Pilonis Nastazja D, Spychalski Piotr, Kalager Mette, Løberg Magnus, Wieszczy Paulina, Didkowska Joanna, Wojciechowska Urszula, Kobiela Jaroslaw, Regula Jaroslaw, Rösch Thomas, Bretthauer Michael, Kaminski Michal F
Department of Gastroenterological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.
JAMA. 2025 Feb 4;333(5):400-407. doi: 10.1001/jama.2024.22975.
Patients of physicians with higher adenoma detection rates (ADRs) during colonoscopy have lower colorectal cancer (CRC) risk after screening colonoscopy (ie, postcolonoscopy CRC). Among physicians with an ADR above the recommended threshold, it is unknown whether improving ADR is associated with a lower incidence of CRC in their patients.
To determine the association of improved ADR in physicians with a range of ADR values at baseline with CRC incidence among their patients.
DESIGN, SETTING, AND PARTICIPANTS: A total of 789 physicians in the Polish Colonoscopy Screening Program were studied between 2000 and 2017, with final follow-up on December 31, 2022. Joinpoint regression analyses were used to identify trends between changes in ADR and postcolonoscopy CRC incidence. Rates of CRC after colonoscopy were compared between physicians whose ADR improved and those without improvement. ADR improvement was defined as either an improvement by at least 1 ADR sextile category or remaining in the highest category.
Physician ADR.
Association of improved ADR with postcolonoscopy CRC incidence.
Of 485 615 patients (mean [SD] age, 57 [5.41] years; 60% female), 1873 CRC diagnoses and 474 CRC-related deaths occurred during a median follow-up of 10.2 years. Among individual physicians at baseline, median (IQR) ADR was 21.8% (15.9%-28.2%) and maximum ADR was 63.0%. Joinpoint regression showed a change in CRC incidence trends at an ADR level of 26%, corresponding to a CRC incidence of 27.1 per 100 000 person-years. Patients of physicians whose ADR was less than 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 31.8 (95% CI, 29.5-34.3) per 100 000 person-years, compared with 40.7 (95% CI, 37.8-43.8) per 100 000 person-years for patients of physicians with an ADR of less than 26% at baseline who did not improve during follow-up (difference, 8.9/100 000 person-years [95% CI, 5.06-12.74]; P < .001). Patients of physicians whose ADR was above 26% at baseline and improved during follow-up had a postcolonoscopy CRC incidence of 23.4 (95% CI, 18.4-29.8) per 100 000 person-years, compared with 22.5 (95% CI, 18.3-27.6) for patients of physicians whose ADR was above 26% at baseline and did not improve during follow-up (difference, 0.9/100 000 person-years [95% CI, -6.46 to 8.26]; P = .80).
In this observational study, improved ADR over time was statistically significantly associated with lower CRC risk in patients who underwent colonoscopy compared with absence of ADR improvement, but only among patients whose physician had a baseline ADR of less than 26%.
在结肠镜检查中腺瘤检出率（ADR）较高的医生的患者，在接受筛查结肠镜检查后（即结肠镜检查后结直肠癌）患结直肠癌（CRC）的风险较低。在ADR高于推荐阈值的医生中，ADR的改善是否与他们患者中较低的CRC发病率相关尚不清楚。
确定基线时ADR值范围不同的医生中ADR的改善与他们患者中CRC发病率之间的关联。
设计、设置和参与者：2000年至2017年期间对波兰结肠镜检查筛查项目中的789名医生进行了研究，最终随访时间为2022年12月31日。采用连接点回归分析来确定ADR变化与结肠镜检查后CRC发病率之间的趋势。比较了ADR有所改善的医生和没有改善的医生的结肠镜检查后CRC发病率。ADR改善定义为至少提高1个ADR六分位数类别或保持在最高类别。
医生的ADR。
ADR的改善与结肠镜检查后CRC发病率之间的关联。
在485615名患者（平均[标准差]年龄为57[5.41]岁；60%为女性）中，在中位随访10.2年期间发生了1873例CRC诊断和474例CRC相关死亡。在基线时的个体医生中，中位（四分位间距）ADR为21.8%（15.9%-28.2%），最大ADR为63.0%。连接点回归显示，在ADR水平为26%时CRC发病率趋势发生变化，对应于每10万人年27.1例CRC发病率。基线时ADR低于26%且在随访期间有所改善的医生的患者，结肠镜检查后CRC发病率为每10万人年31.8例（95%置信区间，29.5-34.3），而基线时ADR低于26%且在随访期间未改善的医生的患者为每10万人年40.7例（95%置信区间，37.8-43.8）（差异为8.9/10万人年[95%置信区间，5.06-12.74]；P < 0.001）。基线时ADR高于26%且在随访期间有所改善的医生的患者，结肠镜检查后CRC发病率为每10万人年23.4例（95%置信区间，18.4-29.8），而基线时ADR高于26%且在随访期间未改善的医生的患者为每10万人年22.5例（95%置信区间，18.3-27.6）（差异为0.9/10万人年[95%置信区间，-6.46至8.26]；P = 0.80）。
在这项观察性研究中，与ADR未改善相比，随着时间推移ADR的改善在接受结肠镜检查的患者中与较低的CRC风险在统计学上显著相关，但仅在其医生基线ADR低于26%的患者中如此。
