Jung Yoon Suk, Lee Jinhee, Lee Hye Ah, Moon Chang Mo
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 03181 Seoul, Korea.
Department of Endocrinology and Metabolism, Ajou University School of Medicine, 16499 Suwon, Korea.
J Clin Med. 2020 Oct 14;9(10):3302. doi: 10.3390/jcm9103302.
The potential role of the fecal immunochemical test (FIT) in individuals with a family history of colorectal cancer (CRC) remains unclear. We assessed interval cancer rate (ICR) after the FIT and FIT diagnostic performance according to family history of CRC.
Using the Korean National Cancer Screening Program Database, we collected data on subjects who underwent the FIT between 2009 and 2011. The interval cancer rate (ICR) was defined as the number of subjects diagnosed with CRC within 1 year after the FIT per 1000 subjects with negative FIT results.
Of 5,643,438 subjects, 224,178 (3.97%) had a family history of CRC. FIT positivity rate (6.4% vs. 5.9%; adjusted relative risk (aRR) 1.11; 95% confidence interval (CI) 1.09-1.13) and ICR (1.4 vs. 1.1; aRR 1.43 (95% CI 1.27-1.60)) were higher in these subjects than in those with no such history. These results were the same regardless of whether subjects had undergone colonoscopy within the last 5 years before the FIT. However, the diagnostic performance of the FIT for CRC, as measured using the area under the operating characteristic curve, was similar between subjects without a family history and those with one (85.5% and 84.6%, respectively; = 0.259).
the FIT was 1.4 times more likely to miss CRC in subjects with a family history than in those without (aRR 1.43 for ICR), although its diagnostic performance was similar between the two groups. Our results suggest that for individuals with a family history of CRC, colonoscopy should be preferred over FIT for both screening and surveillance.
粪便免疫化学检测（FIT）在有结直肠癌（CRC）家族史个体中的潜在作用仍不明确。我们根据CRC家族史评估了FIT后的间期癌症发生率（ICR）以及FIT的诊断性能。
利用韩国国家癌症筛查项目数据库，我们收集了2009年至2011年间接受FIT检查的受试者的数据。间期癌症发生率（ICR）定义为每1000名FIT结果为阴性的受试者中，在FIT后1年内被诊断为CRC的受试者数量。
在5643438名受试者中，224178名（3.97%）有CRC家族史。这些受试者的FIT阳性率（6.4%对5.9%；调整相对风险（aRR）1.11；95%置信区间（CI）1.09 - 1.13）和ICR（1.4对1.1；aRR 1.43（95%CI 1.27 - 1.60））高于无此类家族史的受试者。无论受试者在FIT前最后5年内是否接受过结肠镜检查，结果均相同。然而，使用操作特征曲线下面积衡量的FIT对CRC的诊断性能，在无家族史和有家族史的受试者之间相似（分别为85.5%和84.6%；P = 0.259）。
有家族史的受试者漏诊CRC的可能性是无家族史受试者的1.4倍（ICR的aRR为1.43），尽管两组之间其诊断性能相似。我们的结果表明，对于有CRC家族史的个体，在筛查和监测方面，结肠镜检查应优于FIT。
