Site de l'Ain, Centre Régional de Coordination des Dépistages des Cancers en Auvergne-Rhône-Alpes, Bourg-en-Bresse 01000, France.
Site de Seine-Saint-Denis, Centre Régional de Coordination des Dépistages des Cancers en Ile-de-France, Bondy 93146, France.
World J Gastroenterol. 2021 Aug 21;27(31):5272-5287. doi: 10.3748/wjg.v27.i31.5272.
The rate of positive tests using fecal immunochemical test (FIT) does not decrease with subsequent campaigns, but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test. A relationship between the fecal hemoglobin concentration (Fhb) and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.
To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.
This etiological study included 293750 patients aged 50-74, living in Auvergne-Rhône-Alpes (France). These patients completed at least two FIT [test and test] between June 2015 and December 2019. Delay between test and test was > 1 year and test result was negative (< 150 ngHb/mL). The severity of colorectal lesions diagnosed at test was described according to Fhb measured at test [Fhb]. The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.
The test positive rate was 4.0%, and the colonoscopy completion rate was 97.1% in 11594 patients who showed a positive test. The colonoscopy detection rate was 77.7% in those 11254 patients who underwent a colonoscopy. A total of 8748 colorectal lesions were detected (including 2182 low-risk-polyps, 2400 high-risk-polyp, and 502 colorectal cancer). The colonoscopy detection rate varied significantly with Fhb [0 ngHb/mL: 75.6%, (0-50 ngHb/mL): 77.3%, (50-100 ngHb/mL): 88.7%, (100-150 ngHb/mL): 90.3%; = 0.001]. People with a Fhb within (100-150 ngHb/mL) ( = 0.001) were 2.6 (2.2; 3.0) times more likely to have a high severity level compared to those having a Fhb value of zero. This risk was reduced by 20% in patients aged 55-59 compared to those aged < 55 [adjusted odds ratio: 0.8 (0.6; 1.0)].
The study showed that higher Fhb is correlated to an increased risk of severity of colorectal lesions. This risk of severity increased among first-time participants (age < 55) and the elderly (≥ 70). To avoid the loss of chance in these age groups, the FIT positivity threshold should be reduced to 100 ngHb/mL. The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.
粪便免疫化学检测（FIT）的阳性检出率不会随着后续的筛查活动而降低，但首次阴性检测后，后续筛查活动中高级别肿瘤的阳性预测值会显著降低。粪便血红蛋白浓度（Fhb）与后续筛查中发现结直肠癌的机会之间存在一定关系。
根据既往结直肠癌筛查活动中测量的 Fhb 值，预测结直肠病变的严重程度。
本病因研究纳入了年龄在 50-74 岁的 293750 名居住在奥弗涅-罗讷-阿尔卑斯大区（法国）的患者。这些患者在 2015 年 6 月至 2019 年 12 月期间至少完成了两次 FIT[测试和测试]。两次测试之间的间隔时间大于 1 年，且测试结果为阴性（<150ngHb/mL）。在测试中根据测试时测量的 Fhb[Fhb]描述结直肠病变的严重程度。采用有序多分类多项式回归模型分析了严重程度分为七个有序类别与预测因素之间的关系。
在 11594 名阳性检测患者中，阳性检测率为 4.0%，结肠镜检查完成率为 97.1%。在接受结肠镜检查的 11254 名患者中，结肠镜检查的检出率为 77.7%。共检出 8748 处结直肠病变（包括 2182 处低风险息肉、2400 处高风险息肉和 502 处结直肠癌）。Fhb[0ngHb/mL：75.6%（0-50ngHb/mL）：77.3%（50-100ngHb/mL）：88.7%（100-150ngHb/mL）：90.3%]与结肠镜检查检出率差异有统计学意义（ = 0.001）。Fhb 值在（100-150ngHb/mL）范围内的患者（ = 0.001）与 Fhb 值为零的患者相比，发生严重程度较高的风险增加 2.6 倍（2.2-3.0）。与年龄<55 岁的患者相比，55-59 岁的患者的风险降低 20%（调整优势比：0.8（0.6-1.0））。
该研究表明，较高的 Fhb 值与结直肠病变严重程度的风险增加相关。这种严重程度的风险在首次参与筛查的人群（年龄<55 岁）和老年人（≥70 岁）中增加。为避免在这些年龄组中错失机会，FIT 阳性截断值应降低至 100ngHb/mL。另一种选择是将这些年龄组中两次检测之间的时间间隔从目前的 2 年缩短至 1 年。
