Kerr Jane, Day Peter, Broadstock Marita, Weir Robert, Bidwell Susan
New Zealand Health Technology Assessment, Department of Public Health and General Practice, University of Otago, Christchurch.
N Z Med J. 2007 Jul 20;120(1258):U2629.
To estimate the effectiveness of colorectal cancer screening with faecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), and combinations of FOBT and FS in preventing colorectal cancer (CRC) deaths.
A systematic review was conducted examining randomised controlled trials (RCTs) published between 1997 and 2004 inclusive. A systematic search of Medline, Embase, Current Contents, and the Cochrane Library was undertaken. Studies that evaluated screening with FOBT, FS or combinations of FOBT and FS, were appraised. A meta-analysis of population-based trials of FOBT was conducted.
Four RCTs were identified that examined FOBT screening. The three trials that investigated guaiac-based FOBT found CRC mortality was reduced in the screening group. In the two population-based trials, the pooled relative risk was 0.86 (95%CI 0.79-0.93). A fourth RCT was identified, with shorter term follow-up, which considered FOBT screening combined with FS compared with FOBT alone. No significant reduction in CRC mortality was reported in this trial.
There is high-quality evidence showing that guaiac-based FOBT screening reduces mortality from CRC. No such evidence exists for screening with FS either alone, or in combination with FOBT, but this should be re-evaluated once data become available from four large ongoing trials.
评估粪便潜血试验（FOBT）、乙状结肠镜检查（FS）以及FOBT与FS联合检查在预防结直肠癌（CRC）死亡方面的效果。
进行一项系统评价，考察1997年至2004年（含）期间发表的随机对照试验（RCT）。对Medline、Embase、《现刊目次》和Cochrane图书馆进行系统检索。对评估FOBT、FS或FOBT与FS联合检查的研究进行评价。对基于人群的FOBT试验进行荟萃分析。
确定了四项考察FOBT筛查的RCT。三项研究基于愈创木脂的FOBT的试验发现筛查组的CRC死亡率降低。在两项基于人群的试验中，汇总相对风险为0.86（95%可信区间0.79 - 0.93）。确定了第四项RCT，随访期较短，该试验比较了FOBT筛查联合FS与单独FOBT的效果。该试验未报告CRC死亡率有显著降低。
有高质量证据表明基于愈创木脂的FOBT筛查可降低CRC死亡率。对于单独使用FS或FS与FOBT联合检查进行筛查，尚无此类证据，但一旦四项正在进行的大型试验获得数据，应重新评估。
