大肠癌粪便筛查发现异常后,应尽早做肠镜!
创作:szx 审核:szx 02月22日
  • 纳入204,733名接受粪便隐血检测(FOBT)或粪便免疫化学检测(FIT)后发现异常的患者;
  • 平均随访9.2年期间,确诊6906名结直肠癌患者,1709名因结直肠癌死亡;
  • 相比于在粪便筛查异常1-3个月后进行结肠镜检查的患者,在13-15个月、16-18个月、19-21个月及22-24个月后进行结肠镜检查的患者,结直肠癌发病风险分别显著升高13%、25%、28%及26%;
  • 而在19-21个月及22-24个月后进行结肠镜检查的患者,结直肠癌死亡风险分别显著升高52%及39%。
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szx
来自Gastroenterology上发表的一项回顾性队列研究结果,分析了超过20万名接受结直肠癌粪便筛查后发现异常的患者,发现相比于尽早进行结肠镜检查(粪便筛查异常后1-3个月内)的患者,在粪便筛查异常1年之后才进行结肠镜检查的患者,结直肠癌发病及死亡风险均显著升高。
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Gastroenterology [IF:17.373]

Time to Colonoscopy After Abnormal Stool-Based Screening and Risk for Colorectal Cancer Incidence and Mortality

发现粪便筛查异常后进行结肠镜检查的时间与结直肠癌的发病及死亡风险

10.1053/j.gastro.2021.01.219

02-02, Article

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Background and aims: The optimal time interval for diagnostic colonoscopy completion after an abnormal stool-based colorectal cancer (CRC) screening test is uncertain. We examined the association between time to colonoscopy and CRC outcomes among individuals who underwent diagnostic colonoscopy after abnormal stool-based screening.
Methods: We performed a retrospective cohort study of Veterans age 50-75 years with an abnormal fecal occult blood test (FOBT) or fecal immunochemical test (FIT) between 1999 and 2010. We used multivariable Cox proportional hazards to generate CRC-specific incidence and mortality hazard ratios (HRs) and 95% confidence intervals (CI) for 3-month colonoscopy intervals, with 1-3 months as the reference group. Association of time to colonoscopy with late-stage CRC diagnosis was also examined.
Results: Our cohort included 204,733 patients. Mean age was 61 years (SD: 6.9). Compared to patients who received a colonoscopy at 1-3 months, there was an increased CRC risk for patients who received a colonoscopy at: 13-15 months (HR=1.13, 95%CI:1.00-1.27), 16-18 months (HR=1.25, 95%CI:1.10-1.43), 19-21 months (HR=1.28, 95%CI:1.11-1.48), and 22-24 months (HR=1.26, 95%CI:1.07-1.47). Compared to patients who received a colonoscopy at 1-3 months, mortality risk was higher in groups who received a colonoscopy at: 19-21 months (HR=1.52, 95%CI:1.51-1.99) and 22-44 (HR=1.39, 95%CI:1.03-1.88). Odds for late stage CRC increased at 16 months.
Conclusions: Increased time to colonoscopy is associated with higher risk of CRC incidence, death, and late stage CRC after abnormal FIT/FOBT. Interventions to improve CRC outcomes should emphasize diagnostic follow-up within 1 year of an abnormal FIT/FOBT result.

First Authors:
Yazmin San Miguel,Joshua Demb

Correspondence Authors:
Samir Gupta,Folasade P May

All Authors:
Yazmin San Miguel,Joshua Demb,Maria Elena Martinez,Samir Gupta,Folasade P May

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