重新思考结肠镜后结肠直肠癌风险:内镜师的表现与高风险息肉的存在
Nanette S van Roermund1, Veerle M H Coupé2, Manon C W Spaander3
1Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location VU Medical Center, University of Amsterdam, the Netherlands; Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands.
内镜师的性能,特别是腺瘤检测率 (ADR) 和近端状多体检测率 (PSPDR),显著影响了结肠镜后结肠直肠癌 (PCCRC) 风险. 专注于内镜师的质量对于减少PCCRC至关重要.
科学领域:
- 胃肠病学 胃肠病学
- 在瘤学瘤学.
- 公共卫生 公共卫生
背景情况:
- 目前的多斑切除术后监测指南仅依赖于多的特征.
- 腺瘤检测率 (ADR) 和近端状息肉检测率 (PSPDR) 是已知的结肠镜后结肠直肠癌 (PCCRCs) 的预测指标.
- 这些关键的质量指标目前还没有纳入监测间隔的确定.
研究的目的:
- 调查内镜质量指标 (ADR和PSPDR) 与3年PCCRC风险之间的关联.
- 为了确定内镜师的表现是否是PCCRC风险的一个更重要的因素,而不是多的特征.
主要方法:
- 在荷兰结肠直肠癌查计划中分析了2014-2020年结肠镜检查数据.
- 根据高风险的息肉与没有/低风险的息肉切除而对个体进行分类.
- 考克斯比例危险回归用于评估PCCRC风险,多状况,ADR和PSPDR之间的关联,通过内镜师的性能进行分层分析.
主要成果:
- 高风险的息肉存在与PCCRC风险没有显著关联 (HR 1.00).
- 无论是ADR还是PSPDR,都显示出与PCCRC风险的强烈反向关联 (HR分别为0.94和0.92).
- 低ADR内镜医生检查的没有/低风险息肉体的个体与高ADR内镜医生检查的高风险息肉体相比,PCCRC风险增加了2.11倍.
结论:
- 通过ADR和PSPDR测量的内镜师的表现是个人在结肠镜后的最初几年PCCRC风险的主要驱动因素.
- 基线高风险息肉的存在对短期PCCRC风险的影响要小于内镜质量.
- 监测和审计内镜师的质量指标对于减少PCCRC至关重要,除了适当的监测间隔设置外.
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