腺瘤的检测和切除可降低结直肠癌(CRC)风险。腺瘤检出率(adr)对长期结直肠癌发病率和死亡率的影响尚不清楚。我们使用来自英国乙状结肠镜筛查试验的数据进行调查。

在167,882名英国乙状结肠镜筛查试验参与者中，有40085人在干预组，在13个试验中心接受了乙状结肠镜筛查。中位随访时间为17年。每个中心由1名内窥镜医生进行最灵活的乙状结肠镜检查。采用多变量logistic回归将中心根据其主内镜医师的ADR分为高、中、低检出率组。我们计算了远端和全部位结直肠癌的发生率和死亡率，并使用Cox回归估计95% ci的危险比(hr)。

分别有5个、4个和4个中心被分为高探测器组、中探测器组和低探测器组。各组的平均不良反应分别为15%、12%和9%。在所有组中，与对照组相比，筛查组的远端结直肠癌发病率和死亡率均有所降低，筛查的效果因检测器的等级而有显著差异，在高检测器组中，发病率和死亡率的降低幅度更大(发病率:HR，0.34；95% CI，0.27-0.42；死亡率:HR，0.22，95% CI，0.13-0.37)高于低探测器组(发病率:HR，0.55；95% CI，0.44-0.68；死亡率:HR，0.54；95% CI，0.34-0.86)。在所有部位的结直肠癌中观察到类似的结果，在高检测器中观察到更大的影响(发生率:HR，0.58；95% CI，0.50-0.67；死亡率:HR，0.52；95% CI，0.39-0.69)高于低探测器组(发生率:HR，0.72；95% CI，0.61-0.85；死亡率:HR，0.68；95% CI，0.51-0.92)，尽管异质性没有统计学意义。筛查时较高的不良反应为预防结直肠癌发病率和死亡率提供了更大的长期保护。

Abstract

Background & aims: Detection and removal of adenomas reduces colorectal cancer (CRC) risk. The impact of adenoma detection rates (ADRs) on long-term CRC incidence and mortality is unknown. We investigated this using data from the UK Flexible Sigmoidoscopy Screening Trial.

Methods: Of 167,882 UK Flexible Sigmoidoscopy Screening Trial participants, 40,085 were in the intervention arm and underwent flexible sigmoidoscopy screening at 13 trial centers. The median follow-up time was 17 years. At each center, 1 endoscopist performed most flexible sigmoidoscopies. Multivariable logistic regression was used to classify centers into high-, intermediate-, and low-detector groups based on their main endoscopist's ADR. We calculated the incidence and mortality of distal and all-site CRC, and estimated hazard ratios (HRs) with 95% CIs using Cox regression.

Results: Five, 4, and 4 centers, respectively, were classified into the high-detector, intermediate-detector, and low-detector groups. The average ADRs in each respective group were 15%, 12%, and 9%. Distal CRC incidence and mortality were reduced among those screened compared with controls in all groups, and effects of screening varied significantly by detector ranking, with larger reductions in incidence and mortality seen in the high-detector group (incidence: HR, 0.34; 95% CI, 0.27-0.42; mortality: HR, 0.22, 95% CI, 0.13-0.37) than in the low-detector group (incidence: HR, 0.55; 95% CI, 0.44-0.68; mortality: HR, 0.54; 95% CI, 0.34-0.86). Similar results were observed for all-site CRC, with larger effects seen in the high-detector (incidence: HR, 0.58; 95% CI, 0.50-0.67; mortality: HR, 0.52; 95% CI, 0.39-0.69) than in the low-detector group (incidence: HR, 0.72; 95% CI, 0.61-0.85; mortality: HR, 0.68; 95% CI, 0.51-0.92), although the heterogeneity was not statistically significant.

Conclusions: Higher ADRs at screening provide greater long-term protection against CRC incidence and mortality. Isrctn.org, number: ISRCTN28352761.

原文链接

pubmed.ncbi.nlm.nih.gov/32931959/

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