Jung Yoon Suk, Park Chan Hyuk, Kim Nam Hee, Park Jung Ho, Park Dong Il, Sohn Chong Il
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
PLoS One. 2018 Jan 11;13(1):e0191125. doi: 10.1371/journal.pone.0191125. eCollection 2018.
The fecal immunochemical test (FIT) has low sensitivity for detecting advanced colorectal neoplasia (ACRN); thus, a considerable portion of FIT-negative persons may have ACRN. We aimed to develop a risk-scoring model for predicting ACRN in FIT-negative persons.
We reviewed the records of participants aged ≥40 years who underwent a colonoscopy and FIT during a health check-up. We developed a risk-scoring model for predicting ACRN in FIT-negative persons.
Of 11,873 FIT-negative participants, 255 (2.1%) had ACRN. On the basis of the multivariable logistic regression model, point scores were assigned as follows among FIT-negative persons: age (per year from 40 years old), 1 point; current smoker, 10 points; overweight, 5 points; obese, 7 points; hypertension, 6 points; old cerebrovascular attack (CVA), 15 points. Although the proportion of ACRN in FIT-negative persons increased as risk scores increased (from 0.6% in the group with 0-4 points to 8.1% in the group with 35-39 points), it was significantly lower than that in FIT-positive persons (14.9%). However, there was no statistical difference between the proportion of ACRN in FIT-negative persons with ≥40 points and in FIT-positive persons (10.5% vs. 14.9%, P = 0.321).
FIT-negative persons may need to undergo screening colonoscopy if they clinically have a high risk of ACRN. The scoring model based on age, smoking habits, overweight or obesity, hypertension, and old CVA may be useful in selecting and prioritizing FIT-negative persons for screening colonoscopy.
粪便免疫化学检测（FIT）对晚期结直肠肿瘤（ACRN）的检测灵敏度较低；因此，相当一部分FIT检测结果为阴性的人可能患有ACRN。我们旨在开发一种风险评分模型，用于预测FIT检测结果为阴性的人患ACRN的风险。
我们回顾了年龄≥40岁且在健康体检期间接受结肠镜检查和FIT检测的参与者的记录。我们开发了一种风险评分模型，用于预测FIT检测结果为阴性的人患ACRN的风险。
在11873名FIT检测结果为阴性的参与者中，255人（2.1%）患有ACRN。基于多变量逻辑回归模型，在FIT检测结果为阴性的人群中，评分如下：年龄（从40岁起每年），1分；当前吸烟者，10分；超重，5分；肥胖，7分；高血压，6分；既往有脑血管意外（CVA），15分。尽管FIT检测结果为阴性的人中ACRN的比例随着风险评分的增加而增加（从0 - 4分的组中的0.6%增加到35 - 39分的组中的8.1%），但显著低于FIT检测结果为阳性的人（14.9%）。然而，FIT检测结果为阴性且风险评分≥40分的人与FIT检测结果为阳性的人患ACRN的比例之间没有统计学差异（10.5%对14.9%，P = 0.321）。
如果FIT检测结果为阴性的人临床上患ACRN的风险较高，可能需要接受结肠镜筛查。基于年龄、吸烟习惯、超重或肥胖、高血压和既往CVA的评分模型可能有助于选择FIT检测结果为阴性的人并确定其接受结肠镜筛查的优先顺序。
