结直肠镜漏诊结直肠癌情况一致性的评价研究

刘宇英; 魏君丽; 李艳红; 严岳; 赵安世; 罗琳娜; 伍民庆; 谢传波

doi:10.16462/j.cnki.zhjbkz.2020.08.019

结直肠镜漏诊结直肠癌情况一致性的评价研究

doi: 10.16462/j.cnki.zhjbkz.2020.08.019

1.
510060 广州, 中山大学肿瘤防治中心防癌体检健康管理中心, 华南肿瘤学国家重点实验室, 肿瘤医学协同创新中心
2.
450008 郑州, 郑州大学附属肿瘤医院健康管理中心
3.
510060 广州, 中山大学肿瘤防治中心肿瘤内科, 华南肿瘤学国家重点实验室, 肿瘤医学协同创新中心

详细信息

通讯作者:
谢传波, E-mail:xiechb@sysucc.org.cn

中图分类号: R181;R574
计量
- 文章访问数: 248
- HTML全文浏览量: 198
- PDF下载量: 20
- 被引次数: 0
出版历程
- 收稿日期: 2020-01-06
- 修回日期: 2020-04-13
- 刊出日期: 2020-08-10

Evaluation of the colorectal cancer missing rate by colonscopy

1.
Cancer Prevention Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
2.
Cancer Prevention Center, The Afliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
3.
Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China

More Information

Corresponding author: XIE Chuan-bo, E-mail:xiechb@sysucc.org.cn

摘要

摘要: 目的利用美国前列腺、肺、结直肠及卵巢癌筛查数据库（prostate，lung，colorectal，and ovarian，PLCO），评价结直肠镜漏诊结直肠癌的比例及漏诊病人的特征，为提高结直肠癌的筛查效果提供循证依据。方法选择PLCO研究干预人群中进行了基线检查或者3年或5年结直肠镜复查的结直肠癌病人为研究对象。以基线或者随访结直肠镜检查没发现的结直肠癌患者为分子，以基线或者随访结直肠镜检查一年内发现的所有结直肠癌患者（结直肠镜发现的结直肠癌患者+肿瘤登记系统发现的结直肠癌患者+年度自我报告问卷发现的结直肠癌患者）为分母，计算结直肠镜漏诊结直肠癌的比例。结果共有338名结直肠癌患者纳入分析，其中经结直肠镜检查漏诊59名，漏诊比例为17.5%。65~69岁的漏诊率相对较高（24.2%）、低分化和近端结肠癌漏诊比例较高（32.4%和47.4%）。结论结直肠镜检查漏诊结直肠癌的比例相对较高，漏诊主要集中在近端结肠，提高粪便DNA等检测技术的准确性，可能是克服结直肠镜漏诊问题的有效途径。
- 结直肠癌 /
- PLCO数据库 /
- 漏诊 /
- 结直肠镜 /
- 筛查
Abstract: Objective To evaluate the colonscopy missed colorectal cancer rate using the data collected from Prostate, Lung, Colorectal, and Ovarian (PLCO) study. Methods The colorectal cancer patients who were enrolled in the screening arm of PLCO study and completed the baseline or 3 or 5 years endoscopy screenings were selected as participants. The missing rate was defined as the number of colorectal cancer patients missed by colonscopy divided by the number of colorectal cancer patients confirmed by colonscopy, annual questionnaire, or cancer registry system. Results 59 out of 338 colorectal cancer patients were missed by colonscopy, which accounted for 17.5% of the total patients. The patients aged 65-69 years old (24.2%), with moderately differentiated histological type (32.4%), and with lesion s at proximal colon sites(47.4%)had high missing rates. Conclusions Colonscopy missed a relatively high proportion of colorectal cancer patients especially for those occurring at proximal colon. To improve the diagnostic accuracy of noninvasive screening method might overcome the limitation of high missing rate of endoscopy.
- Colorectal cancer /
- PLCO /
- Missed diagaosis /
- Colonscopy /
- Screening

HTML全文

图 1 不同处理对鲜食玉米品质的影响

Figure 1. Effects of different treatments on fruit quality of fresh corn

下载: 全尺寸图片幻灯片

表 1 不同特征人群结直肠镜漏诊结直肠癌患者情况[n(%)]

Table 1. Proportions of colonsocpy missed colon cancer patients of each subgroup[n(%)]

