Yeh Jen-Hao, Tseng Cheng-Hao, Wang Wen-Lun, Chen Chih-I, Liu Yu-Peng, Lee Yi-Chia, Wang Jaw-Yuan, Lin Yu-Ching
Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA DaChang Hospital, I-Shou University, Kaohsiung 813, Taiwan.
Department of Medical Technology, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan.
Cancers (Basel). 2023 May 31;15(11):3006. doi: 10.3390/cancers15113006.
The incidence of early-onset colorectal cancer (CRC) is increasing. Many guidelines recommend initiating screening at 45 years. This study investigated the detection rate of advanced colorectal neoplasm (ACRN) by using fecal immunochemical tests (FITs) in individuals aged 40-49 years.
PubMed, Embase, and Cochrane Library databases were searched from inception to May 2022. The primary outcomes were the detection rates and positive predictive values of FITs for ACRN and CRC in people aged 40-49 (younger age group) and ≥50 years (average risk group).
Ten studies with 664,159 FITs were included. The FIT positivity rate was 4.9% and 7.3% for the younger age and average risk groups, respectively. Younger individuals with positive FIT results had significantly higher risks of ACRN (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.79-3.73) or CRC (OR 2.86, 95% CI 1.59-5.13) than did individuals in the average-risk group, regardless of FIT results. Individuals aged 45-49 years with positive FIT results had a similar risk of ACRN (OR 0.80, 95% CI 0.49-1.29) to that of people aged 50-59 years with positive FIT results, although significant heterogeneity was observed. The positive predictive values of the FIT were 10-28.1% for ACRN and 2.7-6.8% for CRC in the younger age group.
The detection rate of ACRN and CRC based on FITs in individuals aged 40-49 years is acceptable, and the yield of ACRN might be similar between individuals aged 45-49 and 50-59 years. Further prospective cohort and cost-effective analysis are warranted.
早发性结直肠癌（CRC）的发病率正在上升。许多指南建议在45岁时开始筛查。本研究调查了40至49岁个体使用粪便免疫化学检测（FIT）对晚期结直肠肿瘤（ACRN）的检出率。
检索PubMed、Embase和Cochrane图书馆数据库，检索时间从数据库建立至2022年5月。主要结局是40至49岁（较年轻年龄组）和≥50岁（平均风险组）人群中FIT对ACRN和CRC的检出率及阳性预测值。
纳入了10项研究，共664,159次FIT检测。较年轻年龄组和平均风险组的FIT阳性率分别为4.9%和7.3%。无论FIT检测结果如何，FIT结果为阳性的较年轻个体患ACRN（比值比[OR]2.58，95%置信区间[CI]1.79 - 3.73）或CRC（OR 2.86，95% CI 1.59 - 5.13）的风险显著高于平均风险组个体。FIT结果为阳性的45至49岁个体患ACRN的风险（OR 0.80，95% CI 0.49 - 1.29）与FIT结果为阳性的50至59岁个体相似，尽管观察到显著的异质性。较年轻年龄组中FIT对ACRN的阳性预测值为10% - 28.1%，对CRC的阳性预测值为2.7% - 6.8%。
40至49岁个体基于FIT检测的ACRN和CRC检出率是可接受的，45至49岁和50至59岁个体的ACRN检出率可能相似。有必要进行进一步的前瞻性队列研究和成本效益分析。
