先前的研究支持使用结肠镜检查或粪便免疫化学测试(FIT)预防结直肠癌(CRC)。然而,关于结肠镜检查或FIT降低CRC风险的相对有效性的具体证据很少.在这项研究中,我们使用全国性数据库比较了CRC风险与结肠镜检查和FIT的相关性.
这项基于人群的病例对照研究使用了2002年至2013年韩国国民健康保险系统的结肠镜检查和FIT索赔数据。分析了61,221例新诊断的CRC患者(病例组)和306,099例非CRC患者(对照组)的数据。使用多变量逻辑回归模型来评估CRC与结肠镜检查或FIT之间的关联。
结肠镜检查与后续CRC风险降低相关(校正比值比[OR]0.29)。结肠镜检查和远端CRC之间发现了更强的关联,与近端CRC相比(0.24vs0.47)。在按性别分层的分析中,与男性受试者相比,女性受试者的相关性较弱(0.33vs0.27).任何FIT暴露与CRC风险相关,OR为0.74;远端癌症的这种关联更强。随着累积FIT评估的频率增加(从1增加到≥5),FIT暴露对CRC的OR从0.81逐渐降低至0.45。
远端CRC的结肠镜检查或FIT与降低CRC风险的相关性强于近端CRC。FIT显示与结肠镜检查相比,CRC风险降低较少。然而,随着累积FIT评估频率的增加,与CRC预防的关联变得更强.
Use of colonoscopy or the fecal immunochemical test (FIT) for colorectal cancer (CRC) prevention is supported by previous studies. However, there is little specific evidence regarding comparative effectiveness of colonoscopy or FIT for reducing CRC risk. In this study, we compared the association of CRC risk with colonoscopy and FIT using a nationwide database.
This population-based
case-control study used colonoscopy and FIT claims data from the Korean National Health Insurance System from 2002 to 2013. Data were analyzed from 61,221 patients with newly diagnosed CRC (
case group) and 306,099 individuals without CRC (control group). Multivariable logistic regression models were used to evaluate the association between CRC and colonoscopy or FIT.
Colonoscopy was associated with a reduced subsequent CRC risk (adjusted odds ratio [OR] 0.29). Stronger associations were found between colonoscopy and distal CRC, compared with proximal CRC (0.24 vs 0.47). In an analysis stratified by sex, the association was weaker in female subjects compared with male subjects (0.33 vs 0.27). Any FIT exposure was associated with CRC risk with an OR of 0.74; this association was stronger for distal cancer. As the frequency of cumulative FIT assessments increased (from 1 to ≥5), the OR of FIT exposure for CRC gradually decreased from 0.81 to 0.45.
The association of colonoscopy or FIT with reduced CRC risk was stronger for distal CRC than for proximal CRC. FIT showed less CRC risk reduction than colonoscopy. However, as the frequency of cumulative FIT assessments increased, the association with CRC prevention became stronger.