国家息肉研究项目(NPS)发现，患者往往通过结肠镜下息肉切除手术规避结肠直肠癌的风险。纽约流行病与生物统计医学中心及凯特灵癌症中心Ann G. Zauber博士等人研究了对结肠直肠癌患者实施结肠镜下息肉切除手术后患者长时期死亡率的变化。相关的研究成果发表在国际权威杂志NEJM2012年第8期上。
研究纳入了1980至1990年NPS临床中心所有接受结肠镜检的息肉（腺瘤型或非腺瘤型）患者作为分析样本。利用全国死亡参数确定死亡患者数及死因；随访时间长达23年。将结肠镜下腺瘤性息肉切除手术后结肠直肠癌患者的死亡率与普通人群结肠直肠癌预期死亡率相比较，结果由监督流行病学，最终结果(SEER)程序，以及观察到的非腺瘤息肉结肠直肠癌患者死亡率（作为内参）统计得到。
纳入研究的2602例接受腺瘤性息肉切除的患者，在15.8年的中位随访期中共有1246例患者因各种原因死亡，其中12例死于结肠直肠癌。而同时期普通人群中结肠直肠癌患者预期死亡数则为25.4例，接受结肠镜下息肉切除术的患者与其相比标准死亡率比值为0.47（95%置信区间[CI], 0.26 至0.80），提示死亡率下降53%。在实施息肉切除手术后10年内，腺瘤性和非腺瘤性结肠直肠癌患者死亡率相似（相对危险度，1.2; 95% CI, 0.1至10.6）。
本研究结果支持结肠镜下腺瘤性息肉切除术可有效降低结肠直肠癌死亡率的假说。
（转自丁香园）
附英文摘要：
Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths.
Panish JF,Winawer SJ,Waye JD,et al.
Abstract：
METHODS:We included in this analysis all patients prospectively referred for initial colonoscopy (between 1980 and 1990) at NPS clinical centers who had polyps (adenomas and nonadenomas). The National Death Index was used to identify deaths and to determine the cause of death; follow-up time was as long as 23 years. Mortality from colorectal cancer among patients with adenomas removed was compared with the expected incidence-based mortality from colorectal cancer in the general population, as estimated from the Surveillance Epidemiology and End Results (SEER) Program, and with the observed mortality from colorectal cancer among patients with nonadenomatous polyps (internal control group).
RESULTS:Among 2602 patients who had adenomas removed during participation in the study, after a median of 15.8 years, 1246 patients had died from any cause and 12 had died from colorectal cancer. Given an estimated 25.4 expected deaths from colorectal cancer in the general population, the standardized incidence-based mortality ratio was 0.47 (95% confidence interval [CI], 0.26 to 0.80) with colonoscopic polypectomy, suggesting a 53% reduction in mortality. Mortality from colorectal cancer was similar among patients with adenomas and those with nonadenomatous polyps during the first 10 years after polypectomy (relative risk, 1.2; 95% CI, 0.1 to 10.6).
CONCLUSIONS:These findings support the hypothesis that colonoscopic removal of adenomatous polyps prevents death from colorectal cancer. (Funded by the National Cancer Institute and others.). （The New England journal of medicine.2012-02-23;366(8):687-96.）
