粪便免疫化学试验在结直肠癌筛查中的应用：不同截断值的结肠镜检查结果。
Fecal immunochemical test in colorectal cancer screening: Colonoscopy findings by different cut-off levels.
机构信息
Department of Clinical Science, Intervention and Technology, Karolinska Institute, and Trauma and Reparative Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institute and Stockholm County Council, Stockholm, Sweden.
出版信息
J Gastroenterol Hepatol. 2019 Jan;34(1):103-112. doi: 10.1111/jgh.14373. Epub 2018 Jul 29.
BACKGROUND AND AIM
Fecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening, but number of tests and cut-off level differ by program. The aim was to evaluate CRC screening with two FIT samples in average-risk 60-year-old men and women and to investigate hemoglobin (Hb) level in correlation to adenoma characteristics.
METHODS
We analyzed a cohort from Screening of Swedish Colons trial where participants with at least one of two FIT samples ≥10 μg Hb/g are offered colonoscopy. FIT levels and colonoscopy findings were assessed in multivariable analyses. Cut-off levels 10-80 μg Hb/g for one and two samples were assessed. FIT levels and advanced neoplasia (AN) were investigated by gender.
RESULTS
A total of 12 383 participated and 1182 positives (551 women) completed colonoscopy diagnosing 27 (2.3%) CRC and 269 (23%) advanced adenomas (AA). Median FIT level was 241.0 and 23.8 for CRC and AA compared with 13.4-15.8 in other subgroups (P = 0.002) correlating with adenoma size (P = 0.038). CRC was detected in 22 and 19 subjects for the first sample at cut-off 20 and 40 μg Hb/g, compared with 20 and 17 for the mean of two samples at cut-off 40 and 80 μg Hb/g (P < 0.05). Men had more AN (CRC + AA), (P = 0.003). In women, similar number of AN would be detected with cut-off lowered from 40 to 20 or from 80 to 40 μg Hb/g, requiring additional 26-34% colonoscopies.
CONCLUSION
In average-risk 60-year-olds, FIT was higher in participants with AN and correlated with adenoma size. FIT screening with one sample at low cut-off detected more CRC than two samples at higher cut-off. Applying lower cut-off in women to equalize gender differences in AN would result in considerable increase in colonoscopy workload.
背景与目的
粪便免疫化学检测（FIT）用于结直肠癌（CRC）筛查，但不同项目的检测次数和截断值有所不同。本研究旨在评估在平均风险的 60 岁男性和女性中使用两份 FIT 样本进行 CRC 筛查的效果，并探讨血红蛋白（Hb）水平与腺瘤特征的相关性。
方法
我们分析了来自瑞典结肠筛查试验的队列研究数据，该研究中至少有一份 FIT 样本的 Hb 含量≥10μg/g 的参与者被建议行结肠镜检查。在多变量分析中评估了 FIT 水平和结肠镜检查结果。评估了一份和两份样本的 Hb 含量截断值为 10-80μg/g。根据性别分析了 FIT 水平和高级别瘤变（AN）。
结果
共有 12383 名参与者参加了研究，其中 1182 名阳性（551 名女性）完成了结肠镜检查，诊断出 27 例（2.3%）CRC 和 269 例（23%）高级别腺瘤（AA）。CRC 和 AA 的 FIT 中位数分别为 241.0 和 23.8，与其他亚组（P=0.002）相比，其他亚组的中位数分别为 13.4-15.8（P=0.002），与腺瘤大小相关（P=0.038）。在截断值为 20 和 40μg/g 时，第一份样本检测到 22 例和 19 例 CRC，在截断值为 40 和 80μg/g 时，两份样本的平均值检测到 20 例和 17 例 CRC（P<0.05）。男性的 AN （CRC+AA）更多（P=0.003）。在女性中，将截断值从 40 降低到 20 或从 80 降低到 40μg/g 时，会检测到相同数量的 AN，需要额外进行 26-34%的结肠镜检查。
结论
在平均风险的 60 岁人群中，AN 患者的 FIT 水平更高，且与腺瘤大小相关。使用低截断值的一份样本进行 FIT 筛查比使用高截断值的两份样本检测到更多的 CRC。在女性中应用较低的截断值来平衡 AN 方面的性别差异，将导致结肠镜检查工作量的显著增加。
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