Kawamura Takuji, Amamiya Kana, Inoue Naonori, Sakiyama Naokuni, Okada Yusuke, Sanada Kasumi, Kamaguchi Mai, Nishioji Kenichi, Tanaka Kiyohito, Uno Koji, Yasuda Kenjiro
Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Department of Health Care, Kyoto Second Red Cross Hospital, Kyoto, Japan.
J Anus Rectum Colon. 2021 Oct 28;5(4):340-345. doi: 10.23922/jarc.2020-094. eCollection 2021.
There are patients who do not undergo colonoscopy even if the fecal immunochemistry test (FIT) results are positive and even with repeated positive test results the following year. We aimed to investigate colorectal cancer (CRC) risk in examinees with positive FIT results in our annual screening program.
We analyzed patients who underwent initial colonoscopy from April 2010 to March 2017 because of positive FIT results using an endoscopy database in our hospital. We investigated the difference in the risk of advanced colorectal neoplasia as a surrogate marker of CRC between those who had an initial positive test and those who had repeated positive tests.
A total of 748 patients were included in this analysis. The advanced neoplasia detection rates were 7.6% (50/656) and 18.5% (17/92) for the initial and repeated positive test groups, respectively. Subgroup analysis of those with repeated positive tests revealed that the detection rates in examinees with positive tests 1-2 and >2 years ago were 16.7% (6/36) and 19.6% (11/56), respectively. The odds ratios for advanced neoplasia detection in patients with positive tests 1-2 and >2 years ago compared with those in the initial positive test group were 2.72 (95% confidence interval [CI], 1.04-7.10) and 3.09 (95% CI, 1.47-6.48), respectively.
The risk of CRC appears more than doubled in patients with a repeated positive FIT result. Prompt colonoscopy is recommended for FIT-positive cases.
即使粪便免疫化学检测（FIT）结果呈阳性，甚至次年检测结果反复呈阳性，仍有患者未接受结肠镜检查。我们旨在调查年度筛查项目中FIT结果呈阳性的受检者患结直肠癌（CRC）的风险。
我们利用我院的内镜数据库，分析了2010年4月至2017年3月因FIT结果呈阳性而接受初次结肠镜检查的患者。我们调查了初次检测呈阳性的患者与反复检测呈阳性的患者之间，作为CRC替代标志物的晚期结直肠肿瘤发生风险的差异。
本分析共纳入748例患者。初次和反复阳性检测组的晚期肿瘤检出率分别为7.6%（50/656）和18.5%（17/92）。对反复阳性检测患者的亚组分析显示，1 - 2年前检测呈阳性和>2年前检测呈阳性的受检者的检出率分别为16.7%（6/36）和19.6%（11/56）。与初次阳性检测组相比，1 - 2年前和>2年前检测呈阳性的患者发生晚期肿瘤的比值比分别为2.72（95%置信区间[CI]，1.04 - 7.10）和3.09（95%CI，1.47 - 6.48）。
FIT结果反复呈阳性的患者患CRC的风险似乎增加了一倍多。建议对FIT阳性病例及时进行结肠镜检查。
