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JAMA：软式乙状结肠镜筛检降低结肠直肠癌发病率及死亡率

2014-08-14 伊文 医学论坛网

软式乙状结肠镜筛检结直肠癌
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据8月13日发表在《美国医学会杂志》上的一则研究披露，在约10万名研究参与者中，与不进行筛检相比，用软式乙状结肠镜筛检导致了结肠直肠癌发生率和死亡率的降低。 结肠直肠癌是全世界第三最常发生的癌症。大多数的结肠直肠癌病例是从腺瘤(良性肿瘤)发展而来的。根据文章的背景资料，通过结肠境或软式乙状结肠镜(用于检查直肠及下部结肠内部的一种细的可屈曲带灯光的管子)来移除腺瘤已被批准作为结肠直肠癌的主

据8月13日发表在《美国医学会杂志》上的一则研究披露，在约10万名研究参与者中，与不进行筛检相比，用软式乙状结肠镜筛检导致了结肠直肠癌发生率和死亡率的降低。

结肠直肠癌是全世界第三最常发生的癌症。大多数的结肠直肠癌病例是从腺瘤(良性肿瘤)发展而来的。根据文章的背景资料，通过结肠境或软式乙状结肠镜(用于检查直肠及下部结肠内部的一种细的可屈曲带灯光的管子)来移除腺瘤已被批准作为结肠直肠癌的主要预防工具。

挪威克里斯蒂安桑市克里斯蒂安桑Sorlandet医院的ØyvindHolme,M.D.及其同事在挪威将研究参与者随机分配接受仅做一次的软式乙状结肠镜组(n=10,283);仅做一次软式乙状结肠镜结合粪隐血试验(FOBT;N=10,289)组，或不进行干预(对照组;N=78,220)组。进行筛检的时间为1999-2000年(55-64岁年龄组)及2001年(50-54岁年龄组)，对他们的随访于2011年12月结束。有阳性筛检测试结果的参与者则向其提供结肠镜检查。

在中位数为11年之后，筛检组中有71位参与者死于结肠直肠癌vs对照组有330人死于结肠直肠癌。筛检组中有253名参与者被诊断患有结肠直肠癌vs在对照组中有1086人患有结肠直肠癌。数据分析表明，与没有筛检相比，软式乙状结肠镜筛检使得结肠癌发病率降低了20%(绝对差异，28.4例/100,000人年)而结肠直肠癌死亡率降低了27%(绝对差异，11.7例死亡/100,000人年)。在仅用软式乙状结肠镜vs软式乙状结肠镜加FOBT筛检组之间这些转归没有显著差异。

50-54岁的较年轻参与者从这些筛检干预中看来得到的益处至少与那些年龄55-64岁的较年长参与者一样多。

社论：用软式乙状结肠镜做结肠直肠癌筛检

更多的证据，持续的讽刺

在一则伴随的社论中，南卡罗来纳州哥伦比亚市南卡罗来纳大学医学院的AllanS.Brett,M.D.写道，尽管可能会有用软式乙状结肠镜或结肠镜来筛检结肠直肠癌的争论，但另外一种筛检方法——即粪便DNA检查——可能会使这一争论在不太远的将来变得无实际意义。

“一项大规模的、最近发表的研究对一个多目标的粪便化验进行了检查，该化验发现了数种与结肠直肠癌或癌前期腺瘤有关的DNA异常。以结肠镜检查作为参考标准，用粪便DNA化验来检测癌症的敏感性为92%，发现晚期癌前性病变的敏感性为42%;特异性为90%。值得注意的是，该粪便DNA化验比另外一种给每个参与者所做的粪便免疫化学血红蛋白检测要敏感得多。在某些限定的间隔进行重复化验时，粪便DNA检测有可能会大大降低结肠直肠癌死亡率，并同时让常规的结肠镜检查数锐减。但是，就目前而言，美国的结肠直肠癌筛检的混沌景观仍在继续，而软式乙状结肠镜检查在筛检工具中的地位仍然悬而未决。”

原始出处：

Øyvind Holme,Magnus Løberg,Mette Kalager,Michael Bretthauer,Miguel A. Hernán, Eline Aas,Tor J. Eide,Eva Skovlund,Jørn Schneede,Kjell Magne Tveit,Geir Hoff, MD.Effect of Flexible Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality A Randomized Clinical Trial.JAMA. 2014;312(6):606-615. doi:10.1001/jama.2014.8266.