	人数	肠镜漏诊比例		OR(95% CI)值	P值
	人数	肠镜发现人数	漏诊人数	OR(95% CI)值	P值
年龄分组(岁)
≤59	54	49(90.7)	5(9.3)	1.00
60~	131	110(84.0)	21(16.0)	1.87(0.67, 5.25)	0.234
65~	91	69(75.8)	22(24.2)	3.13(1.11, 8.82)	0.031
≥70	62	51(82.3)	11(17.7)	2.11(0.69, 6.53)	0.193
性别
男	221	191(86.4)	30(13.6)	1.00
女	117	88(75.2)	29(24.8)	2.10(1.19, 3.71)	0.011
分化程度
高分化	48	46(95.8)	2(4.2)	1.00
中分化	207	164(79.2)	43(20.8)	6.03(1.41, 25.84)	0.016
低分化	34	23(67.6)	11(32.4)	11.00(2.25, 53.81)	0.003
未分化	1	1(100.0)	0(0.0)	-
未知	48	45(93.8)	3(6.2)	1.53(0.25, 9.61)	0.648
近端或远端结肠
远端	243	229(94.2)	14(5.8)	1.00
近端	95	50(52.6)	45(47.4)	14.72(7.51, 28.87)	< 0.001
病变位置
直肠或肛门	96	90(93.7)	6(6.3)	1.00
直肠和乙状结肠交界	12	12(100.0)	0(0.0)	-
乙状结肠	121	117(96.7)	4(3.3)	0.51(0.14, 1.87)	0.312
降结肠	14	10(71.4)	4(28.6)	6.00(1.45, 24.92)	0.014
结肠脾曲	10	9(90.0)	1(10.0)	1.67(0.18, 15.43)	0.653
横结肠	20	14(70.0)	6(30.0)	6.43(1.82, 22.75)	0.004
结肠肝曲	12	5(41.7)	7(58.3)	21.00(5.11, 86.38)	< 0.001
升结肠	19	8(42.1)	11(57.9)	20.63(6.03, 70.55)	< 0.001
盲肠	34	14(41.2)	20(58.8)	21.43(7.34, 62.60)	< 0.001
合计	338	227(67.2)	59(17.5)

下载: 导出CSV

参考文献(12)

[1]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2):115-132. DOI: 10.3322/caac.21338.
[2]	Ansa BE, Coughlin SS, Alema-Mensah E, et al. Evaluation of colorectal cancer incidence trends in the United States (2000-2014)[J]. J Clin Med, 2018, 7(2):22. DOI: 10.3390/jcm7020022.
[3]	Gohagan JK, Prorok PC, Hayes RB, et al. The prostate, lung, colorectal and ovarian (PLCO) cancer screening trial of the National Cancer Institute:history, organization, and status[J]. Control Clin Trials, 2000, 21(6 Suppl):251S-272S. DOI: 10.1016/s0197-2456(00)00097-0.
[4]	Bressler B, Paszat LF, Chen Z, et al. Rates of new or missed colorectal cancers after colonoscopy and their risk factors:a population-based analysis[J]. Gastroenterology, 2007, 132(1):96-102. DOI: 10.1053/j.gastro.2006.10.027.
[5]	Zhao S, Wang S, Pan P, et al. Magnitude, risk factors, and factors associated with adenoma miss rate of tandem colonoscopy:a systematic review and meta-analysis[J]. Gastroenterology, 2019, 156(6):1661-1674. DOI: 10.1053/j.gastro.2019.01.260.
[6]	缪敏, 陈长喜, 朱忠伟.肠道准备对初次肠镜检查息肉漏诊的影响[J].浙江实用医学, 2014, (1):37-38. DOI: 10.16794/j.cnki.cn33-1207/r.2014.01.013. Miao M, Chen CX, Zhu ZW. The influence of bowel preparation on the missed diagnosis of polyps in primary endoscopy examination[J]. Zhejiang Pract Med, 2014, (1):37-38. DOI: 10.16794/j.cnki.cn33-1207/r.2014.01.013.
[7]	Park JH, Moon HS, Kwon IS, et al. Quality of preoperative colonoscopy affects missed postoperative adenoma detection in colorectal cancer patients[J]. Dig Dis Sci, 2020, 65(7):2063-2070. DOI: 10.1007/s10620-019-05912-z.
[8]	杨成, 项立, 赵新华, 等.结肠镜退镜时间的研究现状及思考[J].中华消化内镜杂志, 2016, 33(8):512-513. DOI: 10.3760/cma.j.issn.1007-5232.2016.08.002. Yang C, Xiang L, Zhao XH, et al. Current research status and thinking on colonoscopy withdrawal time[J]. Chin J Dig Endoscopy, 2016, 33(8):512-513. DOI: 10.3760/cma.j.issn.1007-5232.2016.08.002.
[9]	Bailey JR, Aggarwal A, Imperiale TF. Colorectal cancer screening:stool DNA and other noninvasive modalities[J]. Gut Liver, 2016, 10(2):204-211. DOI: 10.5009/gnl15420.
[10]	Carethers JM. One colon lumen but two organs[J]. Gastroenterology, 2011, 141(2):411-412. DOI: 10.1053/j.gastro.2011.06.029.
[11]	Petrelli F, Tomasello G, Borgonovo K, et al. Prognostic survival associated with left-sided vs right-sided colon cancer:a systematic review and meta-analysis[J]. JAMA Oncol, 2017, 3(2):211-219. DOI: 10.1001/jamaoncol.2016.4227.
[12]	张爱琴, 周焕明, 李曙辉.电子结肠镜检查中误漏诊的相关因素分析[J].临床误诊误治, 2011, 24(4):70-72. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcwzwz201104047 Zhang AQ, Zhou HM, Li SH. Analysis of the relevant factors of misdiagnosis and missed diagnosis of electric colonoscopy[J]. Clin Mis Diagn Misther, 2011, 24(4):70-72. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcwzwz201104047