Moayyedi Paul, Achkar Edgar
Gastroenterology Division, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Am J Gastroenterol. 2006 Feb;101(2):380-4. doi: 10.1111/j.1572-0241.2006.00537.x.
Colorectal cancer (CRC) is a common cause of cancer mortality. A variety of CRC screening strategies are being adopted in many developed countries. Fecal occult blood testing (FOBT) is one option for screening that has the most evidence for efficacy and is also the cheapest approach. Systematic reviews suggest that FOBT is effective in reducing CRC mortality but the data on overall mortality from any cause has rarely been synthesized.
Randomized controlled trials identified by a Cochrane review of the efficacy of FOBT were reanalyzed. Trials that reported on biennial FOBT with all cause mortality assessed at similar follow-up periods were analyzed. CRC, non-CRC, and all cause mortality were evaluated using a random effects model.
Three trials were analyzed, involving 245,217 subjects with 2,148 CRC deaths after almost 3 million patient-years follow-up. The relative risk (RR) of CRC death in the FOBT arm was 0.87 (95% CI = 0.8-0.95). The RR of non-CRC death in the FOBT group was 1.02 (95% CI = 1.00-1.04, p = 0.015). The increase in non-CRC in the FOBT group balanced the decrease in CRC mortality with no overall impact on mortality (RR of dying in the FOBT arm = 1.002, 95% CI = 0.989-1.015).
The impact of FOBT in reducing mortality from any cause is uncertain and efficacy of this strategy for CRC screening needs reevaluation.
结直肠癌（CRC）是癌症死亡的常见原因。许多发达国家正在采用多种结直肠癌筛查策略。粪便潜血试验（FOBT）是一种筛查选择，有最多的疗效证据，也是最便宜的方法。系统评价表明，FOBT可有效降低结直肠癌死亡率，但关于任何原因导致的总体死亡率的数据很少被综合分析。
对Cochrane关于FOBT疗效的综述中确定的随机对照试验进行重新分析。分析那些报告了每两年进行一次FOBT且在相似随访期评估全因死亡率的试验。使用随机效应模型评估结直肠癌、非结直肠癌和全因死亡率。
分析了三项试验，涉及245,217名受试者，经过近300万患者年的随访后有2,148例结直肠癌死亡。FOBT组结直肠癌死亡的相对风险（RR）为0.87（95%置信区间 = 0.8 - 0.95）。FOBT组非结直肠癌死亡的RR为1.02（95%置信区间 = 1.00 - 1.04，p = 0.015）。FOBT组非结直肠癌死亡的增加抵消了结直肠癌死亡率的降低，对总体死亡率没有总体影响（FOBT组死亡的RR = 1.002，95%置信区间 = 0.989 - 1.015）。
FOBT对降低任何原因导致的死亡率的影响尚不确定，这种结直肠癌筛查策略的疗效需要重新评估。
