提示: 手机请竖屏浏览!

腺瘤切除对于结直肠癌长期死亡率的影响
Long-Term Colorectal-Cancer Mortality after Adenoma Removal


Magnus Løberg ... 肿瘤 • 2014.08.28
相关阅读
• 结直肠病变切除术指南 • 根据基线腺瘤检查结果判断远期结直肠癌风险

摘要


背景

尽管腺瘤切除后采用结直肠镜监测的方法被广泛推荐,但是对于腺瘤患者的结直肠癌死亡率我们却知之甚少。

 

方法

本研究通过对挪威癌症发病和死亡登记信息(Cancer Registry and the Cause of Death Registry of Norway)的分析,对1993—2007年接受结直肠腺瘤切除患者的结直肠癌死亡率进行了评估。患者随访至2011年。我们以挪威总体人群作为参照,计算出标准化死亡比(SMR)。根据挪威的相关指南,对于高危腺瘤患者(如高级别上皮内瘤变、绒毛状生长方式、直径≥10 mm),建议腺瘤摘除10年后进行结直肠镜监测;对于具有3个或更多个腺瘤的患者建议5年后进行结肠镜监测;对于低危险腺瘤的患者不建议监测。该登记信息并未明确腺瘤的大小和具体数量。我们将多发性的、呈绒毛状生长的,以及高级别上皮内瘤变的腺瘤定义为高危险腺瘤。

 

结果

本研究纳入了40,826例接受过结直肠腺瘤切除的患者。平均随访时间7.7年(最长19.0年)后,1,273例患者被诊断罹患结直肠癌。预计共有398例结肠癌患者死亡,实际观察到383例患者死亡,在切除腺瘤的患者中SMR是0.96(95%可信区间[CI],0.87~1.06)。结直肠癌相关性死亡率在高危险腺瘤的患者中有所增加(预计死亡数,209;观察到的死亡数,242;SMR,1.16;95% CI,1.02~1.31),但是在低危险腺瘤的患者中有所降低(预计死亡数,189;观察到的死亡数,141;SMR,0.75;95% CI,0.63~0.88)。

 

结论

通过中位数为7.7年的随访,本研究发现与总体人群相比,结直肠癌死亡率在低危险腺瘤切除的患者中降低,而在高危险腺瘤切除的患者中有一定程度升高(该研究由挪威肿瘤学会[Norwegian Cancer Society]等提供资助)。





作者信息

Magnus Løberg, M.D., Mette Kalager, M.D., Ph.D., Øyvind Holme, M.D., Geir Hoff, M.D., Ph.D., Hans-Olov Adami, M.D., Ph.D., and Michael Bretthauer, M.D., Ph.D.
From the Department of Health Management and Health Economics, University of Oslo, Oslo (M.L., M.K., G.H., H.-O.A., M.B.), Department of Transplantation Medicine, Oslo University Hospital, Oslo (M.L., M.B.), Cancer Registry of Norway, Oslo (G.H.), Department of Research and Development, Telemark Hospital, Skien (M.K., G.H.), and Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand (Ø.H., M.B.) — all in Norway; the Department of Epidemiology, Harvard School of Public Health, Boston (M.L., M.K., Ø.H., H.-O.A., M.B.); and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm (H.-O.A.). Address reprint requests to Dr. Løberg at the Department of Health Management and Health Economics, University of Oslo, 0317 Oslo, Norway, or at magnus.loberg@medisin.uio.no.

 

参考文献

1. Bretthauer M, Kalager M. Colonoscopy as a triage screening test. N Engl J Med 2012;366:759-760

2. Garborg K, Holme Ø, Løberg M, Kalager M, Adami HO, Bretthauer M. Current status of screening for colorectal cancer. Ann Oncol 2013;24:1963-1972

3. Shaukat A, Mongin SJ, Geisser MS, et al. Long-term mortality after screening for colorectal cancer. N Engl J Med 2013;369:1106-1114

4. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993;329:1977-1981

5. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012;366:687-696

6. Nishihara R, Wu K, Lochhead P, et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. N Engl J Med 2013;369:1095-1105

7. Atkin WS, Morson BC, Cuzick J. Long-term risk of colorectal cancer after excision of rectosigmoid adenomas. N Engl J Med 1992;326:658-662

8. Cottet V, Jooste V, Fournel I, Bouvier AM, Faivre J, Bonithon-Kopp C. Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut 2012;61:1180-1186

9. Loeve F, van Ballegooijen M, Boer R, Kuipers EJ, Habbema JDF. Colorectal cancer risk in adenoma patients: a nation-wide study. Int J Cancer 2004;111:147-151

10. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2012;143:844-857

11. Atkin WS, Valori R, Kuipers EJ, et al European guidelines for quality assurance in colorectal cancer screening and diagnosis: first edition — colonoscopic surveillance following adenoma removal. Endoscopy 2012;44:Suppl 3:SE151-SE163.

12. Hassan C, Quintero E, Dumonceau JM, et al. Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2013;45:842-851

13. Lieberman DA, Holub J, Eisen G, Kraemer D, Morris CD. Utilization of colonoscopy in the United States: results from a national consortium. Gastrointest Endosc 2005;62:875-883

14. Larsen IK, Småstuen M, Johannesen TB, et al. Data quality at the Cancer Registry of Norway: an overview of comparability, completeness, validity and timeliness. Eur J Cancer 2009;45:1218-1231

15. Tingulstad S, Halvorsen T, Norstein J, Hagen B, Skjeldestad FE. Completeness and accuracy of registration of ovarian cancer in the cancer registry of Norway. Int J Cancer 2002;98:907-911

16. International classification of diseases for oncology, 3rd edition (ICD-O-3). Geneva: World Health Organization, 2000 (http://www.who.int/classifications/icd/adaptations/oncology/en).

17. Hoff G, Sauar J, Hofstad B, Vatn MH. The Norwegian guidelines for surveillance after polypectomy: 10-year intervals. Scand J Gastroenterol 1996;31:834-836

18. Søreide K, Træland JH, Stokkeland PJ, Glomsaker T, Søreide JA, Kørner H. Adherence to national guidelines for surveillance after curative resection of nonmetastatic colon and rectum cancer: a survey among Norwegian gastrointestinal surgeons. Colorectal Dis 2012;14:320-324

19. Gastronet — quality program. Oslo: Cancer Registry of Norway (http://www.kreftregisteret.no/no/Forskning/Prosjekter/Gastronet).

20. Population, by sex and age. Oslo: Statistics Norway (http://www.ssb.no/statistikkbanken/selecttable/hovedtabellHjem.asp?KortNavnWeb=folkemengde&CMSSubjectArea=befolkning&PLanguage=1&checked=true).

21. Kalager M, Zelen M, Langmark F, Adami H-O. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med 2010;363:1203-1210

22. Gooley TA, Leisenring W, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999;18:695-706

23. Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 1988;16:1141-1154

24. Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon: stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med 1985;312:1604-1608

服务条款 | 隐私政策 | 联系我们