粪便免疫化学试验对结直肠癌生存的影响。
Impact of the faecal immunochemical test on colorectal cancer survival.
机构信息
Osakidetza, OSI Donostialdea, Altza Primary Care; Biodonostia Health Research Institute, San Sebastián, Spain.
Biodonostia Health Research Institute, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain.
出版信息
BMC Cancer. 2020 Jul 1;20(1):616. doi: 10.1186/s12885-020-07074-y.
BACKGROUND
There is already evidence that the faecal immunochemical test (FIT) is a useful tool for the diagnosis of colorectal cancer (CRC) that helps to identify symptomatic patients requiring early colonoscopy. Although the recommendation to use FIT is widely accepted, there are no data concerning whether this strategy improves patient survival.The objective was to assess whether the survival is higher if CRC patients have been first diagnosed by FIT (as compared with the rest of patients with CRC).
METHODS
We identified all cases of CRC diagnosed between 2009 and 2016 in Donostialdea (Spain), excluding all the CRC detected in population screening. We focused on symptomatic patients. One thousand five hundred twenty-seven cases of CRC were divided into two groups based on the route to diagnosis: group 1: individuals who tested positive in a FIT during the year before diagnosis, and group 2: others.Survival was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for differences between groups due to other variables associated with survival.
RESULTS
One thousand nine hundred sixty-seven cases of invasive CRC were identified, of which 22.4% were detected in population screening. Of the 1527 cases diagnosed in symptomatic patients, 317 patients had undergone a FIT in the year before the diagnosis of CRC. In 279 cases(18.3%), the result had been positive and this was the first step towards their CRC diagnosis (group 1). Group 2 was composed of the 1248 cases of CRC (81.7%). Considering these cases, 1210 patients with CRC did not undergo any FIT while 38 patients presented a negative result in the year before the diagnosis. The rate of early-stage disease (stage I or II) was higher in group 1 (51.3% vs 45.5% in group 2) (p = 0.04). Furthermore, the 3-year survival was longer in group 1 (72% vs 59% in group 2) (HR 1.50; 95% CI 1.22-1.84).The variables independently associated with worse survival were: group 2, age > 70 years and stage at the moment of diagnosis.
CONCLUSIONS
The use of FIT as a diagnostic strategy in symptomatic patients may improve survival in CRC. Nonetheless,FIT is still not widely used in our region.
背景
粪便免疫化学检测（FIT）已被证实为一种用于结直肠癌（CRC）诊断的有用工具，有助于发现需要早期结肠镜检查的有症状患者。尽管广泛推荐使用 FIT，但尚无数据表明该策略是否能提高患者的生存率。本研究旨在评估如果 CRC 患者首先通过 FIT（与其余 CRC 患者相比）进行诊断，其生存率是否更高。
方法
我们在西班牙的 Donostialdea 地区确定了 2009 年至 2016 年间诊断的所有 CRC 病例，排除了所有在人群筛查中发现的 CRC。我们专注于有症状的患者。根据诊断途径将 1527 例 CRC 病例分为两组：组 1：在诊断前一年 FIT 检测呈阳性的个体；组 2：其他个体。通过 Kaplan-Meier 估计和对数秩检验评估生存情况。使用 Cox 回归模型来调整因与生存相关的其他变量而导致的组间差异。
结果
共确定了 1967 例侵袭性 CRC 病例，其中 22.4%在人群筛查中发现。在 1527 例诊断为有症状的患者中，有 317 例在 CRC 诊断前一年接受了 FIT 检测。在 279 例（18.3%）中，结果呈阳性，这是他们 CRC 诊断的第一步（组 1）。组 2 由 1248 例 CRC 组成（81.7%）。考虑到这些病例，1210 例 CRC 患者未进行任何 FIT 检测，而 38 例患者在诊断前一年的检测结果为阴性。组 1 中早期疾病（I 期或 II 期）的比例更高（51.3% vs 组 2 的 45.5%）（p=0.04）。此外，组 1 的 3 年生存率更长（72% vs 组 2 的 59%）（HR 1.50；95%CI 1.22-1.84）。与生存率较差相关的独立变量为：组 2、年龄>70 岁和诊断时的分期。
结论
在有症状的患者中使用 FIT 作为诊断策略可能会提高 CRC 的生存率。然而，在我们的地区，FIT 尚未广泛使用。
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