Wu Q N, Zhang Z, Kong X H
Department of Gastrointestinal Endoscopy, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou510655, China Biomedical Innovation Center, the Sixth Affiliated Hospital, Sun Yat-sen University,Guangzhou510655, China.
Department of Gastrointestinal Endoscopy, Shipai Hospital of Dongguan, Dongguan523330, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Dec 25;27(12):1269-1275. doi: 10.3760/cma.j.cn441530-20240423-00151.
To examine follow-up data of different subgroups in order to further evaluate the performance and practical value of community colorectal cancer screening by detection of stool methylation syndecan-2 gene (m) among residents of Shipai Town, Dongguan City. This was an observational study. From May 2021 to February 2022, the Shipai Town government of Dongguan City completed screening for colorectal cancer by detection of stool m in 10,708 residents from 18 villages who had met the initial screening criteria and been selected using whole population sampling. From May 2022 to February 2023, the research group conducted follow-up of participants about one year after the initial screening. Residents in the gray zone according to the initial screening were followed up by colonoscopy. Additionally, 1,000 residents with negative results on the initial screening were randomly sampled to undergo colonoscopy. Stool m detection was performed again on residents who had had positive results on the initial screening, and colonoscopy was performed on those who again tested positive. Compliance with colonoscopy and detection of gastrointestinal lesions during follow-up were assessed in different subgroups. Of the 438 residents in the gray zone on the initial screening, 155 underwent colonoscopy follow-up (colonoscopy compliance rate 35.4% [155/438]). These colonoscopies revealed that 27 (17.4%) of the participants had gastrointestinal lesions, including advanced adenomas in 22 cases (14.2%) and non-adenomatous polyps in two cases (3.2%). No colorectal carcinomas was identified. Of the 1, 000 randomly sampled residents with negative results on initial screening, 286 underwent colonoscopy follow-up (colonoscopy compliance rate 28.6% [286/1000]), These colonoscopies revealed that 11 (3.8%)of these individuals had gastrointestinal lesions, including three advanced adenomas (1.0%), five non-advanced adenomas (1.7%), one serrated adenoma or polyp (0.3%), and two non-adenomatous polyps (0.7%), but no colorectal carcinomas. Of the 821 residents who tested positive in the initial screening, 511 again underwent stool mSDC2 detection one year later (follow-up rate 62.2% [511/821]). Of these participants, 66 tested positive again (rate of 12.9% [66/511]), 39 (7.6%) of them in the gray zone, whereas 406(79.5%) tested negative. Forty-seven of the residents with positive results underwent colonoscopy (colonoscopy compliance rate 71.2% [47/66]), which revealed 36 (76.6%) gastrointestinal lesions, including 10 advanced adenomas (21.3%), nine non-advanced adenomas (19.1%) and 17 non-adenomatous polyps (36.2%). Stool m detection performs well as a screening tool. In our study, colorectal cancer or precancerous lesions were extremely rare in participants who tested negative on the initial screening. However, some of the participants who tested in the gray zone on initial screening had precancerous colorectal lesions, particularly advanced adenomas, which would have been missed without follow-up colonoscopy. Of note, stool m detection has good follow-up value in individuals who test positive on initial screening.
为了进一步评估东莞市石排镇居民通过检测粪便甲基化Syndecan-2基因（m）进行社区结直肠癌筛查的不同亚组的随访数据、性能及实用价值。这是一项观察性研究。2021年5月至2022年2月，东莞市石排镇政府对来自18个村庄的10708名符合初始筛查标准并通过整群抽样入选的居民进行了粪便m检测的结直肠癌筛查。2022年5月至2023年2月，研究组在初始筛查约一年后对参与者进行随访。根据初始筛查处于灰色区域的居民通过结肠镜检查进行随访。此外，对1000名初始筛查结果为阴性的居民进行随机抽样以接受结肠镜检查。对初始筛查结果为阳性的居民再次进行粪便m检测，对再次检测为阳性的居民进行结肠镜检查。评估不同亚组在随访期间结肠镜检查的依从性及胃肠道病变的检出情况。初始筛查处于灰色区域的438名居民中，155名接受了结肠镜随访（结肠镜检查依从率为35.4%[155/438]）。这些结肠镜检查显示，27名（17.4%）参与者有胃肠道病变，包括22例高级别腺瘤（14.2%）和2例非腺瘤性息肉（3.2%）。未发现结直肠癌。在随机抽样的1000名初始筛查结果为阴性的居民中，286名接受了结肠镜随访（结肠镜检查依从率为28.6%[286/1000]），这些结肠镜检查显示，其中11名（3.8%）个体有胃肠道病变，包括3例高级别腺瘤（1.0%）、5例非高级别腺瘤（1.7%）、1例锯齿状腺瘤或息肉（0.3%）和2例非腺瘤性息肉（0.7%），未发现结直肠癌。在初始筛查呈阳性的821名居民中，511名在一年后再次进行了粪便mSDC2检测（随访率为62.2%[511/821]）。在这些参与者中，66名再次检测为阳性（比率为12.9%[66/511]），其中39名（7.6%）处于灰色区域，而406名（79.5%）检测为阴性。47名检测结果为阳性的居民接受了结肠镜检查（结肠镜检查依从率为71.2%[47/66]），检查发现36名（76.6%）有胃肠道病变，包括10例高级别腺瘤（21.3%）、9例非高级别腺瘤（19.1%）和17例非腺瘤性息肉（36.2%）。粪便m检测作为一种筛查工具表现良好。在我们的研究中，初始筛查呈阴性的参与者中结直肠癌或癌前病变极为罕见。然而，一些初始筛查处于灰色区域的参与者有结直肠癌前病变，特别是高级别腺瘤，若不进行后续结肠镜检查这些病变将会漏诊。值得注意的是，粪便m检测对初始筛查呈阳性的个体具有良好的随访价值。
