Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, the China National Ministry of Education, Key Laboratory of Molecular Biology in Medical Sciences, Zhejiang, The Zhejiang University School of Medicine Affiliated Second Hospital, Zhejiang; Zhejiang Provincial Clinical Research Center for Cancer and Cancer Center of Zhejiang University, Hangzhou, Zhejiang.
Cancer Prevention Institute of Jiashan County, Jiashan, Zhejiang.
ESMO Open. 2024 Sep;9(9):103676. doi: 10.1016/j.esmoop.2024.103676. Epub 2024 Aug 20.
Colorectal cancer (CRC) incidence has been increasing. Colonoscopy is still a gold standard method for its early diagnosis but using colonoscopy alone as a mass screening method is unrealistic. This study is to investigate whether combining fecal immunochemical test (FIT) and high-risk-factors questionnaire (HRFQ) with colonoscopy improve the cost-effectiveness of a mass CRC screening.
CRC screening protocol combining FITs and HRFQ in the first stage and colonoscopy in the second stage was used in 50 villages/towns in 2007-2015. Residents aged 40-74 years were eligible for this free screening. A total of 160 210 (76.12%) participants completed first-stage screening, and 28 679 (17.90%) participants were defined as positive, among which 21 715 (75.72%) participants completed colonoscopy and were included in the final analysis. Outcomes were followed up until 2020.
The compliance was 76.12% and 75.72% in the first and second screening stage, respectively. A total of 252 CRC, 4033 adenoma, 1234 advanced neoplasm, and 5534 total neoplasm cases were detected in the screening. The positive predictive values of CRC, adenoma, advanced neoplasm, and total neoplasm were higher in FITs+ than those in the HRFQ+ population, respectively. A total of 64.60% and 43.42% total neoplasm cases were found in FITs+ and HRFQ+ (8.02% for both), respectively. The total colorectal neoplasm and CRC cases detected by combining HRFQ and FITs increased by 55.08% and 40.00%, respectively, and their increases were higher compared to HRFQ. The detection cost per any neoplasm by combining HRFQ and FITs was <$5331, while that by FITs and HRFQ alone was <$4570 and $5380, respectively.
Combining FITs and HRFQ with colonoscopy improve the cost-effectiveness of a mass CRC screening program. This protocol can be recommended for most populations, especially those in the countries and areas with high population density and low physician/population ratio.
结直肠癌（CRC）的发病率一直在上升。结肠镜检查仍然是早期诊断的金标准方法，但单独使用结肠镜检查作为大规模筛查方法是不现实的。本研究旨在探讨粪便免疫化学检测（FIT）和高危因素问卷（HRFQ）联合结肠镜检查是否能提高大规模 CRC 筛查的成本效益。
2007-2015 年，在 50 个村镇使用联合 FIT 和 HRFQ 的 CRC 筛查方案。40-74 岁的居民有资格参加这项免费筛查。共有 160210 名（76.12%）参与者完成了第一阶段筛查，其中 28679 名（17.90%）参与者呈阳性，其中 21715 名（75.72%）参与者完成了结肠镜检查并纳入最终分析。结果随访至 2020 年。
第一和第二阶段筛查的依从率分别为 76.12%和 75.72%。在筛查中共发现 252 例 CRC、4033 例腺瘤、1234 例高级别瘤变和 5534 例总瘤变病例。FITs+组 CRC、腺瘤、高级别瘤变和总瘤变的阳性预测值均高于 HRFQ+组。FITs+组和 HRFQ+组（均为 8.02%）分别发现了 64.60%和 43.42%的总瘤变病例。联合 HRFQ 和 FITs 检测到的总结直肠瘤和 CRC 病例分别增加了 55.08%和 40.00%，与 HRFQ 相比增加更高。联合 HRFQ 和 FITs 的每例任何瘤变的检测成本<5331 美元，而单独使用 FITs 和 HRFQ 的检测成本分别<4570 美元和 5380 美元。
联合使用 FIT 和 HRFQ 与结肠镜检查可提高大规模 CRC 筛查计划的成本效益。该方案可推荐给大多数人群，特别是在人口密度高、医生与人口比例低的国家和地区。
