Division of Biostatistics, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
Gut. 2021 Jul;70(7):1318-1324. doi: 10.1136/gutjnl-2020-320761. Epub 2020 Sep 28.
Subjects with a positive faecal immunochemical test (FIT) have a much higher likelihood of advanced neoplasms than the general population. Whether FIT-positive subjects with negative colonoscopy should receive subsequent FIT screening remain unclear.
Subjects with a negative colonoscopy after positive FIT in the first screening in the Taiwanese Colorectal Cancer (CRC) Screening Program 2004-2009 were followed until the end of 2014. CRC incidence was compared between those who did and did not receive subsequent FIT screening. Cox regression analysis was conducted, adjusting for major confounders to investigate whether subsequent FIT was associated with lower risk of incident CRC.
The study cohort was comprised of 9179 subjects who had negative diagnostic colonoscopy after positive FIT in 2004-2009, of whom 6195 received subsequent FIT during the study period. The CRC incidence (per 1000 person years) was 1.34 in those who received subsequent FIT and 2.69 in those who did not, with corresponding adjusted HR (aHR) of 0.47 (95% CI 0.31 to 0.71). Lower adenoma detection rate of diagnostic colonoscopy was associated with higher risk of incident CRC but became non-significant in multivariable analysis after adjustment for subsequent FIT. Higher baseline faecal haemoglobin concentration (FHbC, μg haemoglobin/g faeces) was associated with increased risk of incident CRC (reference: FHbC=20-39; aHR=1.93 (1.04-3.56), 0.95 (0.45-2.00), 2.26 (1.16-4.43) and 2.44 (1.44-4.12) for FHbC=40-59, 60-99, 100-149 and ≥150, respectively).
Subsequent FIT should be scheduled after negative colonoscopy to detect missed neoplasms and reduce the risk of incident CRC in a national FIT screening programme.
粪便免疫化学检测（FIT）阳性的受试者发生高级别肿瘤的可能性远高于一般人群。对于 FIT 阳性但结肠镜检查阴性的患者，是否应进行后续 FIT 筛查仍不清楚。
对 2004-2009 年台湾结直肠癌筛查计划中首次筛查 FIT 阳性但结肠镜检查阴性的患者进行随访，直至 2014 年底。比较接受和未接受后续 FIT 筛查的患者的结直肠癌发病率。采用 Cox 回归分析，调整主要混杂因素，探讨是否接受后续 FIT 与结直肠癌发病风险降低有关。
研究队列包括 9179 名 2004-2009 年 FIT 阳性但结肠镜检查阴性的患者，其中 6195 名在研究期间接受了后续 FIT 检查。接受后续 FIT 检查的患者 CRC 发病率（每 1000 人年）为 1.34，未接受后续 FIT 检查的患者为 2.69，相应的调整后 HR（aHR）为 0.47（95%CI 0.31-0.71）。诊断性结肠镜检查的腺瘤检出率较低与 CRC 发病风险增加相关，但在调整后续 FIT 后，多变量分析结果无统计学意义。较高的基线粪便血红蛋白浓度（FHbC，μg 血红蛋白/粪便）与 CRC 发病风险增加相关（参考：FHbC=20-39；aHR=1.93（1.04-3.56），0.95（0.45-2.00），2.26（1.16-4.43）和 2.44（1.44-4.12），对于 FHbC=40-59、60-99、100-149 和≥150，分别）。
在全国性的 FIT 筛查计划中，对于结肠镜检查阴性的患者，应安排后续的 FIT 检查，以发现漏诊的肿瘤并降低 CRC 发病风险。
