Centre for Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK.
Public Health Scotland, Edinburgh, UK.
Colorectal Dis. 2024 Apr;26(4):675-683. doi: 10.1111/codi.16925. Epub 2024 Feb 29.
Faecal immunochemical testing (FIT) is used in the detection of colorectal cancer (CRC). FIT is invariably used at a single faecal haemoglobin (f-Hb) concentration threshold. The aim of this observational study was to explore risk scoring models (RSMs) with f-Hb and other risk factors for CRC in symptomatic patients attending primary care, potentially speeding diagnosis and saving endoscopy resources.
Records of patients completing FIT were linked with The Scottish Cancer Registry and with other databases with symptoms, full blood count and demographic variables, and randomized into derivation and validation cohorts. Stepwise multivariable logistic regression created RSMs assessed in the validation cohort.
Of 18 805 unique patients, 9374 and 9431 were in the derivation and validation cohorts, respectively: f-Hb, male sex, increasing age, iron deficiency anaemia and raised systemic immune inflammation index created the final RSM. A risk score threshold of ≥2.363, generating the same number of colonoscopies as a f-Hb threshold of ≥10 μg Hb/g gave improved sensitivity for CRC in both cohorts. A RSM which excluded f-Hb was used to investigate the effect of raising the f-Hb threshold from ≥10 to ≥20 μg Hb/g in those with a low risk score. This approach would have generated 234 fewer colonoscopies but missed four CRCs.
The RSM conferred no significant benefit to patients with very low f-Hb and CRC. Alternative strategies combining FIT with other variables may be more appropriate for safety-netting of symptomatic patients. Further work to develop and investigate the value of RSM for significant bowel disease other than CRC may also be beneficial.
粪便免疫化学检测（FIT）用于结直肠癌（CRC）的检测。FIT 始终在单个粪便血红蛋白（f-Hb）浓度阈值下使用。本观察性研究的目的是探索风险评分模型（RSM），该模型结合 f-Hb 和其他初级保健中出现症状的 CRC 患者的危险因素，以加速诊断并节省内镜资源。
完成 FIT 的患者记录与苏格兰癌症登记处以及具有症状、全血细胞计数和人口统计学变量的其他数据库相关联，并随机分为推导和验证队列。逐步多变量逻辑回归创建了在验证队列中评估的 RSM。
在 18805 名独特的患者中，分别有 9374 名和 9431 名患者在推导和验证队列中：f-Hb、男性、年龄增加、缺铁性贫血和升高的全身免疫炎症指数构成了最终的 RSM。风险评分阈值≥2.363 与 f-Hb 阈值≥10μg Hb/g 产生相同数量的结肠镜检查，可提高两个队列中 CRC 的敏感性。排除 f-Hb 的 RSM 用于研究在低风险评分患者中，将 f-Hb 阈值从≥10 提高到≥20μg Hb/g 的效果。这种方法可以减少 234 次结肠镜检查，但会遗漏 4 例 CRC。
RSM 对 f-Hb 极低且患有 CRC 的患者没有带来显著获益。替代策略，即 FIT 与其他变量相结合，可能更适合对有症状的患者进行安全网筛查。进一步开发和研究 RSM 对除 CRC 以外的重要肠道疾病的价值也可能是有益的。
