■随机临床筛选试验表明乙状结肠镜检查可降低结直肠癌(CRC)的发病率和死亡率。结肠镜检查已在很大程度上取代了乙状结肠镜检查用于CRC筛查,但有关结肠镜筛查的随机试验的长期结果仍缺乏.
■评估结肠镜检查与乙状结肠镜检查相比的额外筛查益处。
■这项比较有效性模拟研究汇集了在挪威进行的4项随机乙状结肠镜筛查试验中随机分配到乙状结肠镜筛查或常规护理的358名204名男性和女性的数据,意大利,美国,和英国,纳入期为1993年至2001年。这项研究的主要分析是在2021年1月19日至12月30日进行的。
■内窥镜检查邀请。
■主要结局是CRC发病率和死亡率。使用汇总的15年随访数据,在乙状结肠镜检查筛查试验中,在近端结肠的结肠镜检查效果与远端结肠的结肠镜检查效果相似的情况下,评估结肠镜检查筛查效果.在结肠镜筛查试验中,使用挪威参与者的数据验证了模拟模型。
这项分析包括358204名(181971名女性[51%]),年龄在55至64岁之间,中位随访时间为15至17年。与平时护理相比,结肠镜检查估计每10万人年可预防50例(95%CI,42-58)CRC病例,对应于30%的发病率降低(比率,0.70[95%CI,0.66-0.75]),并防止每10万人年估计有15例(95%CI,11-19)CRC死亡,对应于32%的死亡率降低(比率,0.68[95%CI,0.61-0.76])。与乙状结肠镜检查相比,结肠镜检查的额外益处是每10万人年减少12例(95%CI,10-14)CRC病例和4例(95%CI,3-5)CRC死亡人数。对应CRC发病率降低6.9个百分点(95%CI,6.0-7.9),CRC死亡率降低7.6个百分点(95%CI,5.7-9.6).从乙状结肠镜检查到结肠镜检查所需的人数为560(95%CI,486-661)以防止1例CRC病例和1611(95%CI,1275-2188)以防止1例CRC死亡。
这项评估CRC筛查后长期随访效果的比较研究结果表明,与乙状结肠镜筛查相比,结肠镜筛查对CRC发病率和死亡率有额外的预防作用。但额外的预防效果低于在没有筛查的情况下引入乙状结肠镜筛查所取得的效果.与乙状结肠镜筛查相比,结果可能代表了结肠镜筛查可能达到的上限。
UNASSIGNED: Randomized clinical screening trials have shown that
sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced
sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking.
UNASSIGNED: To estimate the additional screening benefit of colonoscopy compared with
sigmoidoscopy.
UNASSIGNED: This comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized
sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021.
UNASSIGNED: Invitation to endoscopic screening.
UNASSIGNED: Primary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimated assuming that the efficacy of colonoscopy in the proximal colon was similar to that observed in the distal colon in the sigmoidoscopy screening trials. The simulation model was validated using data from Norwegian participants in a colonoscopy screening trial.
UNASSIGNED: This analysis included 358 204 individuals (181 971 women [51%]) aged 55 to 64 years at inclusion with a median follow-up time ranging from 15 to 17 years. Compared with usual care, colonoscopy prevented an estimated 50 (95% CI, 42-58) CRC cases per 100 000 person-years, corresponding to 30% incidence reduction (rate ratio, 0.70 [95% CI, 0.66-0.75]), and prevented an estimated 15 (95% CI, 11-19) CRC deaths per 100 000 person-years, corresponding to 32% mortality reduction (rate ratio, 0.68 [95% CI, 0.61-0.76]). The additional benefit of colonoscopy screening compared with sigmoidoscopy was 12 (95% CI, 10-14) fewer CRC cases and 4 (95% CI, 3-5) fewer CRC deaths per 100 000 person-years, corresponding to percentage point reductions of 6.9 (95% CI, 6.0-7.9) for CRC incidence and 7.6 (95% CI, 5.7-9.6) for CRC mortality. The number needed to switch from
sigmoidoscopy to colonoscopy screening was 560 (95% CI, 486-661) to prevent 1 CRC case and 1611 (95% CI, 1275-2188) to prevent 1 CRC death.
UNASSIGNED: The findings of this comparative effectiveness study assessing long-term follow-up after CRC screening suggest that there was an additional preventive effect on CRC incidence and mortality associated with colonoscopy screening compared with sigmoidoscopy screening, but the additional preventive effect was less than what was achieved by introducing sigmoidoscopy screening where no screening existed. The results probably represent the upper limit of what may be achieved with colonoscopy screening compared with sigmoidoscopy screening.