School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
Lancet Oncol. 2011 Jun;12(6):551-8. doi: 10.1016/S1470-2045(11)70101-2. Epub 2011 May 16.
Despite widespread use of the immunochemical faecal occult blood test (iFOBT), little is known about the subsequent risk of developing colorectal neoplasia for participants with negative iFOBT results. We investigated whether the concentration of faecal haemoglobin at the first screen is predictive of the subsequent incidence of colorectal neoplasia in those with a negative screening result.
Between 2001 and 2007, we did a prospective cohort study within the Keelung community-based iFOBT screening programme for residents aged 40-69 years, using a cutoff faecal haemoglobin concentration of 100 ng/mL to classify attendees as negative and positive groups for further clinical investigations. 44,324 participants with negative findings and 1668 with a positive result at the first screen (854 non-referrals who refused colonoscopy and 814 with a false-positive result as assessed by colonoscopy) were followed up to ascertain cases of colorectal neoplasia. We investigated the association between baseline faecal haemoglobin concentration and risk of incident colorectal neoplasia, after adjusting for possible confounders.
Median follow-up was 4·39 years (IQR 2·53-6·12) for all 45 992 participants, during which the incidence of colorectal neoplasia increased from 1·74 per 1000 person-years for those with baseline faecal haemoglobin concentration 1-19 ng/mL, to 7·08 per 1000 person-years for those with a baseline concentration of 80-99 ng/mL. The adjusted hazard ratios (HRs) increased from 1·43 (95% CI 1·08-1·88) for baseline faecal haemoglobin concentration of 20-39 ng/mL, to 3·41 (2·02-5·75) for a baseline concentration of 80-99 ng/mL (trend test p<0·0001), relative to 1-19 ng/mL. These results did not change when we included repeated iFOBT measurements. Non-referrals had the highest risk of incident colorectal neoplasia (adjusted HR 8·46 [6·08-11·76]).
Quantitative faecal haemoglobin concentration at first screening predicts subsequent risk of incident colorectal neoplasia. During follow-up, risk stratification based on faecal haemoglobin could help clinicians, with particular attention being paid to those with higher initial faecal haemoglobin concentrations, especially those just under the threshold taken to indicate presence of colorectal neoplasia.
None.
尽管免疫化学粪便潜血试验（iFOBT）被广泛应用，但对于 iFOBT 阴性结果的参与者，后续结直肠肿瘤发生的风险知之甚少。我们研究了首次筛查时粪便血红蛋白浓度是否可预测筛查阴性人群结直肠肿瘤的后续发生率。
在 2001 年至 2007 年间，我们在基隆社区为 40-69 岁居民开展了一项基于 iFOBT 的前瞻性队列研究，使用粪便血红蛋白浓度 100ng/ml 作为截断值将参与者分为阴性和阳性组，以进行进一步的临床研究。44324 名首次筛查结果为阴性的参与者和 1668 名首次筛查阳性的参与者（854 名拒绝结肠镜检查的非转诊者和 814 名结肠镜检查结果为假阳性者）进行了随访，以确定结直肠肿瘤病例。我们在调整了可能的混杂因素后，研究了基线粪便血红蛋白浓度与新发结直肠肿瘤风险之间的关系。
在所有 45992 名参与者中，中位随访时间为 4.39 年（IQR 2.53-6.12），结直肠肿瘤的发病率从基线粪便血红蛋白浓度为 1-19ng/ml 的参与者的 1.74/1000 人年增加到基线粪便血红蛋白浓度为 80-99ng/ml 的参与者的 7.08/1000 人年。调整后的危险比（HR）从基线粪便血红蛋白浓度为 20-39ng/ml 的 1.43（95%CI 1.08-1.88）增加到基线粪便血红蛋白浓度为 80-99ng/ml 的 3.41（2.02-5.75）（趋势检验 p<0.0001），与 1-19ng/ml 相比。当我们纳入重复 iFOBT 测量时，这些结果没有改变。非转诊者发生结直肠肿瘤的风险最高（调整后的 HR 8.46[6.08-11.76]）。
首次筛查时粪便血红蛋白的定量浓度可预测随后发生结直肠肿瘤的风险。在随访期间，基于粪便血红蛋白的风险分层可以帮助临床医生，特别注意那些初始粪便血红蛋白浓度较高的患者，尤其是那些刚刚低于提示结直肠肿瘤存在的阈值的患者。
无。
