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四种筛查策略可降低结直肠癌死亡率
作者:小柯机器人 发布时间:2019/10/3 15:56:47

结直肠癌的免疫化学检测、乙状结肠镜或结肠镜筛查效果的比较,这一成果由荷兰鹿特丹大学医学中心Maaike Buskermolen研究小组取得。2019年10月2日在线发表在《英国医学期刊》上。

研究组进行了一项微模拟建模研究,对挪威50-79岁、15年结直肠癌风险为1-7%的成人进行了研究。采用4种筛查策略:每两年一次或每年一次进行粪便免疫化学试验(FIT)、单次乙状结肠镜检查或单次结肠镜检查,所有参与者的依从性均为100%。

经过15年的随访,50-79岁、结直肠癌风险为3%的人群在进行每年一次FIT或单次结肠镜检查后,结直肠癌的死亡率降低了6/1000,单次乙状结肠镜检查和两年一次FIT可将死亡率降低5/1000。结肠镜检查、乙状结肠镜检查和每年一次FIT分别将结直肠癌的发病率降低了10/1000、8/1000和4/1000,而两年一次FIT降低了1/1000。估计严重危害率为3-5/1000,且随着年龄的增长而增加。筛查的绝对效益随着结直肠癌风险的增加而增大,但受基线风险的影响较小。

总之,在15年中,四种筛查策略都可在相似程度上降低结直肠癌的死亡率。结肠镜和乙状结肠镜可降低结直肠癌的发病率,且优于FIT。严重危害较为少见,各筛查策略间相差不大。

附:英文原文

Title: Colorectal cancer screening with faecal immunochemical testing, sigmoidoscopy or colonoscopy: a microsimulation modelling study

Author: Maaike Buskermolen, Dayna R Cenin, Lise M Helsingen, Gordon Guyatt, Per Olav Vandvik, Ulrike Haug, Michael Bretthauer, Iris Lansdorp-Vogelaar

Issue&Volume: 2019/10/02

Abstract: 

Objective To estimate benefits and harms of different colorectal cancer screening strategies, stratified by (baseline) 15-year colorectal cancer risk.

Design Microsimulation modelling study using MIcrosimulation SCreening ANalysis-Colon (MISCAN-Colon).

Setting A parallel guideline committee (BMJ Rapid Recommendations) defined the time frame and screening interventions, including selection of outcome measures.

Population Norwegian men and women aged 50-79 years with varying 15-year colorectal cancer risk (1-7%).

Comparisons Four screening strategies were compared with no screening: biennial or annual faecal immunochemical test (FIT) or single sigmoidoscopy or colonoscopy at 100% adherence.

Main outcome measures Colorectal cancer mortality and incidence, burdens, and harms over 15 years of follow-up. The certainty of the evidence was assessed using the GRADE approach.

Results Over 15 years of follow-up, screening individuals aged 50-79 at 3% risk of colorectal cancer with annual FIT or single colonoscopy reduced colorectal cancer mortality by 6 per 1000 individuals. Single sigmoidoscopy and biennial FIT reduced it by 5 per 1000 individuals. Colonoscopy, sigmoidoscopy, and annual FIT reduced colorectal cancer incidence by 10, 8, and 4 per 1000 individuals, respectively. The estimated incidence reduction for biennial FIT was 1 per 1000 individuals. Serious harms were estimated to be between 3 per 1000 (biennial FIT) and 5 per 1000 individuals (colonoscopy); harms increased with older age. The absolute benefits of screening increased with increasing colorectal cancer risk, while harms were less affected by baseline risk. Results were sensitive to the setting defined by the guideline panel. Because of uncertainty associated with modelling assumptions, we applied a GRADE rating of low certainty evidence to all estimates.

Conclusions Over a 15 year period, all screening strategies may reduce colorectal cancer mortality to a similar extent. Colonoscopy and sigmoidoscopy may also reduce colorectal cancer incidence, while FIT shows a smaller incidence reduction. Harms are rare and of similar magnitude for all screening strategies.

DOI: 10.1136/bmj.l5383

Source: https://www.bmj.com/content/367/bmj.l5383

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj