Dawsey Sonja P, Vacek Pamela M, Ganguly Eric K
Division of Gastroenterology and Hepatology, University of Vermont Medical Center, Burlington, Vermont.
Department of Medical Biostatistics, University of Vermont, Burlington, Vermont.
Gastro Hep Adv. 2022 Mar 30;1(3):277-286. doi: 10.1016/j.gastha.2022.01.001. eCollection 2022.
Colonoscopy is imperfect for colorectal cancer (CRC) prevention. Postcolonoscopy CRC (PCCRC) is defined as CRC detected after a screening or surveillance colonoscopy. PCCRCs can be divided into noninterval CRC and interval CRC. We performed a case-control study to identify risk factors for PCCRCs and to compare risks between noninterval and interval PCCRCs.
We designed a retrospective case-control study. Using a Vermont tumor registry data set, we identified all PCCRCs diagnosed at our medical center from January 2012 to September 2017. Cases were matched 1:3 with controls of the same age, sex, and index colonoscopy date.
Fifty-four PCCRCs were matched with 162 controls and divided into noninterval (N = 27) and interval (N = 27) subsets. Overall PCCRC risk and noninterval PCCRC risk were significantly associated with history of polyps (odds ratio [OR] PCCRC = 2.71, OR noninterval = 4.41), sessile serrated polyps (OR PCCRC = 3.94, OR noninterval = 5.79), and high-risk adenoma (HRA) (OR PCCRC = 6.58, OR noninterval = 16.46) and with the index colonoscopy having a large polyp (OR PCCRC = 4.45, OR noninterval = 10.46) or having an HRA (OR PCCRC = 3.68, OR noninterval = 8.04). PCCRC risk and interval PCCRC risk were significantly associated with follow-up recommendations that did not correlate with American Gastroenterological Association surveillance guidelines (OR PCCRC = 3.30, OR interval = 4.85). Approximately 30% of PCCRCs could be attributed to endoscopic quality.
Overall PCCRC risk and noninterval PCCRC risk were significantly associated with traditional CRC risk factors including precancerous polyps and HRA on the index colonoscopy. Interval PCCRC was not associated with these risk factors. Many PCCRCs can be attributed to endoscopic quality, and nonadherence to CRC surveillance guidelines may be a novel risk factor.
结肠镜检查在预防结直肠癌（CRC）方面并不完美。结肠镜检查后结直肠癌（PCCRC）定义为在筛查或监测结肠镜检查后发现的结直肠癌。PCCRC可分为非间期结直肠癌和间期结直肠癌。我们进行了一项病例对照研究，以确定PCCRC的危险因素，并比较非间期和间期PCCRC的风险。
我们设计了一项回顾性病例对照研究。利用佛蒙特州肿瘤登记数据集，我们确定了2012年1月至2017年9月在我们医疗中心诊断的所有PCCRC。病例与年龄、性别和首次结肠镜检查日期相同的对照按1:3匹配。
54例PCCRC与162例对照匹配，并分为非间期（N = 27）和间期（N = 27）亚组。总体PCCRC风险和非间期PCCRC风险与息肉病史（优势比[OR]PCCRC = 2.71，OR非间期 = 4.41）、无蒂锯齿状息肉（OR PCCRC = 3.94，OR非间期 = 5.79）和高危腺瘤（HRA）（OR PCCRC = 6.58，OR非间期 = 16.46）以及首次结肠镜检查发现大息肉（OR PCCRC = 4.45，OR非间期 = 10.46）或发现HRA（OR PCCRC = 3.68，OR非间期 = 8.04）显著相关。PCCRC风险和间期PCCRC风险与不符合美国胃肠病学会监测指南的随访建议显著相关（OR PCCRC = 3.30，OR间期 = 4.85）。约30%的PCCRC可归因于内镜质量。
总体PCCRC风险和非间期PCCRC风险与传统的CRC危险因素显著相关，包括首次结肠镜检查时的癌前息肉和HRA。间期PCCRC与这些危险因素无关。许多PCCRC可归因于内镜质量，不遵守CRC监测指南可能是一个新的危险因素。
