代謝症候群對大腸腫瘤盛行率與大腸直腸癌篩檢的影響

Abstract

背景 性別和代謝症候群都已經被證實，在大腸直腸腫瘤的形成過程中扮演重要角色。雖然代謝症候群會增加大腸瘜肉和大腸癌的風險，但是，有代謝症候群的民眾是否需要提早接受大腸癌篩檢，目前尚無定論，這些民眾若提早接受篩檢，所需要消耗的大腸鏡資源，也是很重要的研究題目。 目的 瞭解代謝症候群在不同性別與年齡，對大腸腫瘤(特別是癌前病變—進行性腺瘤，advanced adenoma)盛行率的影響，並比較有無代謝症候群的民眾，分別利用糞便潛血檢查和大腸鏡做為大腸癌篩檢工具時，分別需要做多少隻大腸鏡才能發現一個進行性腺瘤。 方法 我們分析接受包括糞便潛血檢查和大腸鏡的全身健康檢查之民眾，從2006年至2009年，共納入了10,884位個案，除了糞便和內視鏡檢查外，血壓、腹圍、身高、體重、和包含血糖及血脂的血液檢查也都被記錄下來。透過不同年齡、性別、和代謝症候群的分組下，比較大腸腫瘤的盛行率在各組之間有甚麼差異。此外，同時換算出，在利用糞便潛血檢查和大腸鏡做為篩檢工具的狀況下，各自需要做多少個大腸鏡才能夠發現一顆進行性腺瘤。 結果 在五十歲以上的族群，無論是在男女或哪一個年齡層，有代謝症候群的人都具有較高的比例罹患大腸腫瘤，不管是大腸腫瘤的盛行率，或者是糞便潛血檢查的陽性預測值，有代謝症候群的人都比沒有的人來的高，這樣的趨勢，在40-49歲的男性也可以看得到，但是在此年齡層的女性卻沒有這樣的變化。進行性腺瘤在40-49歲有代謝症候群男性的盛行率，和50-59歲女性比較起來相仿，分別為2.4%和2.0% (p值為0.709)，若把罹患進行性腺瘤的風險換算為偵測一顆進行性腺瘤所需要的大腸鏡檢查個數(number need to scope)，40-49歲代謝症候群男性在以大腸鏡與以糞便潛血做為篩檢的條件下，分別為44和7，50-59歲的女性則分別為47和8。 結論 不論是大腸腫瘤的盛行率，或是大腸癌篩檢的陽性檢出率，代謝症候群對40-49歲的男性，都有著相當程度的影響，然而，這個族群是否該提早接受大腸癌篩檢，需要更多的研究來支持。

Background Gender and metabolic disorders have proven to play an important role on the risk of colorectal neoplasm. Whether the presence of metabolic syndrome (MetS) may warrant earlier screening is intriguing and its impact on endoscopic capacity is worthwhile of investigation. Methods We analyzed a screening colonoscopy cohort comprised of 10,884 average-risk subjects who had concurrently received screening colonoscopy and fecal immunochemical testing as a part of thorough health check-up from the period of 2006 to 2009. Results of anthropometric measurements, blood pressure, and laboratory tests including fasting blood sugar, triglyceride, and cholesterol levels were all collected. Prevalence of colorectal neoplasm were assessed and compared in association with age, gender, and the presence of metabolic syndrome. The number of colonoscopy that needed to be performed with either endoscopy-based or stool-based screening strategies to detect one advanced neoplasm was calculated and compared. Results Subjects with MetS had significantly higher prevalence of colorectal neoplasms and positive predictive values of stool tests in both genders across different age groups in those aged 50 or greater. Such trend is only significant in male aged 40 to 49 but not in female. The prevalence of advanced adenoma in MetS male aged 40 to 49 was comparable to that of average-risk female aged 50 to 59 (2.4% vs. 2.0%, p=0.709). The number need to endoscope (NNE) to detect one advanced adenoma in MetS male aged 40 to 49 and average-risk female aged 50-59 were 44 and 47 in with endoscopic-based screening scenario and 7 and 8 with stool-based screening scenario. Conclusions MetS has more significant impact on both colorectal neoplasm prevalence and the diagnostic yields of screening tests in male aged 40 to 49. Whether our findings justify earlier screening in this subgroup needs further study.