结直肠镜初筛阴性人群再次行结直肠镜筛查的时间间隔研究

Investigation of the screening interval for population with negative colonoscopy examinations

目的探讨结直肠镜初筛阴性人群再次进行结直肠镜筛查的时间间隔。方法选择美国前列腺、肺、结直肠及卵巢筛查数据库中基线期结肠镜检查结果正常(初筛阴性)、完成两次结肠镜筛查的14606名研究对象,收集社会人口学特征(性别、年龄、婚姻状态、种族、吸烟)、生活习惯、癌症家族史及结直肠筛查结果等信息。采用Cochran-Armitage趋势检验分析随着筛查间隔的延长阳性病例(结直肠癌、进展期腺瘤、腺瘤、息肉)检出率的变化趋势,采用内部标准人口计算各筛查间隔组阳性病例的标化例数、阳性率和构成比。结果研究对象基线期的年龄为(61.9±5.2)岁,男性占54.4%(7948名);有癌症家族史占46.2%(6745名);筛查间隔为(1639.1±320.9)d,筛查阳性者共1716例。随着筛查间隔的延长,结直肠癌、进展期腺瘤、腺瘤和息肉的阳性检出率均呈上升趋势(P趋势<0.001)。经内部标准化人口(14606名)标化后,采用3、5年筛查间隔方案分别检出17.99、11.57例结直肠癌和177.37、240.35例进展期腺瘤。结论基于美国结肠镜检查初筛阴性人群,3年筛查间隔方案能筛出相对较多的结直肠癌病例,但其卫生经济学评价尚待进一步研究。

Objective To investigate the colonscopy screening interval among patients with negative colonscopy.Methods We selected 14606 participants who completed the baseline and 3-year or 5-year colonoscopy examinations in the American Prostate,Lung,Colorectal,and Ovarian(PLCO)dataset as the target population.Sociodemographic characteristics(i.e.,sex,age,marital status,race,and smoking),lifestyle,family history of cancer,and family history of colorectal cancer were collected.Cochran-Armitage trend analysis was used to examine whether the rate of positive cases(colorectal cancer,advanced adenoma,adenoma,and hyperplastic polyp)was increased with the length of screening interval.We compared the differences in number of detected cases,positive rates,and proportions of 3-year and 5-year screening interval strategies using internal standardization method.Results The age of the population was(61.9±5.2)years and over half of them were males(54.4%)and 46.2%had family cancer history.The mean screening interval between the first and second endoscopies was(1639.1±320.9)days.A total of 1716 cases had positive endoscopic findings.With the screening interval extended,rate of the screened positive cases was also increased(P for trend<0.001).After standardized by the internal standardized population(14606),17.99 and 11.57 colorectal cancer cases and 177.37 and 240.35 advanced adenoma cases were detected by 3-year and 5-year screening interval strategies,respectively.Conclusion Based on the initial screening negative population of colonoscopy in the United States,the 3-year screening interval strategy could detect a relatively large number of colorectal cancer cases,but its health and economic evaluation needs to be further explored.