基于粪便检测的息肉切除术后结直肠癌监测可安全减少结肠镜检查：MOCCAS研究。

Stool-Based Testing for Post-Polypectomy Colorectal Cancer Surveillance Safely Reduces Colonoscopies: The MOCCAS Study.

作者信息

Carvalho Beatriz, de Klaver Willemijn, van Wifferen Francine, van Lanschot Meta C J, van Wetering Alouisa J P, van der Zander Quirine E W, Lemmens Margriet, Bolijn Anne S, Tijssen Marianne, Delis-van Diemen Pien, Buekers Nikkie, Daenen Kathleen, van der Meer Jaleesa, van Mulligen Pauline G, Hijmans Brenda S, de Ridder Sander, Meiqari Lana, Bierkens Mariska, van der Hulst René W M, Kuyvenhoven Johan P H, van Berkel Annemarie M, Depla Annekatrien C T M, van Leerdam Monique E, Jansen Jeroen M, Wientjes Caroline A, Straathof Jan W A, Keulen Eric T P, Ramsoekh Dewkoemar, Moons Leon M G, Zacherl Michael, Masclee Ad A M, de Wit Meike, Greuter Marjolein J E, van Engeland Manon, Dekker Evelien, Coupé Veerle M H, Meijer Gerrit A

机构信息

Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.

Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.

出版信息

Gastroenterology. 2025 Jan;168(1):121-135.e16. doi: 10.1053/j.gastro.2024.08.022. Epub 2024 Aug 30.

DOI:10.1053/j.gastro.2024.08.022

PMID:39218164

Abstract

BACKGROUND & AIMS: Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and health care. Stool tests may help to reduce surveillance colonoscopies by limiting colonoscopies to individuals at increased risk of advanced neoplasia.

METHODS

This cross-sectional observational study included individuals aged 50-75 years with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA test and 2 fecal immunochemical tests (FITs). Test accuracy was calculated for all surveillance indications. For the post-polypectomy indication only, which is the most common and is associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA) model. Stool-based strategies were simulated to tune each test's positivity threshold to obtain strategies at least as effective as colonoscopy surveillance.

RESULTS

There were 3453 individuals with results for all stool tests and colonoscopy; 2226 had previous polypectomy, 1003 had previous CRC, and 224 had a familial risk. Areas under the receiver operating characteristic curve for advanced neoplasia were 0.72 (95% CI, 0.69-0.75) for the multitarget stool DNA test, 0.61 (95% CI, 0.58-0.64) for the FIT OC-SENSOR (Eiken Chemical Co, Tokyo, Japan) and 0.59 (95% CI, 0.56-0.61) for the FIT FOB-Gold (Sentinel, Milan, Italy). Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance reduced the number of colonoscopies by 15%-41% and required 5.6-9.5 stool tests over a person's lifetime. Multitarget stool DNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs.

CONCLUSIONS

This study found that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.

CLINICALTRIALS

gov, Number: NCT02715141.

摘要

背景与目的

基于结肠镜检查的监测用于预防结直肠癌（CRC），给患者和医疗保健带来了沉重负担。粪便检测可能有助于减少监测性结肠镜检查，方法是将结肠镜检查局限于高级别瘤变风险增加的个体。

方法

这项横断面观察性研究纳入了有监测指征的50 - 75岁个体。在肠道准备前，参与者收集样本进行多靶点粪便DNA检测和2种粪便免疫化学检测（FIT）。计算所有监测指征下检测的准确性。仅针对息肉切除术后指征（这是最常见的指征且与相对较低的CRC风险相关），使用结直肠癌腺瘤和锯齿状途径（ASCCA）模型评估基于粪便的监测的长期影响。模拟基于粪便的策略来调整每种检测的阳性阈值，以获得至少与结肠镜检查监测同样有效的策略。

结果

共有3453名个体完成了所有粪便检测和结肠镜检查；2226人曾接受息肉切除术，1003人曾患CRC，224人有家族风险。多靶点粪便DNA检测针对高级别瘤变的受试者工作特征曲线下面积为0.72（95%CI，0.69 - 0.75），FIT OC - SENSOR（日本东京荣化学公司）为0.61（95%CI，0.58 - 0.64），FIT FOB - Gold（意大利米兰哨兵公司）为0.59（95%CI，0.56 - 0.61）。至少与结肠镜检查监测同样有效的基于粪便的息肉切除术后监测策略可将结肠镜检查次数减少15% - 41%，且一个人一生中需要进行5.6 - 9.5次粪便检测。基于多靶点粪便DNA的监测比结肠镜检查监测成本更高，而基于FIT的监测节省成本。