肠镜检查对结直肠癌发病风险影响的前瞻性评价研究

目的 评价肠镜检查对人群结直肠癌发病风险的影响。方法 基于浙江省嘉善县结直肠癌早诊早治筛查项目，以2007年1月至2015年12月初筛阳性需要进一步接受肠镜检查的人群为研究对象，分析中剔除基线信息不完整者、参加筛查前已患结直肠癌者和基线时发现的结直肠癌、肠炎或肠道溃疡患者，最终纳入25 894例。使用Cox比例风险回归模型分析肠镜检查与结直肠癌发病风险的关联。结果 研究累计随访160 113人年，中位随访期为5.67年，期间观察到结直肠癌新发病例127例。未接受检查组、未发现病变组和发现病变组的结直肠癌发病密度分别为202.35/10万人年、40.93/10万人年和63.62/10万人年，差异有统计学意义（P<0.05）。调整潜在的混杂因素后，与未接受肠镜检查者相比，接受肠镜检查未发现病变者和发现病变者发生结直肠癌的HR值（95% CI）分别为0.24（0.16~0.36）和0.29（0.17~0.49）。对病理部位开展的亚组分析和以年龄、性别为分层因素的分析结果均显示肠镜检查与结直肠癌发病呈负关联。结论 肠镜检查能有效降低高危人群结直肠癌的发病风险。

Prospective evaluation on the impact of colonoscopy regarding the incidence of colorectal cancer

Objective To evaluate the impact of colonoscopy on the incidence of colorectal cancer (CRC). Methods This study was based on the Screening Project of Early Diagnosis and Treatment of CRC in Jiashan county, Zhejiang province. After excluding participants with incomplete information, these with individual history of CRC, those with CRC, enteritis or ulcer, noticed through colonoscopy exam at baseline, a total of 25 894 participants were finally included. Cox proportional hazards regression model was used to analyze the association between colonoscopy and the incidence of CRC. Results This study was followed up for 160 113 person-years with a median of 5.67 years. During the follow-up period, 127 of them developed the CRC. The incidence rates of CRC in participants, were 202.35 per 100 000 person-years, 40.93 per 100 000 person-years and 63.62 per 100 000 person-years, respectively among the following three groups: who did not take the colonoscopy, without colorectal lesions or with benign colorectal lesions noticed by the colonoscopy and the differences were statistically significant (P<0.05). After adjusting for potential confounding factors, the HRs(95% CI) of CRC were 0.24 (0.16-0.36) and 0.29 (0.17-0.49), among those who did not have or had colorectal lesions in the participants who underwent the colonoscopy. Stratified by anatomic site, age and sex, results showed that the associations among the aforementioned groups were relatively stable. Conclusion Colonoscopy could effectively contribute to the reduction of CRC incidence in the high-risk population.