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Gastroenterology :45岁后要定期做肠镜

2021-03-23 MedSci原创 MedSci原创

45-49岁时接受结肠镜检查与随后的大肠癌发病率显著降低有很强的相关性。

由于50岁以下人群中结直肠癌(CRC)发病率在不断上升,建议将结直肠癌筛查年龄降至45岁,但缺乏45-49岁筛查的证据。这项研究提供了令人信服的证据,表明45-49岁的结肠镜检查可以降低结直肠癌的风险。结直肠癌(CRC)是全球第三大癌症死亡原因。CRC的发病率和死亡率与人类发展指数相关,在美国,CRC是癌症死亡的第二大原因。美国老年人CRC发生率的大幅下降在很大程度上归因于广泛的筛查。相比之下,在美国和许多其他国家50岁以下人群中,CRC发病率正在上升,这可能是由于早期肠镜检查。大多数CRC发生于腺瘤或无蒂的锯齿状息肉,结肠镜加息肉切除术可以防止发展为CRC。乙状结肠镜和愈创木脂粪便潜血试验(gFOBT)的随机对照试验表明筛查可以降低CRC的发生率和死亡率。在美国,结肠镜检查是最常见的结直肠癌筛查试验。根据观察数据,结肠镜可以作为筛查的依据,并可从乙状结肠镜和gFOBT的随机试验结果延伸而来。2018年,美国癌症协会(ACS)建议将CRC筛查的平均风险年龄从50岁降至45岁。美国预防服务工作组(USPSTF)目前正在审查其指南,可能会批准45岁时进行筛查。美国多社会特别工作组(MSTF)和国家综合癌症网络(NCCN)仍然建议50岁开始治疗。ACS承认缺乏45-49岁年龄段的CRC筛查数据,并基于50岁前后筛查效果相似的预期提出建议。加利福尼亚大学Maanek Sehga对此展开研究,成果发表在Gastroenterology杂志。

该研究目的是研究结肠镜检查与45-49岁患者继发结直肠癌之间的关系,并将结果与50-54岁患者的结果进行比较。

在一项基于人群的回顾性队列研究中,作者研究了在45-49岁或50-54岁接受结肠镜检查与大肠癌发病率之间的关系,该研究使用了佛罗里达州2005年至2017年强制报告的关联医疗成本和利用项目数据库,以及针对时变暴露扩展的Cox模型。

在45~49岁接受结肠镜检查的19.56万人和未接受结肠镜检查的260万人中,276人和4844人患大肠癌,其发病率分别为20.8(95%CI,18.5~23.4)和30.6(95%CI,29.8~31.5)/10万人年。在660248名50-54岁接受结肠镜检查和240万名未接受结肠镜检查的人群中,798名和6757名患大肠癌,结直肠癌发病率分别为19.0(95%可信区间,17.7-20.4)和51.9(95%可信区间,50.7-53.1)/10万人年。与未接受结肠镜检查相比,接受结肠镜检查后发生大肠癌的调整风险比在45-49岁时为0.50(95%CI,0.44-0.56),在50-54岁时为0.32(95%CI,0.29-0.34)。女性和男性的结果相似(45~49岁0.48, 95%CI,0.40~0.57 vs 0.52, 95%CI,0.43~0.62; 50~54岁0.35, 95%CI,0.31~0.39 vs 0.29, 95%CI,0.26~0.32)。

45-49岁或50-54岁的结肠镜检查与随后的大肠癌发病率显著降低有关。这些发现可以为筛查指南提供依据。

综上所述,该研究发现45-49岁时接受结肠镜检查与随后的大肠癌发病率显著降低有很强的相关性。鉴于45-49岁结直肠癌筛查的随机对照试验可能永远不会进行,该研究的数据可能为评估45岁开始结直肠癌筛查的潜在益处提供最好的可用基础,并为未来的指南和临床实践提供参考。

原文出处:

Sehgal M ,  Ladabaum M U ,  Mithal A , et al. Colorectal Cancer Incidence after Colonoscopy at Ages 45-49 or 50-54 Years[J]. Gastroenterology:S0016-5085(21)00402-9.

 

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    2021-11-05 许安
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    2021-06-17 zhmscau
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encodeId=e028950410c5, content=50岁以上最好也还是两年查一次肠镜, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/iaqwic5175nrtKvMqt0IWiblUI1zbqYutrQNa7TcwSo20h2vGiaWldS0t9eIRibSzLia12KtHeczN8vyxNQq5mAMwvIHtUXdoEfOal/0, createdBy=81fe1999477, createdName=xiao2126223, createdTime=Tue Mar 23 17:07:31 CST 2021, time=2021-03-23, status=1, ipAttribution=)]
    2021-04-04 ms3000001705278282

    签到得积分

    0

  6. 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encodeId=e028950410c5, content=50岁以上最好也还是两年查一次肠镜, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/iaqwic5175nrtKvMqt0IWiblUI1zbqYutrQNa7TcwSo20h2vGiaWldS0t9eIRibSzLia12KtHeczN8vyxNQq5mAMwvIHtUXdoEfOal/0, createdBy=81fe1999477, createdName=xiao2126223, createdTime=Tue Mar 23 17:07:31 CST 2021, time=2021-03-23, status=1, ipAttribution=)]
    2021-03-25 zhouqu_8
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    2021-03-24 海盗船长

    学习了,建议在高危地区展开研究

    0

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    2021-03-24 ms3000000110189438

    学习打卡

    0

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encodeId=e05495068394, content=学习了,建议在高危地区展开研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqgjrd5sqia9SxoRDrrHyGx1rdtniayrW3OZxZq1ZFwnic0zYSSLeowYhMR0cNFfhHbRZuPcJQfMd9WQ/132, createdBy=22452183242, createdName=海盗船长, createdTime=Wed Mar 24 11:13:01 CST 2021, time=2021-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=950608, encodeId=a0a69506085f, content=学习打卡, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=da245469042, createdName=ms3000000110189438, createdTime=Wed Mar 24 07:44:33 CST 2021, time=2021-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=950410, encodeId=e028950410c5, content=50岁以上最好也还是两年查一次肠镜, beContent=null, objectType=article, channel=null, level=null, likeNumber=135, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/iaqwic5175nrtKvMqt0IWiblUI1zbqYutrQNa7TcwSo20h2vGiaWldS0t9eIRibSzLia12KtHeczN8vyxNQq5mAMwvIHtUXdoEfOal/0, createdBy=81fe1999477, createdName=xiao2126223, createdTime=Tue Mar 23 17:07:31 CST 2021, time=2021-03-23, status=1, ipAttribution=)]
    2021-03-23 xiao2126223

    50岁以上最好也还是两年查一次肠镜

    0

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