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Lead Time Bias May Contribute to the Shorter Life Expectancy in Post-colonoscopy Colorectal Cancer

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Abstract

Background

The long-term outcomes of post-colonoscopy colorectal cancer have varied in previous studies. Our nationwide cohort analysis estimated expected years of life lost to adjust for lead time bias.

Aim

We recalculated the long-term outcomes for post-colonoscopy and detected colorectal cancer.

Methods

Patients with colorectal cancer registered in the Taiwan Cancer Registry between 2002 and 2009 were enrolled. The detected group included 22,169 cases of colorectal cancer confirmed within 6 months after a colonoscopy. The post-colonoscopy group included 1653 cancer patients who received a colonoscopy 6–60 months before diagnosis. Patients were followed up until 2011. We simulated age-, sex-, and calendar year-matched referents from life tables in the Taiwan National Vital Statistics using a Monte Carlo method. The life expectancy and expected years of life lost of the cancer patients were obtained from extrapolation of the logit transformation of the survival ratio between the cancer cohorts and the referent groups.

Results

Post-colonoscopy colorectal cancer had shorter life expectancies than detected cancer (stages 2–4: 13.6 vs. 16.1 years; 8.7 vs. 12.6 years; 2.1 vs. 4.1 years, p < 0.001). The loss-of-life expectancy did not show this trend after adjusting for lead time bias. Post-colonoscopy colorectal cancer was found at an older age, more often proximal, and was associated with previous endoscopic polypectomy procedures (p < 0.001).

Conclusions

Post-colonoscopy colorectal cancer leads to a shorter life expectancy, which appears partially explained by the presence of lead time bias. Quality assurance for colonoscopy and close surveillance for high risk groups would reduce post-colonoscopy colorectal cancer.

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Abbreviations

DCRC:

Detected colorectal cancer

EYLL:

Expected years of life lost

LE:

Life expectancy

NHIRD:

National Health Insurance Research Database

PCCRC:

Post-colonoscopy colorectal cancer

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Acknowledgments

This study was funded in part by grants from the Ministry of Science and Technology, Taiwan (MOST 105-2314-B-006-026, MOST 107-2627-M-006-007), and by National Cheng Kung University Hospital (NCKUH-10504002). No pharmaceutical company paid to have this article written.

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Author notes

  1. Jung‑Der Wang and Bor‑Shyang Sheu have contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138 Sheng Li Road, Tainan, 70428, Taiwan

    Wei-Ying Chen, Hsiu-Chi Cheng, Wei-Chun Cheng, Jung-Der Wang & Bor-Shyang Sheu

  2. Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138 Sheng Li Road, Tainan, 70428, Taiwan

    Hsiu-Chi Cheng & Bor-Shyang Sheu

  3. Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 70101, Taiwan

    Jung-Der Wang

  4. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138 Sheng Li Road, Tainan, 70428, Taiwan

    Jung-Der Wang

  5. Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, No.125 Jhuang-San Road, Tainan, 70101, Taiwan

    Wei-Chun Cheng & Bor-Shyang Sheu

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  1. Wei-Ying Chen
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Correspondence to Bor-Shyang Sheu.

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Chen, WY., Cheng, HC., Cheng, WC. et al. Lead Time Bias May Contribute to the Shorter Life Expectancy in Post-colonoscopy Colorectal Cancer. Dig Dis Sci 64, 2622–2630 (2019). https://doi.org/10.1007/s10620-019-05566-x

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  • DOI: https://doi.org/10.1007/s10620-019-05566-x

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