Kim Byung Chang, Kang Minjoo, Park Eunjung, Shim Jeong-Im, Kang Shinhee, Lee Jessie, Tchoe Ha Jin, Kong Kyeong Ae, Kim Duk Hwan, Kim Yu Jin, Choi Kui Son, Moon Chang Mo
Center for Colorectal Cancer, Center for Cancer Prevention and Detection, Cancer Epidemiology Branch, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do 10408, Korea.
National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea.
J Clin Med. 2020 Jan 18;9(1):260. doi: 10.3390/jcm9010260.
Background The compliance with the follow-up examination after a positive fecal occult blood test (FOBT) is lower than expected. We aimed to evaluate the adherence rate to the follow-up examination in patients with a positive FOBT and to identify the clinical factors associated with this adherence.
The study population comprised adults aged ≥50 years who participated in the National Cancer Screening Program for colorectal cancer (CRC) in 2013. Compliance was defined as undergoing follow-up examination within 1 year of a positive FOBT.
From 214,131 individuals with a positive FOBT, 120,911 (56.5%) were in the compliance group and 93,220 (43.5%) were in the non-compliance group. On multivariate analysis, good compliance was associated with men (odds ratio (OR) = 1.12, 95% confidence interval (CI) (1.09-1.15)), younger ages (70-79 years, OR = 2.19 (2.09-2.31); 60-69 years, OR = 3.29 (3.13-3.46); 50-59 years, OR = 3.57 (3.39-3.75) vs. >80 years), previous experience of CRC screening (a negative FOBT, OR = 1.18 (1.15-1.21); a positive FOBT, OR = 2.42 (2.31-2.54)), absent previous experience of colonoscopy or barium enema (OR = 2.06 (1.99-2.13)), higher economic income (quartile, 75%, OR = 1.14 (1.11-1.17); 100%, OR = 1.22 (1.19-1.25)), current smokers (OR = 1.12 (1.09-1.15)), alcohol intake (OR = 1.03 (1.01-1.05)), active physical activity (≥3 times/week, OR = 1.13 (1.11-1.15)), depression (OR = 1.11 (1.08-1.14)), and present comorbidities (Charlson Comorbidity Index, ≥1).
This study identified clinical factors, namely, male, younger ages, prior experience of fecal test, absent history of colonoscopy or double-contrast barium enema (DCBE) within 5 years, and high socioeconomic status to be associated with good adherence to the follow-up examination after a positive FOBT.
背景 粪便潜血试验（FOBT）呈阳性后进行后续检查的依从性低于预期。我们旨在评估FOBT阳性患者进行后续检查的依从率，并确定与该依从性相关的临床因素。
研究人群包括2013年参加全国结直肠癌（CRC）癌症筛查项目的年龄≥50岁的成年人。依从性定义为在FOBT阳性后1年内接受后续检查。
在214,131名FOBT阳性个体中，120,911名（56.5%）属于依从组，93,220名（43.5%）属于非依从组。多因素分析显示，良好的依从性与男性（比值比（OR）=1.12，95%置信区间（CI）（1.09 - 1.15））、较年轻年龄（70 - 79岁，OR = 2.19（2.09 - 2.31）；60 - 69岁，OR = 3.29（3.13 - 3.46）；50 - 59岁，OR = 3.57（3.39 - 3.75）对比>80岁）、既往CRC筛查经历（FOBT阴性，OR = 1.18（1.15 - 1.21）；FOBT阳性，OR = 2.42（2.31 - 2.54））、既往无结肠镜检查或钡灌肠经历（OR = 2.06（1.99 - 2.13））、较高经济收入（四分位数，75%，OR = 1.14（1.11 - 1.17）；100%，OR = 1.22（1.19 - 1.25））、当前吸烟者（OR = 1.12（1.09 - 1.15））、饮酒（OR = 1.03（1.01 - 1.05））、积极的体育活动（≥3次/周，OR = 1.13（1.11 - 1.15））、抑郁（OR = 1.11（1.08 - 1.14））以及存在合并症（Charlson合并症指数，≥1）有关。
本研究确定了临床因素，即男性、较年轻年龄、既往粪便检查经历、5年内无结肠镜检查或双对比钡灌肠（DCBE）病史以及较高的社会经济地位与FOBT阳性后对后续检查的良好依从性相关。
