Department of Surgery, Kuopio University Hospital and School of Medicine, University of Eastern Finland, Kuopio, Finland.
Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil.
Anticancer Res. 2020 Jul;40(7):3591-3604. doi: 10.21873/anticanres.14349.
BACKGROUND/AIM: Noninvasive fecal occult blood tests (FOBTs) are recommended by current guidelines for colorectal cancer (CRC) screening. Our aim was to assess the diagnostic performance of traditional guaiac-based FOBTs (gFOBT) and new-generation immunochemical FOBTs (iFOBT) in CRC screening by carrying out a systematic review and meta-analysis.
PubMed, Embase, Cochrane Library, and Web of Science were searched for eligible articles published before February 17, 2020. Three independent investigators conducted study assessment and data extraction. Diagnosis-related indicators for use of FOBTs in the detection of CRC (as the endpoint) in a screening setting were summarized, and further stratified by the type of FOBT (gFOBT vs. iFOBT). STATA software was used to conduct the meta-analysis. Pooled sensitivities and specificities were calculated using a random-effects model. Hierarchical summary receiver operating characteristic curves were plotted and area under the curves (AUC) were calculated.
The electronic search identified 573 records after duplicates were removed, of which 75 full-text articles were assessed for eligibility. Finally, a total of 31 studies were eligible for the meta-analysis. In the ROC comparison test, there was a statistically significant difference in the performance of gFOBT and iFOBT tests, with AUC=0.77 (95% confidence intervaI=0.75-0.79) and AUC=0.87 (95% confidence intervaI=0.85-0.88), respectively (p=0.0017). In formal meta-regression, test brand did not prove to be a significant study-level covariate that would explain the observed heterogeneity between the studies.
New-generation iFOBTs were found to have a significantly higher diagnostic performance as compared with gFOBTs, advocating the use of only fecal immunochemical tests in all newly implemented CRC screening programs.
背景/目的：目前的指南建议使用非侵入性粪便潜血检测（FOBT）进行结直肠癌（CRC）筛查。我们的目的是通过系统评价和荟萃分析评估传统愈创木脂FOBT（gFOBT）和新一代免疫化学FOBT（iFOBT）在 CRC 筛查中的诊断性能。
检索了 2020 年 2 月 17 日前发表的符合条件的 PubMed、Embase、Cochrane 图书馆和 Web of Science 文章。三名独立的调查员进行了研究评估和数据提取。总结了用于检测 CRC（作为终点）的 FOBT 检测的诊断相关指标，并进一步按 FOBT 类型（gFOBT 与 iFOBT）进行分层。使用 STATA 软件进行荟萃分析。使用随机效应模型计算汇总敏感性和特异性。绘制分层汇总受试者工作特征曲线并计算曲线下面积（AUC）。
电子搜索去除重复项后共识别出 573 条记录，其中有 75 篇全文文章进行了合格性评估。最终，共有 31 项研究符合荟萃分析的条件。在 ROC 比较检验中，gFOBT 和 iFOBT 检测的性能存在统计学显著差异，AUC 分别为 0.77（95%置信区间为 0.75-0.79）和 0.87（95%置信区间为 0.85-0.88）（p=0.0017）。在正式的 meta 回归中，检测品牌并未被证明是一个显著的研究水平协变量，无法解释研究之间的观察到的异质性。
与 gFOBT 相比，新一代 iFOBT 的诊断性能明显更高，因此提倡在所有新实施的 CRC 筛查计划中仅使用粪便免疫化学检测。
