Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK.
eHealth, Corporate Services, Business Intelligence, NHS Greater Glasgow and Clyde, Glasgow, UK.
Int J Colorectal Dis. 2022 Feb;37(2):457-466. doi: 10.1007/s00384-021-04079-2. Epub 2021 Dec 21.
Faecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients.
A retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10-149/150-399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ test. Multivariate binary logistic regression identified independent predictors of CRC.
A total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683-142.325; p < 0.001)), and anaemia (OR 1.956 (1.071-3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC.
GP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.
粪便免疫化学测试（FIT）已被证明可用于检测有症状的患者中的结直肠癌（CRC）。大多数研究都检查了从初级保健转介的有症状患者中的 FIT。我们调查了转介和非转介有症状患者中 CRC 和 FIT 之间的关联。
对 2018 年 8 月至 2019 年 1 月在 NHS GG&C 提交的所有 FIT 患者进行了回顾性观察性研究。记录了转介给结直肠/胃肠病学和进行结肠镜检查的决定。FIT 结果分为 f-Hb<10/10-149/150-399/>=400μg/g。MCN 癌症登记处确定了新的 CRC 病例。使用 χ2 检验比较协变量。多变量二元逻辑回归确定了 CRC 的独立预测因素。
共纳入 4968 例患者。升高的 FIT 与转诊决定（p<0.001）和范围（p<0.001）相关。中位随访 23 个月，61 例患者被诊断为 CRC。这些患者年龄较大（中位数 69 岁与 59 岁，癌症和无癌症分别，p=0.001），更可能为男性（55.7%与 42.1%，p=0.033），并报告直肠出血（51.7%与 36.1%，p=0.013）。FIT（<10μg/g 8.2%与 76.7%和≥400μg/g 55.7%与 3.8%，p<0.001）和贫血（45.9%与 19.7%，p<0.001）与 CRC 相关。多变量分析显示，年龄（p=0.023）、男性（p=0.04）、FIT（≥400 OR 54.256（95%CI：20.683-142.325；p<0.001））和贫血（OR 1.956（1.071-3.574；p=0.029））独立预测 CRC。一名 FIT 阴性和血红蛋白正常的患者（0.04%）患有 CRC。
全科医生的转诊和二级保健调查模式受到 FIT 的影响。Hb 和 f-Hb 正常排除 CRC 的概率为 99.96%，这为那些优先考虑获得内镜服务的患者提供了极好的保证。
