Digby Jayne, Fraser Callum G, Carey Francis A, Diament Robert H, Balsitis Margaret, Steele Robert Jc
1 Scottish Bowel Screening Research Unit, Ninewells Hospital and Medical School, Dundee, Scotland.
2 Centre for Research into Cancer Prevention and Screening, Ninewells Hospital and Medical School, Dundee, Scotland.
J Med Screen. 2017 Jun;24(2):62-68. doi: 10.1177/0969141316653983. Epub 2016 Jul 1.
Objective To examine associations between faecal haemoglobin concentrations below the cut-off used in colorectal cancer screening and outcomes in the next screening round. Methods In the Scottish Bowel Screening Programme, faecal haemoglobin concentrations and diagnostic outcomes were investigated for participants with a negative result (faecal haemoglobin concentrations < 80.0 µg Hb/g faeces), followed by a positive result within two years. Results Of 37,780 participants with negative results, at the next screening round, 556 (1.5%) screened positive and 30,293 (80.2%) negative. Initial median faecal haemoglobin concentrations (2.1 µg Hb/g faeces, IQR: 0.0-13.2) were higher in those with subsequent positive results than those with subsequent negative results (0.0 µg Hb/g faeces, IQR: 0.0-1.4; p < 0.0001). Using faecal haemoglobin concentrations 0.0-19.9 µg Hb/g faeces as reference, logistic regression analysis showed high adjusted odds ratios for advanced neoplasia (advanced neoplasia: colorectal cancer or higher risk adenoma) detection at the next round of 14.3 (95% CI: 8.9-23.1) in those with initial faecal haemoglobin concentrations 20.0-39.9 µg Hb/g faeces, and 38.0 (95% CI: 20.2-71.2) with 60.0-79.9 µg Hb/g faeces. Conclusions A higher proportion of participants with faecal haemoglobin concentrations of ≥ 20 µg Hb/g faeces had advanced neoplasia detected at the next round than participants with lower faecal haemoglobin concentrations. Although most relevant when using high faecal haemoglobin concentrations cut-offs, studies of faecal haemoglobin concentrations and outcomes over screening rounds may provide strategies to direct available colonoscopy towards those at highest risk.
目的 研究低于结直肠癌筛查所用临界值的粪便血红蛋白浓度与下一轮筛查结果之间的关联。方法 在苏格兰肠道筛查项目中，对首次筛查结果为阴性（粪便血红蛋白浓度＜80.0µg Hb/g粪便）且在两年内随后筛查结果为阳性的参与者的粪便血红蛋白浓度和诊断结果进行调查。结果 在37780名首次筛查结果为阴性的参与者中，在下一轮筛查时，556人（1.5%）筛查结果为阳性，30293人（80.2%）为阴性。后续筛查结果为阳性者的初始粪便血红蛋白浓度中位数（2.1µg Hb/g粪便，四分位间距：0.0 - 13.2）高于后续筛查结果为阴性者（0.0µg Hb/g粪便，四分位间距：0.0 - 1.4；p＜0.0001）。以粪便血红蛋白浓度0.0 - 19.9µg Hb/g粪便为参照，逻辑回归分析显示，初始粪便血红蛋白浓度为20.0 - 39.9µg Hb/g粪便者在下一轮筛查中检测到晚期肿瘤（晚期肿瘤：结直肠癌或高风险腺瘤）的校正优势比高，为14.3（95%置信区间：8.9 - 23.1），而初始粪便血红蛋白浓度为60.0 - 79.9µg Hb/g粪便者的校正优势比为38.0（95%置信区间：20.2 - 71.2）。结论 粪便血红蛋白浓度≥20µg Hb/g粪便的参与者在下一轮筛查中检测到晚期肿瘤的比例高于粪便血红蛋白浓度较低的参与者。尽管在使用高粪便血红蛋白浓度临界值时最为相关，但对多轮筛查中粪便血红蛋白浓度和结果的研究可能会提供策略，以便将可用的结肠镜检查指向风险最高的人群。
