Kader Rawen, Hadjinicolaou Andreas V, Burr Nicholas E, Bassett Paul, Ahmad Omer F, Pedersen Lasse, Chand Manish, Valori Roland, Stoyanov Danail, Lovat Laurence B
Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), London, United Kingdom.
Department of Gastroenterology, Cambridge University Hospitals, Cambridge, United Kingdom; Early Cancer Institute, University of Cambridge, Cambridge, United Kingdom.
Clin Gastroenterol Hepatol. 2025 Mar;23(4):519-530. doi: 10.1016/j.cgh.2024.07.039. Epub 2024 Aug 27.
BACKGROUND & AIMS: In 2018, the World Endoscopy Organization (WEO) introduced standardized methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences.
We searched 5 databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratios (ORs) of subgroups were compared.
Several studies failed to adhere to the WEO methodology. Eight studies from 4 Western European and 2 Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRCs) and 18,148 PCCRCs between 2002 and 2017. The pooled Western World PCCRC-3yr was 7.5% (95% confidence interval [CI], 6.4%-8.7%). The PCCRC-3yr significantly (P < .05) decreased from 7.9% (95% CI, 6.6%-9.4%) in 2006 to 6.7% (95% CI, 6.1%-7.3%) in 2012 (OR, 0.79; 95% CI, 0.72-0.87). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr, 29.3%; OR, 6.17; 95% CI, 4.73-8.06), prior CRC (PCCRC-3yr, 29.8%; OR, 3.03; 95% CI, 1.34-4.72), proximal CRC (PCCRC-3yr, 8.6%; OR, 1.51; 95% CI, 1.41-1.61), diverticular disease (PCCRC 3-yr, 11.6%; OR, 1.74; 95% CI, 1.37-2.10), and female sex (PCCRC-3yr, 7.9%; OR, 1.15; 95% CI, 1.11-1.20).
According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorization of patients in future PCCRC-3yr studies.
2018年，世界内镜组织（WEO）推出了计算结肠镜检查后结直肠癌3年发生率（PCCRC - 3yr）的标准化方法。本系统评价旨在根据WEO方法计算全球PCCRC - 3yr，分析其随时间的变化，并衡量风险因素与PCCRC发生之间的关联。
我们检索了5个数据库，从数据库建立至2024年1月，查找严格遵循WEO方法的PCCRC - 3yr研究。计算总体合并的PCCRC - 3yr。对于风险因素和时间趋势分析，比较亚组的合并PCCRC - 3yr和比值比（OR）。
多项研究未遵循WEO方法。纳入了来自4个西欧国家和2个北美国家的8项研究，2002年至2017年间共有220,106例检测到的结直肠癌（CRC）和18,148例PCCRC。西方世界合并的PCCRC - 3yr为7.5%（95%置信区间[CI]，6.4% - 8.7%）。PCCRC - 3yr从2006年的7.9%（95% CI，6.6% - 9.4%）显著（P <.05）降至2012年的6.7%（95% CI，6.1% - 7.3%）（OR，0.79；95% CI，0.72 - 0.87）。炎症性肠病患者的发生率显著更高（PCCRC - 3yr，29.3%；OR，6.17；95% CI，4.73 - 8.06），既往有CRC者（PCCRC - 3yr，29.8%；OR，3.03；95% CI，1.34 - 4.72），近端CRC患者（PCCRC - 3yr，8.6%；OR，1.51；95% CI，1.41 - 1.61），憩室病患者（PCCRC 3年发生率，11.6%；OR，1.74；95% CI，1.37 - 2.10），以及女性（PCCRC - 3yr，7.9%；OR，1.15；95% CI，1.11 - 1.20）。
根据WEO方法，西方世界的PCCRC - 3yr为7.5%。令人欣慰的是，这一发生率随时间有所下降，但仍需要进一步研究以确定PCCRC发生的原因，尤其是在高危人群中。我们设计了一份WEO方法检查表，以提高其采用率，并在未来的PCCRC - 3yr研究中规范患者分类。
