Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Gut. 2019 May;68(5):873-881. doi: 10.1136/gutjnl-2017-315340. Epub 2018 Jun 22.
Faecal immunochemical tests (FITs) are replacing guaiac faecal occult blood tests (gFOBTs) for colorectal cancer (CRC) screening. Incidence of interval colorectal cancer (iCRC) following a negative stool test result is not yet known. We aimed to compare incidence of iCRC following a negative FIT or gFOBT.
We searched Ovid Medline, Embase, Cochrane Library, Science Citation Index, PubMed and Google Scholar from inception to 12 December 2017 for citations related to CRC screening based on stool tests. We included studies on FIT or gFOBT iCRC in average-risk screening populations. Main outcome was pooled incidence rate of iCRCs per 100 000 person-years (p-y). Pooled incidence rates were obtained by fitting random-effect Poisson regression models.
We identified 7 426 records and included 29 studies. Meta-analyses comprised data of 6 987 825 subjects with a negative test result, in whom 11 932 screen-detected CRCs and 5 548 gFOBT or FIT iCRCs were documented. Median faecal haemoglobin (Hb) positivity cut-off used was 20 (range 10-200) µg Hb/g faeces in the 17 studies that provided FIT results. Pooled incidence rates of iCRC following FIT and gFOBT were 20 (95% CI 14 to 29; I=99%) and 34 (95% CI 20 to 57; I=99%) per 100 000 p-y, respectively. Pooled incidence rate ratio of FIT versus gFOBT iCRC was 0.58 (95% CI 0.32 to 1.07; I=99%) and 0.36 (95% CI 0.17 to 0.75; I=10%) in sensitivity analysis. For every FIT iCRC, 2.6 screen-detected CRCs were found (ratio 1:2.6); for gFOBT, the ratio between iCRC and screen-detected CRC was 1:1.2. Age below 60 years and the third screening round were significantly associated with a lower iCRC rate.
A negative gFOBT result is associated with a higher iCRC incidence than a negative FIT. This supports the use of FIT over gFOBT as CRC screening tool.
粪便免疫化学检测（FIT）正在取代愈创木脂粪便潜血检测（gFOBT）用于结直肠癌（CRC）筛查。阴性粪便检测结果后的间期结直肠癌（iCRC）的发生率尚不清楚。本研究旨在比较阴性 FIT 或 gFOBT 后的 iCRC 发生率。
我们检索了 Ovid Medline、Embase、Cochrane 图书馆、科学引文索引、PubMed 和 Google Scholar，以获取截至 2017 年 12 月 12 日基于粪便检测的 CRC 筛查相关文献。我们纳入了平均风险筛查人群中 FIT 或 gFOBT-iCRC 的研究。主要结局是每 100000 人年（p-y）的 iCRCs 累积发生率。累积发生率通过拟合随机效应泊松回归模型获得。
我们共确定了 7426 条记录，并纳入了 29 项研究。荟萃分析纳入了 6987825 名阴性检测结果的受试者数据，其中 11932 例为筛查发现的 CRC 和 5548 例 gFOBT 或 FIT-iCRC。17 项提供 FIT 结果的研究中，中位数粪便血红蛋白（Hb）阳性截断值为 20（范围 10-200）µg Hb/g 粪便。阴性 FIT 和 gFOBT 后 iCRC 的累积发生率分别为 20（95%CI 14-29；I=99%）和 34（95%CI 20-57；I=99%）/100000 p-y。FIT 与 gFOBT-iCRC 的累积发生率比值分别为 0.58（95%CI 0.32-1.07；I=99%）和 0.36（95%CI 0.17-0.75；I=10%）。在敏感性分析中，每例 FIT-iCRC 发现 2.6 例筛查发现的 CRC（比值 1:2.6）；而 gFOBT 中，iCRC 与筛查发现 CRC 的比值为 1:1.2。年龄低于 60 岁和第三轮筛查与较低的 iCRC 发生率显著相关。
阴性 gFOBT 结果与较高的 iCRC 发生率相关，而阴性 FIT 结果则不然。这支持将 FIT 用作 CRC 筛查工具，而不是 gFOBT。
