Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers. | SNFGE.org - Société savante médicale française d'hépato-gastroentérologie et d’oncologie digestive

Thématique :
- Endoscopie/Imagerie

Originalité :
Réexamen

Solidité :

A confirmer

Doit faire évoluer notre pratique :

Dans certains cas

Nom du veilleur :
Docteur Patrice PIENKOWSKI

Coup de coeur :


	Gut
	2016/06

	2016 Jun;65(6):971-6
	doi: 10.1136/gutjnl-2014-308578

	Population-based assessment of the outcomes in patients with postcolonoscopy colorectal cancers.

	Govindarajan A, Rabeneck L, Yun L, Tinmouth J, Paszat LF, Baxter NN

	http://www.ncbi.nlm.nih.gov/pubmed/25748649

	OBJECTIVE: The potential for cancers to not be detected on colonoscopy is increasingly recognised, but little is known about patient outcomes. The objective of this study was to assess the outcomes of patients diagnosed with postcolonoscopy colorectal cancers (PCCRCs). DESIGN: We conducted a population-based retrospective cohort study, including all patients diagnosed with colorectal cancer (CRC) in Ontario, Canada from 2003 to 2009. Patients were categorised into three groups: DETECTED (diagnosed within 6 months of first colonoscopy), PCCRC (diagnosed 6-36 months after first colonoscopy) or NOSCOPE (no colonoscopy within 36 months of diagnosis). Univariate and multivariable analyses were conducted to study overall survival, surgical treatment, emergency presentation and surgical complications. RESULTS:Overall, 45 104 patients were included, with 2804 being classified as having a PCCRC. Compared with the DETECTED group, PCCRC was associated with a significantly higher likelihood of stage IV disease (17.2% vs 12.9%), worse overall survival (5 year OS: 60.8% vs 68.3%, p<0.0001; adjusted HR: 1.25, 95% CI 1.17 to 1.32, p<0.0001), a higher likelihood of emergency presentation (OR: 2.86, 95% CI 2.56 to 3.13, p<0.001) and lower likelihood of surgical resection (OR: 0.61, 95% CI 0.55 to 0.67, p<0.001). However, patients with PCCRC had significantly better outcomes than those in the NOSCOPE group (stage IV: 37.1%, 5 year OS: 38.9%) CONCLUSIONS:Compared with CRC detected by colonoscopy, PCCRCs are associated with a higher risk of emergent presentation, a lower likelihood of surgical resection and most notably, significantly worse oncological outcomes. However, they have better outcomes than patients with no recent colonoscopy.

	Évaluation des caractéristiques cliniques et évolutives de 2804 CCR d’intervalle (CCRi) dans une étude de cohorte rétrospective patients utilisant la base de données du registre des cancers de l’Ontario ?


	Dans cette étude canadienne, les CCRi se caractérisent par un moins bon pronostic : une fréquence plus élevée de stade IV (17.2% vs 12.9%), une moindre survie à 5 ans (60.8% vs 68.3%, p<0.0001), un mode de révélation aigu (RR: 2.86, p<0.001) et un taux de résecabilité moindre (RR: 0.61, p<0.001.



	Dans la littérature, les études sur le pronostic des CCRi sont très discordantes et plus nuancées. Cette étude canadienne porte sur les années 2003 à 2009 ; la même équipe avait publié des résultats décevants de la coloscopie pour le diagnostic des CCR proximaux mais les critères de qualité de l’examen n’étaient pas optimaux. Faut-il y voir un lien de cause à effet ?