Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
White River Junction VAMC.
Cancer Prev Res (Phila). 2022 Jul 5;15(7):455-464. doi: 10.1158/1940-6207.CAPR-21-0581.
Few studies compare fecal immunochemical test (FIT) and multi-target stool DNA (mt-sDNA) outcomes in practice. We compared colonoscopy yield following FIT+ or mt-sDNA+ tests to colonoscopies without preceding stool tests in the comprehensive population-based New Hampshire Colonoscopy Registry (NHCR). Outcomes were any neoplasia and an ordered outcome: adenocarcinoma, advanced neoplasia (adenoma/serrated polyp ≥ 1 cm/villous/high-grade dysplasia), nonadvanced neoplasia, or normal. Our total sample included 306 mt-sDNA+ (average age ± SD 67.0 ± 7.9), 276 FIT+ (66.6 ± 8.7), and 50,990 colonoscopy-only patients (61.8 ± 8.1). Among average-risk patients (N = 240 mt-sDNA+, N = 194 FIT+, N = 26,221 colonoscopy only), mt-sDNA+ patients had a higher risk for any neoplasia (67.1%) compared with FIT+ (54.6%, P = 0.00098) or colonoscopy (40.8%, P < 0.0001). Severity of findings and histology subtypes differed across the three groups (P < 0.0001 for both), with a higher yield of advanced findings in mt-sDNA+ patients. In particular, clinically relevant serrated polyps (hyperplastic polyps ≥10 mm/traditional serrated adenomas/sessile serrated polyps) were detected at a higher frequency in mt-sDNA+ patients as compared with FIT+ or colonoscopy-only patients. Even after adjustment, patients with positive mt-sDNA [OR = 2.82; 95% confidence interval (CI), 2.00-4.02] or FIT+ tests (OR = 1.67; 95% CI, 1.19-2.36) were more likely to have histologically more advanced findings than colonoscopy alone. At follow-up colonoscopy, mt-sDNA+ tests were more likely to predict neoplasia than FIT+, largely due to increased detection of serrated polyps. Prevention Relevance: Colorectal cancer screening options include colonoscopy and stool-based tests, including the fecal immunochemical test (FIT) and the multi-target stool DNA (mt-sDNA) test which, if positive, must be followed by a colonoscopy. Assessing "real-world" outcomes of colonoscopies following positive stool tests can inform their clinical use. See related Spotlight, p. 417.
很少有研究比较粪便免疫化学检测（FIT）和多靶点粪便 DNA（mt-sDNA）在实际中的结果。我们比较了在综合人群为基础的新罕布什尔州结肠镜检查登记处（NHCR）中，FIT+或 mt-sDNA+检测后行结肠镜检查与未行粪便检测的结肠镜检查的结果。结果为任何肿瘤和有序结果：腺癌、高级别肿瘤（腺瘤/锯齿状息肉≥1cm/绒毛状/高级别异型增生）、非高级别肿瘤或正常。我们的总样本包括 306 例 mt-sDNA+（平均年龄±SD 67.0±7.9）、276 例 FIT+（66.6±8.7）和 50990 例仅行结肠镜检查的患者（61.8±8.1）。在平均风险患者中（N=240 例 mt-sDNA+，N=194 例 FIT+，N=26221 例仅行结肠镜检查），mt-sDNA+患者的任何肿瘤风险高于 FIT+（54.6%，P=0.00098）或仅行结肠镜检查（40.8%，P<0.0001）。三组间发现的严重程度和组织学亚型不同（均 P<0.0001），mt-sDNA+患者的高级别发现发生率更高。特别是，在 mt-sDNA+患者中，临床上相关的锯齿状息肉（增生性息肉≥10mm/传统锯齿状腺瘤/无蒂锯齿状息肉）的检出率高于 FIT+或仅行结肠镜检查的患者。即使调整后，mt-sDNA 阳性[比值比（OR）=2.82；95%置信区间（CI），2.00-4.02]或 FIT+检测阳性的患者[OR=1.67；95%CI，1.19-2.36]的组织学更高级别发现的可能性也高于仅行结肠镜检查的患者。在随访结肠镜检查中，mt-sDNA+检测比 FIT+更能预测肿瘤，这主要是由于锯齿状息肉的检出率增加。预防相关性：结直肠癌筛查选择包括结肠镜检查和基于粪便的检测，包括粪便免疫化学检测（FIT）和多靶点粪便 DNA（mt-sDNA）检测，如果阳性，必须进行结肠镜检查。评估阳性粪便检测后结肠镜检查的“真实世界”结果可以为其临床应用提供信息。另见相关重点文章，第 417 页。