Allan S. Brett.Flexible Sigmoidoscopy for Colorectal Cancer ScreeningMore Evidence, Persistent Ironies.JAMA. 2014;312(6):601-602. doi:10.1001/jama.2014.8613


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    2015-04-22 chenhongpeng

    #癌发病率#

    0

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    2015-01-13 12498636m49(暂无昵称)

    #癌发病#

    0

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    2015-03-31 lifestar

    #发病率#

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    2014-08-16 zhouqu_8

    #肠镜#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2079231, encodeId=425a20e923155, content=<a href='/topic/show?id=659ce1280ee' target=_blank style='color:#2F92EE;'>#癌发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71280, encryptionId=659ce1280ee, topicName=癌发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Wed Apr 22 11:17:00 CST 2015, time=2015-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799795, encodeId=25951e997955a, content=<a href='/topic/show?id=9e3fe127909' target=_blank style='color:#2F92EE;'>#癌发病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71279, encryptionId=9e3fe127909, topicName=癌发病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Tue Jan 13 11:17:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823219, encodeId=34ed1823219b1, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Tue Mar 31 19:17:00 CST 2015, time=2015-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1434411, encodeId=00681434411b9, content=<a href='/topic/show?id=95de81e4889' target=_blank style='color:#2F92EE;'>#肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81748, encryptionId=95de81e4889, topicName=肠镜)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586927, encodeId=335f158692ee5, content=<a href='/topic/show?id=a8fae87846b' target=_blank style='color:#2F92EE;'>#结肠直肠癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78784, encryptionId=a8fae87846b, topicName=结肠直肠癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=87c517396713, createdName=lmm403, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1625763, encodeId=94c21625e6347, content=<a href='/topic/show?id=3d7423411e7' target=_blank style='color:#2F92EE;'>#乙状结肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23411, encryptionId=3d7423411e7, topicName=乙状结肠镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=018620859641, createdName=waiwai3037, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=)]
    2014-08-16 lmm403

    #结肠直肠癌#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=2079231, encodeId=425a20e923155, content=<a href='/topic/show?id=659ce1280ee' target=_blank style='color:#2F92EE;'>#癌发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71280, encryptionId=659ce1280ee, topicName=癌发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1777154, createdName=chenhongpeng, createdTime=Wed Apr 22 11:17:00 CST 2015, time=2015-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799795, encodeId=25951e997955a, content=<a href='/topic/show?id=9e3fe127909' target=_blank style='color:#2F92EE;'>#癌发病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71279, encryptionId=9e3fe127909, topicName=癌发病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Tue Jan 13 11:17:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823219, encodeId=34ed1823219b1, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Tue Mar 31 19:17:00 CST 2015, time=2015-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1434411, encodeId=00681434411b9, content=<a href='/topic/show?id=95de81e4889' target=_blank style='color:#2F92EE;'>#肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81748, encryptionId=95de81e4889, topicName=肠镜)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1586927, encodeId=335f158692ee5, content=<a href='/topic/show?id=a8fae87846b' target=_blank style='color:#2F92EE;'>#结肠直肠癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78784, encryptionId=a8fae87846b, topicName=结肠直肠癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=87c517396713, createdName=lmm403, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1625763, encodeId=94c21625e6347, content=<a href='/topic/show?id=3d7423411e7' target=_blank style='color:#2F92EE;'>#乙状结肠镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23411, encryptionId=3d7423411e7, topicName=乙状结肠镜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=018620859641, createdName=waiwai3037, createdTime=Sat Aug 16 00:17:00 CST 2014, time=2014-08-16, status=1, ipAttribution=)]
    2014-08-16 waiwai3037

    #乙状结肠镜#

    0

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