结肠镜检查前粪便检测呈阳性和阴性的患者吸烟状况与晚期结局患病率之间的关联：来自新罕布什尔州结肠镜检查登记处的数据
Association Between Smoking Status and Prevalence of Advanced Outcomes in Patients With and Without Positive Stool Test Prior to Colonoscopy: Data from the New Hampshire Colonoscopy Registry.
作者信息
Anderson Joseph C, Hisey William M, Robinson Christina M, Limburg Paul J, Kneedler Bonny L, Butterly Lynn F
机构信息
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
White River Junction VAMC, 163 Veterans Dr, White River Junction, VT, 05009, USA.
出版信息
Dig Dis Sci. 2025 Apr;70(4):1495-1502. doi: 10.1007/s10620-025-08918-y. Epub 2025 Feb 20.
BACKGROUND AND AIMS
Our goal was to examine the association between smoking status (current, former, and never) and prevalence of advanced findings in patients with colonoscopy after a positive multi-target stool DNA test (mt-sDNA), patients with colonoscopy after a positive Fecal Immunochemical Test (FIT), and patients with colonoscopy only (no prior stool test).
METHODS
Our main outcome was prevalence of advanced lesions (any colorectal cancer (CRC), advanced adenoma, or advanced serrated polyp). We also looked at advanced adenomas and advanced serrated polyps separately. We performed logistic regressions comparing findings by smoking status within mt-sDNA + , FIT + , and colonoscopy-only patients, adjusting for age, sex, and CRC risk. We also performed logistic regressions within all current smokers comparing outcome odds between each screening method cohort.
RESULTS
Our sample included 967 mt-sDNA + , 498 FIT + , and 58,682 colonoscopy-only patients. Within the FIT + (OR = 2.46; 95%CI 1.16-5.26) and mt-sDNA + (OR = 1.65; 95%CI 1.05-2.59) groups, current smokers had higher odds of advanced serrated polyps than never-smokers (reference). In addition, FIT + current smokers (OR = 1.97; 95%CI 1.11-3.50) or mt-sDNA (OR = 3.27; 95%CI 2.25-4.74) current smokers had higher odds of advanced lesions than colonoscopy-only smokers (reference).
CONCLUSIONS
Within stool-test-positive patients, current smokers have higher odds of advanced serrated polyps than never-smokers, reinforcing the heightened importance of a follow-up colonoscopy in smokers with positive stool tests. We also found higher yields of advanced outcomes in FIT + and mt-sDNA + smokers vs. smokers who underwent colonoscopy without a prior stool test. Endoscopists need to be particularly vigilant in detecting advanced serrated polyps in patients who smoke and have a positive stool test.
背景与目的
我们的目标是研究吸烟状态（当前吸烟者、既往吸烟者和从不吸烟者）与多靶点粪便DNA检测（mt-sDNA）阳性后接受结肠镜检查的患者、粪便免疫化学检测（FIT）阳性后接受结肠镜检查的患者以及仅接受结肠镜检查的患者（无先前粪便检测）中高级别检查结果的患病率之间的关联。
方法
我们的主要结局是高级别病变（任何结直肠癌（CRC）、高级别腺瘤或高级别锯齿状息肉）的患病率。我们还分别研究了高级别腺瘤和高级别锯齿状息肉。我们进行了逻辑回归分析，比较了mt-sDNA阳性、FIT阳性和仅接受结肠镜检查的患者中按吸烟状态划分的检查结果，并对年龄、性别和CRC风险进行了调整。我们还在所有当前吸烟者中进行了逻辑回归分析，比较了每个筛查方法队列之间的结局几率。
结果
我们的样本包括967例mt-sDNA阳性患者、498例FIT阳性患者和58,682例仅接受结肠镜检查的患者。在FIT阳性组（OR = 2.46；95%CI 1.16 - 5.26）和mt-sDNA阳性组（OR = 1.65；95%CI 1.05 - 2.59）中，当前吸烟者患高级别锯齿状息肉的几率高于从不吸烟者（参照组）。此外，FIT阳性的当前吸烟者（OR = 1.97；95%CI 1.11 - 3.50）或mt-sDNA阳性的当前吸烟者（OR = 3.27；95%CI 2.25 - 4.74）患高级别病变的几率高于仅接受结肠镜检查的吸烟者（参照组）。
结论
在粪便检测呈阳性的患者中，当前吸烟者患高级别锯齿状息肉的几率高于从不吸烟者，这强化了对粪便检测呈阳性的吸烟者进行后续结肠镜检查的重要性。我们还发现，与未进行先前粪便检测而接受结肠镜检查的吸烟者相比，FIT阳性和mt-sDNA阳性的吸烟者中高级别结局的检出率更高。内镜医师在检测吸烟且粪便检测呈阳性的患者中的高级别锯齿状息肉时需要格外警惕。
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