Li Ji-Bin, Qiu Zhi-Yu, Deng Yu-Xiang, Li Yin, Lin Zhuo-Chen, Wu Yan-Ping, Weng Fan, Tian Huan, Ou Qing-Jian, Gong Cheng-Hua, Pan Zhi-Zhong, Wan De-Sen, Peng Jian-Hong, Fang Yu-Jing
Sun Yat-sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, People's Republic of China.
Discov Oncol. 2022 Jan 8;13(1):4. doi: 10.1007/s12672-022-00463-8.
The positive predictive value (PPV) of high risk factor questionnaire (HRFQ) plus fecal immunochemical test (FIT) as preliminary screening strategy for colorectal-related neoplasia is relatively low. We aim to explore independent factors associated with PPVs of HRFQ combined FIT for selecting high risk individuals for colonoscopy.
A total of 6971 residents were enrolled in a community-based screening program. Participants who had positive results of HRFQ and/or FIT and subsequently received colonoscopy were involved. The associations of socio-demographic factors, lifestyle behaviors, and high risk factors of colorectal cancer with PPVs of HRFQ, FIT, and their combination were evaluated by multivariable logistic regression models.
Among 572 involved cases, 249 (43.5%) colorectal neoplasms were detected by colonoscopy, including 71 advanced adenoma (12.4%) and 9 colorectal cancer (CRC) (1.6%). The PPVs of preliminary screening were 43.5% for total colorectal neoplasms, 14.0% for advanced neoplasm, and 1.6% for CRC. Adding positive HRFQ to FIT could improve the PPV from 3.5 to 8.0% for detecting CRC. Preliminarily screened positive individuals who were males [adjusted odds ratio (AOR): 1.95, 95% CI 1.31, 2.90; p < 0.001], elders (> 60 years) (AOR: 1.70, 95% CI 1.17, 2.46; p = 0.005), or ex-/current smokers (AOR: 3.04, 95% CI 1.31, 7.09; p = 0.10) had higher odds of PPVs of detecting colorectal neoplasms.
Combining HRFQ and FIT could largely improve PPVs for screening advanced neoplasm and CRC. Gender and age-specific FIT cut-off values as well as initiating ages for CRC screening might be recommended to improve the accuracy and effectiveness of current screening algorithm.
高风险因素问卷（HRFQ）联合粪便免疫化学检测（FIT）作为结直肠相关肿瘤的初步筛查策略，其阳性预测值（PPV）相对较低。我们旨在探讨与HRFQ联合FIT的PPV相关的独立因素，以筛选出适合结肠镜检查的高风险个体。
共有6971名居民参加了一项基于社区的筛查项目。纳入那些HRFQ和/或FIT结果为阳性且随后接受结肠镜检查的参与者。通过多变量逻辑回归模型评估社会人口统计学因素、生活方式行为以及结直肠癌高风险因素与HRFQ、FIT及其组合的PPV之间的关联。
在572例纳入病例中，结肠镜检查发现249例（43.5%）结直肠肿瘤，包括71例高级别腺瘤（12.4%）和9例结直肠癌（CRC）（1.6%）。初步筛查的PPV对于总的结直肠肿瘤为43.5%，对于高级别肿瘤为14.0%，对于CRC为1.6%。将HRFQ阳性结果添加到FIT中，检测CRC的PPV可从3.5%提高到8.0%。初步筛查为阳性的男性个体[调整优势比（AOR）：1.95，95%置信区间1.31，2.90；p＜0.001]、老年人（＞60岁）（AOR：1.70，95%置信区间1.17，2.46；p = 0.005）或曾经/现在吸烟者（AOR：3.04，95%置信区间1.31，7.09；p = 0.010）检测到结直肠肿瘤的PPV几率更高。
联合HRFQ和FIT可大幅提高筛查高级别肿瘤和CRC的PPV。可能建议针对性别和年龄设定FIT临界值以及CRC筛查的起始年龄，以提高当前筛查算法的准确性和有效性。
