PO.PR01.02 · 预防研究
新筛查指南实施后40至49岁成人中的筛查性结肠镜检出情况
Screening colonoscopy yields among adults aged 40 to 49 years after new screening guidelines
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摘要 Abstract
中文摘要
目的：分析自《中国结直肠癌筛查与早诊早治指南（2020，北京）》将筛查起始年龄扩展至40岁以来，40至49岁成人的筛查性结肠镜检出情况，从而为将筛查起始年龄下调至40岁提供证据支持。
方法：这项基于人群的横断面研究是中国政府发起的癌症筛查项目框架的一部分。我们纳入2020-2024年间首次接受筛查性结肠镜的40-59岁居民。研究结局包括：结直肠癌（结肠或直肠腺癌）；进展期病变（至少一枚腺瘤≥10mm，或至少一枚含绒毛成分或高级别异型增生的腺瘤）；以及其他良性病变。采用稳健Poisson回归估计各年龄组间结局的校正风险比（aRR），以50至59岁人群作为参照组。回归模型对地区、性别、合并症、体重指数（BMI）和吸烟史进行了校正。
结果：2020-2024年间共5040名符合条件的患者接受了筛查性结肠镜，其中40-49岁1529名，50-59岁3511名。女性占总队列的60.5%，53.7%有合并症，23.7%有吸烟史，39.7%的体重指数≥24（以体重公斤数除以身高米数的平方计算）。与年长组相比，年轻组的筛查性结肠镜结局总体上略少见，仅其他良性病变（12.0%对19.4%；aRR 0.67；95%CI 0.54-0.82）和阴性（85.8%对77.3%；aRR 1.06；95%CI 1.04-1.09）具有统计学意义。所有其他结肠镜检查结果在两年龄组间无显著差异，包括进展期病变（1.7%对2.6%；aRR 0.69；95%CI 0.39-1.22）和结直肠癌（0.3%对0.5%；aRR 0.55；95%CI 0.19-1.57）。此外，女性中所有病变类型在各年龄组间均无显著差异。在男性中，除其他良性病变和阴性外，各类病变亦无显著差异。
结论：本研究结果扩展了以下观察：40至49岁与50至59岁人群在进展期病变和结直肠癌的筛查性结肠镜检出率相似，并支持以下观点，即不太可能因年轻患者进入筛查人群而需要下调进展期病变和结直肠癌检出率的基准。两年龄组间进展期病变和结直肠癌检出率相似也为将筛查起始年龄下调至40岁提供了支持。关键词：结直肠癌；筛查性结肠镜；进展期病变
查看英文原文 English abstract
Objective: To analyze screening colonoscopy yields among adults aged 40 to 49 years since China Guideline for the Screening, Early Detection and Early Treatment of colorectal cancer (2020, Beijing) expanded the screening initiation age to 40, thus providing evidence to support lowering the screening initiation age to 40.
Method : This population-based cross-sectional study was part of the framework of the Cancer Screening Program initiated by the Chinese government. We included residents aged 40-59 who underwent their first screening colonoscopy in 2020-2024. The study outcomes included: colorectal cancer (colon or rectal adenocarcinoma); advanced lesions (at least one adenoma ≥10mm or at least one adenoma with villous components or high-grade dysplasia); and other benign lesions. Robust Poisson regression was used to estimate the adjusted risk ratios (aRRs) for outcomes between age groups, with 50- to 59-year-olds serving as the reference group. Regression models were adjusted for region, sex, comorbidities, body mass index (BMI), and tobacco smoking history.
Result : A total of 5040 eligible patients underwent a screening colonoscopy in 2020-2024, including 1529 aged 40-49 and 3511 aged 50-59. Females comprised 60.5% of the overall cohort, 53.7% had comorbidity, 23.7% had a history of tobacco smoking, and 39.7% had body mass index>=24 (calculated as weight in kilograms divided by height in meters squared). Screening colonoscopy outcomes were generally slightly less frequent among the younger group compared with the older group, only the aRR for other benign lesions (12.0% vs. 19.4%; aRR, 0.67; 95% CI, 0.54-0.82) and negative (85.8% vs 77.3%; aRR, 1.06; 95% CI, 1.04-1.09) were statistically significant. All other colonoscopy findings did not differ significantly between the 2 age groups, including for advanced lesions (1.7% vs. 2.6%; aRR, 0.69; 95% CI, 0.39-1.22) and colorectal cancer (0.3% vs. 0.5%; aRR, 0.55; 95% CI, 0.19-1.57). In addition, there were no significant differences between age groups for all lesion types among women. Other than for other benign lesions and negative, there were no significant differences in the types of lesions among men.
Conclusion : The current study findings extend the observation of similar screening colonoscopy detection rates for advanced lesions and colorectal cancer in those aged 40 to 49 years vs 50 to 59 years and support the suggestion that there is likely no need to reduce advanced lesions and colorectal cancer detection rate benchmarks because of the infusion of younger patients into the screening pool. The similar rates of advanced lesions and colorectal cancer detection between age groups also provide support for lowering the start of screening initiation to age 40 years. Keywords: Colorectal cancer; Screening Colonoscopy ; advanced lesions
利益披露 Disclosure
X. Qi, None..
X. Wu, None..
B. Zhu, None.