有结肠直肠癌家族史的患者行结肠镜监测预防结肠直肠癌:一项为期16年的前瞻性、随访研究

作     者：Dove-Edwin I. Sasieni P. Adams J. Thomas H.J.W. 李宏宇 

作者机构：Cancer Research UK Centre for Epidemiology Mathematics and StatisticsWolfson Institute of Preventive Medicine London EC1M 6BQ Germany.Prof 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第3期

页      面：2-3页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：结肠直肠癌 结肠镜检 随访研究 高危腺瘤 预后指标 患病风险 一级亲属 观察随访 癌发生率 成员需要 

摘      要：Objective: To determine to what extent individuals with various family histories of colorectal cancer (from one to three or more affected first degree relatives) benefit from colonoscopic surveillance. Design: Prospective, observational study of high risk families, followed up over 16 years. Setting: Tertiary referral family cancer clinic in London. Participants: 1678 individuals from families registered with die clinic. Individuals were classified according to die strength of their family history: hereditary non-polyposis colorectal cancer (if they fulfilled the Amsterdam criteria), and one, two, or three affected first degree relatives (moderate risk). Interventions: Colonoscopy was initially offered at five year intervals or three year intervals if an adenoma was detected. Main outcome measures: The incidence of adenomas with high risk pathological features or cancer. This was analysed by age, the extent of the family history, and findings on previous colonoscopies. The cohort was flagged for cancer and death. Incidence of colorectal cancer and mortality during over 15 000 person years of follow-up were compared with those expected in the absence of surveillance. Results: High risk adenomas and cancer were most common in families with hereditary non-polyposis colorectal cancer (on initial colonoscopy 5.7%and 0.9%, respectively). In the families with moderate risk, these findings were particularly uncommon under age 45 (1.1%and 0%) and on follow-up colonoscopy if advanced neoplasia was absent initially (1.7%and 0.1%). The incidence of colorectal cancer was substantially lower-80%in families with moderate risk (P = 0.00004), and 43%in families with hereditary non-polyposis colorectal cancer (P = 0.06) than the expected incidence in the absence of surveillance when the family history was taken into account. Conclusions: Colonoscopic surveillance reduces the risk of colorectal cancer in people with a strong family history. This study confirms that members of families