前一年粪便免疫化学检测筛查结果为阴性的参与者中通过该检测筛查出的晚期结直肠癌的特征。
Characteristics of Advanced Colorectal Cancer Detected by Fecal Immunochemical Test Screening in Participants with a Negative Result the Previous Year.
作者信息
Hasegawa Ryosuke, Yashima Kazuo, Ikebuchi Yuichiro, Sasaki Shuji, Yoshida Akira, Kawaguchi Koichiro, Isomoto Hajime
机构信息
Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504 Japan.
出版信息
Yonago Acta Med. 2020 Feb 20;63(1):63-69. doi: 10.33160/yam.2020.02.009. eCollection 2020 Feb.
BACKGROUND
There is sufficient evidence to show the mortality reduction effect of colorectal cancer (CRC) screening programs using the fecal occult blood test (FOBT). However, we see cases that are found to be advanced CRC despite yearly FOBT screening.
METHODS
The aim of this study was to investigate the characteristics of advanced CRC detected by a fecal immunochemical test (FIT) screening program in participants with a negative screening result the previous year, which we call "Negative advanced CRC". A total of 109,639 participants (10.0% required colonoscopy, of whom 76.9% received one) underwent a CRC screening program using a FIT from fiscal 2009 to 2017. Negative advanced CRC was compared with advanced CRC (First advanced CRC) found at the first visit in a person who had not had a FIT screening history for more than 3 years. In addition, we compared the characteristics of Negative advanced CRC with those of interval cancer: cancer cases detected after a negative screening result and before the date of the next recommended screening.
RESULTS
A total of 339 cases of CRC (175 male: 164 female, 173 early stage: 166 advanced stage) were detected in the nine-year CRC screening period. The rate of right-sided CRCs was significantly higher in female ( < 0.01), advanced stage ( < 0.01), negative result previous year ( < 0.01), and symptom-negative ( < 0.01) participants than in each counterpart, respectively. The ratio of female (22/35; 62.9%) patients in Negative advanced CRCs tended to be high compared with that (40/83; 48.2%) in First advanced CRCs ( = 0.145). Overall, 22 (62.9%) of 35 Negative advanced CRCs and 28 (33.7%) of 83 First advanced CRCs were located in the right-sided colon, and the rate was significantly higher in Negative advanced CRCs ( < 0.01). In addition, the frequency of female patients was significantly higher in right-sided Negative advanced CRCs than in right-sided First advanced CRCs ( = 0.03).
CONCLUSION
The characteristics of Negative advanced CRC cases (female and right-sided colon) were similar to those of interval cancer reported so far. In the future, it will be necessary to introduce a screening program that is highly sensitive to right-sided CRC.
背景
有充分证据表明使用粪便潜血试验（FOBT）的结直肠癌（CRC）筛查项目具有降低死亡率的效果。然而，我们发现尽管每年进行FOBT筛查，仍有一些病例被诊断为晚期CRC。
方法
本研究的目的是调查在前一年筛查结果为阴性的参与者中，通过粪便免疫化学试验（FIT）筛查项目检测出的晚期CRC的特征，我们将其称为“阴性晚期CRC”。2009财年至2017年期间，共有109,639名参与者（10.0%需要进行结肠镜检查，其中76.9%接受了检查）接受了使用FIT的CRC筛查项目。将阴性晚期CRC与在未进行FIT筛查超过3年的首次就诊时发现的晚期CRC（首次晚期CRC）进行比较。此外，我们还比较了阴性晚期CRC与间期癌的特征：在筛查结果为阴性后且在下一次推荐筛查日期之前检测到的癌症病例。
结果
在为期九年的CRC筛查期间，共检测到339例CRC（男性175例：女性164例，早期173例：晚期166例）。右侧CRC的发生率在女性（<0.01）、晚期（<0.01）、前一年结果为阴性（<0.01）和无症状（<0.01）的参与者中分别显著高于各自对应的参与者。阴性晚期CRC中的女性患者比例（22/35；62.9%）与首次晚期CRC中的女性患者比例（40/83；48.2%）相比有升高趋势（=0.145）。总体而言，35例阴性晚期CRC中有22例（62.9%）位于右侧结肠，83例首次晚期CRC中有28例（33.7%）位于右侧结肠上。阴性晚期CRC的发生率显著更高（<0.01）。此外，右侧阴性晚期CRC中的女性患者频率显著高于右侧首次晚期CRC中的女性患者频率（=0.03）。
结论
阴性晚期CRC病例（女性和右侧结肠）的特征与迄今为止报道的间期癌相似。未来，有必要引入对右侧CRC高度敏感的筛查项目。
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