Department of Research and Development, Telemark Hospital, Skien, Norway; Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Norway; Department of Medicine, Ostfold Hospital Trust, Grålum, Norway.
Department of Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway; Norwegian National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.
Gastroenterology. 2019 May;156(6):1642-1649.e1. doi: 10.1053/j.gastro.2019.01.040. Epub 2019 Jan 25.
BACKGROUND & AIMS: The fecal immunochemical test (FIT) is the tool most frequently used for colorectal cancer (CRC) screening worldwide. It is unclear how the use of aspirin and oral anticoagulants in the screening population affects the diagnostic performance of FIT.
We performed a cross-sectional study in an ongoing CRC screening trial in Norway. Participants aged 50-74 years with a positive result from an FIT (>15 μg hemoglobin/g feces) and subsequent colonoscopy (reference standard) were included. Those who used regular aspirin, warfarin, or direct-acting oral anticoagulants (DOACs) were defined as users. Non-users were matched according to age, sex, screening center, and screening round. The primary outcomes were the positive predictive value (PPV) for CRC and advanced adenoma.
Among 4908 eligible participants, 1008 used aspirin, 147 used warfarin, 212 used DOACs, and 3541 were non-users. CRCs were found in 234 individuals and advanced adenomas in 1305 individuals. The PPV for CRC was 3.8% for aspirin users vs 6.4% for matched non-users (P = .006), The PPV for advanced adenoma in aspirin users was 27.2% vs 32.6% for matched non-users (P = .011). For DOAC, the PPV for CRC was 0.9% in users vs 6.8% in matched non-users (P = .001). The PPV for advanced adenoma in DOAC users was 20.5% vs 32.4% in matched non-users (P = .002). There was no significant difference in PPV for CRC or advanced adenoma in warfarin users compared to non-users.
In a large screening cohort in Norway, regular use of aspirin and particularly DOACs, were associated with lower PPV of FIT for detection of CRCs and advanced adenomas. ClinicalTrials.gov ID NCT01538550.
粪便免疫化学检测（FIT）是目前世界范围内用于结直肠癌（CRC）筛查的最常用工具。但在筛查人群中使用阿司匹林和口服抗凝剂如何影响 FIT 的诊断性能尚不清楚。
我们在挪威正在进行的 CRC 筛查试验中进行了一项横断面研究。纳入了 FIT（>15 μg 血红蛋白/克粪便）阳性且随后行结肠镜检查（参考标准）的年龄在 50-74 岁之间的参与者。将常规使用阿司匹林、华法林或直接作用的口服抗凝剂（DOAC）的参与者定义为使用者。根据年龄、性别、筛查中心和筛查轮次，对非使用者进行匹配。主要结局是 CRC 和高级腺瘤的阳性预测值（PPV）。
在 4908 名符合条件的参与者中，有 1008 名使用阿司匹林，147 名使用华法林，212 名使用 DOAC，3541 名是非使用者。共发现 234 例 CRC 和 1305 例高级腺瘤。阿司匹林使用者 CRC 的 PPV 为 3.8%，匹配的非使用者为 6.4%（P=0.006）。阿司匹林使用者高级腺瘤的 PPV 为 27.2%，匹配的非使用者为 32.6%（P=0.011）。对于 DOAC，使用者 CRC 的 PPV 为 0.9%，匹配的非使用者为 6.8%（P=0.001）。DOAC 使用者高级腺瘤的 PPV 为 20.5%，匹配的非使用者为 32.4%（P=0.002）。与非使用者相比，华法林使用者 CRC 或高级腺瘤的 PPV 无显著差异。
在挪威的一个大型筛查队列中，常规使用阿司匹林，特别是 DOAC，与 FIT 检测 CRC 和高级腺瘤的 PPV 降低相关。ClinicalTrials.gov 注册号 NCT01538550。
