通过查内镜减少结直肠癌的发生率
Hermann Brenner1,2,3, Thomas Heisser4, Rafael Cardoso4
1Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. h.brenner@dkfz.de.
结肠直肠癌查结肠镜显著降低了老年人癌症的发病率,尽管试验结果表明影响适度. 现实数据表明,比最初报告的效益更大,支持更广泛的查实施.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 公共卫生 公共卫生
背景情况:
- 在美国老年人群中,结肠直肠癌 (CRC) 发病率显著下降,这与广泛采用查结肠镜相吻合.
- 来自NordICC研究等随机试验的新兴数据表明,查结肠镜检查的影响比在现实环境中观察到的要小得多.
- 这种差异突出了解释试验数据与人口水平结果的潜在局限性.
研究的目的:
- 为了协调现实世界的证据和随机试验结果之间的差异,关于对结肠直肠癌查结肠镜检查的有效性.
- 探索可能减弱查内镜试验效果估计的因素.
- 倡导更广泛地实施和采用有效的结直肠癌查计划.
主要方法:
- 对结肠直肠癌发生率趋势的基于人口的分析,与查结肠镜检查的吸收相关.
- 审查和解释对查结肠镜随机对照试验的结果,如NordICC研究.
- 探索影响查试验效果大小估计的方法因素,包括依从性,非协议使用和流行病例包含.
主要成果:
- 现实数据显示,在广泛的查结肠镜检查后,老年人群中CRC发病率降低了50%.
- 随机试验数据,如NordICC,最初报告的益处较为温和.
- 诸如有限的坚持,非协议结肠镜的使用,以及将流行病例纳入试验等因素可以减轻观察到的效应大小.
结论:
- 在查内镜试验中调整患病率偏差使其结果与观察到的人口水平CRC发病率的减少保持一致.
- 查结肠镜在减少结肠直肠癌发病率方面的实际有效性是相当大的.
- 这些发现支持并鼓励更广泛地实施和采用有效的结直肠癌查策略.
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