Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.
Division of Gastroenterology and Hepatology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Clin Gastroenterol Hepatol. 2021 Jul;19(7):1344-1354.e8. doi: 10.1016/j.cgh.2020.09.048. Epub 2020 Oct 1.
BACKGROUND & AIMS: Colonoscopy is required following a positive fecal screening test for colorectal cancer (CRC). It remains unclear to what extent time to colonoscopy is associated with CRC-related outcomes. We performed a systematic review to elucidate this relationship.
An electronic search was performed through April 2020 for studies reporting associations between time from positive fecal testing to colonoscopy and outcomes including CRC incidence (primary outcome), CRC stage at diagnosis, and/or CRC-specific mortality. Our primary objective was to quantify these relationships following positive fecal immunochemical testing (FIT). Two authors independently performed screening, abstraction, and risk of bias assessments.
From 1,612 initial studies, 8 were included in the systematic review, with 5 reporting outcomes for FIT. Although meta-analysis was not possible, consistent trends between longer time delays and worse outcomes were apparent in all studies. Colonoscopy performed beyond 9 months from positive FIT compared to within 1 month was significantly associated with a higher incidence of CRC, with adjusted odds ratios (AORs) of 1.75 and 1.48 in the two largest studies. These studies also reported significant associations between colonoscopy performed beyond 9 months and higher incidence of advanced stage CRC (stage III or IV) at diagnosis, with AORs of 2.79 and 1.55, respectively.
Colonoscopy for positive FIT should not be delayed beyond 9 months. Given the additional time required for urgent referrals and surgical planning for CRC, colonoscopy should ideally be performed well in advance of 9 months following a positive FIT.
结直肠癌（CRC）粪便筛查阳性后需要行结肠镜检查。目前尚不清楚结肠镜检查的时间与 CRC 相关结局之间存在何种关联。我们进行了一项系统综述，以阐明这种关系。
通过电子检索，于 2020 年 4 月前检索了报告粪便免疫化学检测（FIT）阳性后，从阳性粪便检测到结肠镜检查的时间与 CRC 发病率（主要结局）、诊断时的 CRC 分期和/或 CRC 特异性死亡率等结局之间关联的研究。我们的主要目的是量化 FIT 阳性后这些关联。两名作者独立进行了筛选、提取和偏倚风险评估。
从最初的 1612 项研究中，有 8 项研究被纳入系统综述，其中 5 项研究报告了 FIT 的结局。尽管无法进行荟萃分析，但所有研究都显示出较长时间延迟与较差结局之间的一致趋势。与 FIT 阳性后 1 个月内相比，结肠镜检查超过 9 个月进行与 CRC 发病率升高显著相关，两项最大的研究中调整后的优势比（AOR）分别为 1.75 和 1.48。这两项研究还报告了结肠镜检查超过 9 个月与诊断时更高的晚期 CRC（III 期或 IV 期）发生率之间存在显著关联，AOR 分别为 2.79 和 1.55。
对于 FIT 阳性的患者，结肠镜检查不应延迟超过 9 个月。鉴于 CRC 需要紧急转诊和手术计划，因此理想情况下，在 FIT 阳性后 9 个月之前，应尽早进行结肠镜检查。
