Chen Hongda, Wang Le, Lu Ming, Zhu Chen, Zhu Yunfeng, Ma Weihua, Chen Xinmin, Du Lingbin, Chen Wanqing
Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Cancer Prevention, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences/Cancer Hospital of University of Chinese Academy of Sciences/Zhejiang Cancer Hospital, Hangzhou 310005, China.
Chin J Cancer Res. 2021 Aug 31;33(4):512-521. doi: 10.21147/j.issn.1000-9604.2021.04.08.
Integration of risk stratification into fecal immunochemical test (FIT) might aid in the suboptimal detection of advanced neoplasms by FIT in colorectal cancer (CRC) screening. A comparative study was conducted to evaluate the participation and diagnostic yield of the parallel combination of questionnaire-based risk assessment (QRA) and FIT, FIT-only and QRA-only strategies in a CRC screening program in China.
The study included 29,626 individuals aged 40-74 years and invited to participate in a CRC screening program in China. Participants were first invited to undertake QRA and one-time FIT (OC-sensor). Participants with positive QRA or FIT were deemed to be high-risk individuals who were recommended for subsequent colonoscopy. Participation, detection rate, and resource demand for colonoscopy were calculated and compared.
Of the 29,626 invitees, 20,203 completed the parallel combination, 8,592 completed the QRA-only, and 11 completed the FIT-only strategy. For the parallel combination, FIT-only, and QRA-only strategies, the overall positivity rates were 10.2% (2,928/28,806), 5.4% (1,096/20,214), and 6.8% (1,944/28,795), respectively; the yield of advanced neoplasm per 10,000 invitees were 46.9 [95% confidence interval (95% CI): 39.8-55.4], 36.8 (95% CI: 30.5-44.4), and 12.2 (95% CI: 8.8-16.8), respectively; the positive predictive values for detecting advanced neoplasms among participants who completed colonoscopy were 4.7% (95% CI: 4.0%-5.6%), 9.9% (95% CI: 8.3%-11.9%), and 1.9% (95% CI: 1.3%-2.6%), respectively; the number of colonoscopies required to detect one advanced neoplasm was 11.4 (95% CI: 9.8-13.4), 5.7 (95% CI: 4.8-6.7), and 28.4 (95% CI: 20.7-39.2), respectively.
The parallel combination of QRA and FIT did not show superior efficacy for detecting advanced neoplasm compared with FIT alone in this CRC screening program.
将风险分层纳入粪便免疫化学检测（FIT）可能有助于改善FIT在结直肠癌（CRC）筛查中对晚期肿瘤的检测效果欠佳的情况。开展了一项比较研究，以评估基于问卷的风险评估（QRA）与FIT并行组合、仅FIT和仅QRA策略在中国CRC筛查项目中的参与度和诊断率。
该研究纳入了29626名年龄在40 - 74岁之间且受邀参加中国CRC筛查项目的个体。参与者首先被邀请进行QRA和一次性FIT（OC传感器）检测。QRA或FIT呈阳性的参与者被视为高危个体，建议进行后续结肠镜检查。计算并比较了结肠镜检查的参与度、检出率和资源需求。
在29626名受邀者中，20203人完成了并行组合，8592人完成了仅QRA检测，11人完成了仅FIT策略。对于并行组合、仅FIT和仅QRA策略，总体阳性率分别为10.2%（2928/28806）、5.4%（1096/20214）和6.8%（1944/28795）；每10000名受邀者中晚期肿瘤的检出率分别为46.9 [95%置信区间（95%CI）：39.8 - 55.4]、36.8（95%CI：30.5 - 44.4）和12.2（95%CI：8.8 - 16.8）；在完成结肠镜检查的参与者中检测晚期肿瘤的阳性预测值分别为4.7%（95%CI：4.0% - 5.6%）、9.9%（95%CI：8.3% - 11.9%）和1.9%（95%CI：1.3% - 2.6%）；检测出一例晚期肿瘤所需的结肠镜检查次数分别为11.4（95%CI：9.8 - 13.4）、5.7（95%CI：4.8 - 6.7）和28.4（95%CI：20.7 - 39.2）。
在该CRC筛查项目中，与单独使用FIT相比，QRA与FIT的并行组合在检测晚期肿瘤方面未显示出更优的效果。
