Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Gut. 2023 Jan;72(1):101-108. doi: 10.1136/gutjnl-2022-327188. Epub 2022 May 10.
To examine the prognostic potential of repeated faecal haemoglobin (F-Hb) concentration measurements in faecal immunochemical test (FIT)-based screening for colorectal cancer (CRC).
Prognostic model.
Dutch biennial FIT-based screening programme during 2014-2018.
265 881 participants completing three rounds of FIT, with negative test results (F-Hb <47 µg Hb/g faeces) in rounds 1 and 2.
Colonoscopy follow-up in participants with a positive FIT (F-Hb ≥47 µg Hb/g faeces).
We evaluated prognostic models for detecting advanced neoplasia (AN) and CRC in round 3, with as predictors, participant age, sex, F-Hb in rounds 1 and 2, and categories/combinations/non-linear transformations of F-Hb. Primary evaluation criteria included: risk prediction accuracy (calibration), discrimination of participants with versus without AN or CRC (optimism-adjusted C-statistics, range 0.5-1.0), the degree of risk stratification and C-statistics in external validation.
Among study participants, 8806 (3.3%) had a positive FIT result, 3254 (1.2%) had AN detected and 557 (0.2%) had cancer. F-Hb concentrations in rounds 1 and 2 were the strongest outcome predictors, with adjusted ORs of up to 9.4 (95% CI 7.5 to 11.7) for the highest F-Hb category. Risk predictions matched the observed risk for most participants (calibration intercept -0.008 to -0.099; slope 0.982-0.998), and discriminated participants with versus without AN or CRC with C-statistics of 0.78 (95% CI 0.77 to 0.79) and 0.73 (95% CI 0.71 to 0.75), respectively. The predicted risk ranged from 0.4% to 36.7% for AN and from 0.0% to 5.5% for CRC across participants. In external validation, the model retained similar discrimination accuracy for AN (C-statistic 0.77, 95% CI 0.66 to 0.87) and CRC (C-statistic 0.78, 95% CI 0.66 to 0.91).
Participants at lower versus higher risk of future AN or CRC can be accurately identified based on their age, sex and particularly, prior F-Hb concentrations. Risk stratification should be considered based on this information.
检测粪便血红蛋白（F-Hb）浓度在粪便免疫化学试验（FIT）基础的结直肠癌（CRC）筛查中重复测量的预后潜力。
预后模型。
2014-2018 年荷兰每两年进行一次基于 FIT 的筛查计划。
265881 名参与者完成了三轮 FIT，前两轮的检测结果为阴性（F-Hb<47µg Hb/g 粪便）。
对 FIT 阳性（F-Hb≥47µg Hb/g 粪便）的参与者进行结肠镜随访。
我们评估了在第 3 轮检测晚期肿瘤（AN）和 CRC 的预后模型，预测因子包括参与者年龄、性别、第 1 轮和第 2 轮的 F-Hb 以及 F-Hb 的类别/组合/非线性变换。主要评估标准包括：风险预测准确性（校准）、有和无 AN 或 CRC 的参与者之间的区分（校正后 C 统计量，范围 0.5-1.0）、风险分层程度和外部验证的 C 统计量。
在研究参与者中，8806 名（3.3%）的 FIT 结果为阳性，3254 名（1.2%）发现有 AN，557 名（0.2%）患有癌症。第 1 轮和第 2 轮的 F-Hb 浓度是最强的结果预测因子，最高 F-Hb 类别下的调整比值比（OR）高达 9.4（95%CI 7.5-11.7）。风险预测与大多数参与者的实际风险相匹配（校准截距-0.008 至-0.099；斜率 0.982-0.998），并通过 C 统计量为 0.78（95%CI 0.77-0.79）和 0.73（95%CI 0.71-0.75）区分了有和无 AN 或 CRC 的参与者。在整个参与者中，AN 的预测风险范围为 0.4%至 36.7%，CRC 的预测风险范围为 0.0%至 5.5%。在外部验证中，该模型对 AN（C 统计量 0.77，95%CI 0.66-0.87）和 CRC（C 统计量 0.78，95%CI 0.66-0.91）的区分准确性保持相似。
可根据参与者的年龄、性别以及特别是之前的 F-Hb 浓度，准确识别出未来发生 AN 或 CRC 的低风险和高风险人群。应根据这些信息进行风险分层。
