Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China.
World J Gastroenterol. 2009 Dec 28;15(48):6111-6. doi: 10.3748/wjg.15.6111.
To analyze the performance value of high risk factors in population-based colorectal cancer (CRC) screening in China.
We compared the performance value of the immunochemical fecal occult blood test (iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation. Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy.
The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia. The iFOBT had the highest sensitivity, lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas. A history of chronic cholecystitis or cholecystectomy, chronic appendicitis or appendectomy, and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas. The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for non-adenomatous polyps. A history of chronic appendicitis or appendectomy, chronic constipation, chronic diarrhea, mucous and bloody stool, CRC in first degree relatives, malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps. Except for a history of malignant tumor in screening for non-adenomatous polyps, the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality.
The iFOBT may be the best marker for screening for advanced neoplasias and adenomas. Some unique high risk factors may play an important role in CRC screening in China.
分析中国人群基于人群的结直肠癌（CRC）筛查中高危因素的性能值。
我们比较了免疫化学粪便潜血试验（iFOBT）和其他高危因素问卷在完成 iFOBT 和问卷调查的 13214 名社区居民人群样本中的性能值。iFOBT 和/或问卷阳性的患者被视为高危人群，符合条件的患者被要求进行结肠镜检查。
iFOBT 在筛查进展性肿瘤方面具有最高的阳性预测值和阴性预测值。iFOBT 在筛查进展性肿瘤和腺瘤方面具有最高的灵敏度，最低的额外假阳性结果数，与检测一个额外异常相关，用于筛查进展性肿瘤和腺瘤。慢性胆囊炎或胆囊切除术、慢性阑尾炎或阑尾切除术和慢性腹泻的病史在筛查进展性肿瘤和腺瘤方面也比腺瘤病史具有更高的灵敏度。在筛查非腺瘤性息肉方面，慢性胆囊炎或胆囊切除术的病史是 10 个高危因素中灵敏度最高的。慢性阑尾炎或阑尾切除术、慢性便秘、慢性腹泻、黏液和血便、一级亲属 CRC、恶性肿瘤和 iFOBT 阳性在筛查非腺瘤性息肉方面也比腺瘤病史具有更高的灵敏度。除了在筛查非腺瘤性息肉方面的恶性肿瘤病史外，灵敏度的提高与检测一个额外异常时额外假阳性结果的增加有关。
iFOBT 可能是筛查进展性肿瘤和腺瘤的最佳标志物。一些独特的高危因素可能在中国的 CRC 筛查中发挥重要作用。
