6%（11/698），而37.9%（260/698）的检查发现了进展性腺瘤。既往CRC（发病率比[IRR] 5.9，95%可信区间[CI] 1.5 - 22.5）、年龄≥85岁（IRR 5.8，95% CI 1.6 - 20.1）和当前吸烟（IRR 4.9，95% CI 1.0 - 24.4）与CRC诊断独立相关，而前次结肠镜检查时的进展性腺瘤（IRR 1.6，95% CI 1.3 - 2.0）和多种药物治疗（IRR 1.2，95% CI 1.0 - 1.5）与无症状老年参与者（≥75岁）监测性结肠镜检查时的进展性腺瘤相关。
在该队列完成的超过三分之一的监测检查中发现了高级别肿瘤。对于既往有CRC或当前吸烟的参与者（前提是他们适合接受结肠镜检查），可考虑在75岁以后继续进行监测。在其他情况下，如仅既往有进展性腺瘤，应结合参与者的意愿和健康状况考虑是否需要持续监测。
