Yield and Effectiveness of Two-Sample Fecal Immunochemical Test-based Screening Program for Colorectal Cancer.

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2024-11-05 DOI:10.1016/j.cgh.2024.10.010

Zenghao Xu, Jinhua Yang, Jiabei He, Qilong Li, Xinglin Fei, Hao Bai, Kai Gao, Yuanliang He, Chen Li, Mengling Tang, Jianbing Wang, Mingjuan Jin, Kun Chen

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Abstract

Background and aims: Colorectal cancer (CRC) incidence and mortality of China account for nearly 30% of the global attributable fraction. We aimed to estimate the yield and effectiveness of two-sample fecal immunochemical test (FIT)-based screening program in China.

Methods: Eligible individuals were invited for two-sample FIT between 2007 and 2021, with positive ones (cutoff: 40 μg/g before 2013, and 20 μg/g thereafter) referred for colonoscopy. Participation rates, detection rates, and positive predictive values (PPVs) were calculated. Participants were classified into: FIT+ / colonoscopy compliers, FIT+ / colonoscopy non-compliers, and FIT- as controls. We compared CRC incidence and mortality, and calculated the age reaching comparable risk.

Results: Among 246,349 invitees, 150,524 (61.10%) participated in two-sample FIT, with 16,994 (11.29%) identified as FIT+; 12,816 (75.41%) underwent colonoscopy, yielding a detection rate and PPV of 0.57% and 6.70% for advanced neoplasia. Median follow-up was 10.58 years. Compared with FIT- participants, CRC incidence and mortality were relatively similar among FIT+ / colonoscopy compliers with hazard ratio (HR) and 95% confidence interval (CI) of 0.94 (0.75-1.19) and 1.62 (1.09-2.41), but higher among non-compliers with HR and 95% CI of 3.52 (2.85-4.34) and 4.41 (2.96-6.55). Taking CRC incidence and mortality risk of FIT- participants at age 50.0 as the benchmark, FIT+ / colonoscopy compliers reached same risk at 50.6 and 46.1 years, while non-compliers at age 38.0 and 37.9 years, respectively.

Conclusions: Two-sample FIT could effectively identify high-risk populations, and colonoscopy compliance is associated with a lower risk of CRC incidence and mortality. This strategy might facilitate CRC screening practice in countries with large populations.

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基于两份粪便免疫化学检验样本的大肠癌筛查计划的收益和效果。

背景和目的：中国的结直肠癌（CRC）发病率和死亡率占全球的近30%。我们旨在估算中国以粪便免疫化学检验（FIT）为基础的双样本筛查项目的收益率和有效性：方法：2007 年至 2021 年间，我们邀请符合条件的个人进行双样本粪便免疫化学检测，阳性者（2013 年前的临界值为 40 μg/g，之后为 20 μg/g）将被转诊至结肠镜检查。计算了参与率、检出率和阳性预测值 (PPV)。参与者被分为FIT+/结肠镜检查符合者、FIT+/结肠镜检查不符合者和 FIT- 作为对照组。我们比较了 CRC 发病率和死亡率，并计算了达到可比风险的年龄：在 246,349 名受邀者中，150,524 人（61.10%）参加了双样本 FIT，其中 16,994 人（11.29%）被确定为 FIT+；12,816 人（75.41%）接受了结肠镜检查，晚期肿瘤的检出率和 PPV 分别为 0.57% 和 6.70%。中位随访时间为 10.58 年。与 FIT- 参与者相比，FIT+/结肠镜检查合格者的 CRC 发病率和死亡率相对相似，危险比 (HR) 和 95% 置信区间 (CI) 分别为 0.94 (0.75-1.19) 和 1.62 (1.09-2.41)，但非合格者的 CRC 发病率和死亡率较高，危险比和 95% 置信区间分别为 3.52 (2.85-4.34) 和 4.41 (2.96-6.55)。以 FIT- 参与者 50.0 岁时的 CRC 发病率和死亡率风险为基准，FIT+/结肠镜检查符合者分别在 50.6 岁和 46.1 岁时达到相同的风险，而非符合者分别在 38.0 岁和 37.9 岁时达到相同的风险：结论：双样本 FIT 可有效识别高风险人群，结肠镜检查达标与较低的 CRC 发病率和死亡率风险相关。这一策略可能会促进人口众多国家的 CRC 筛查实践。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.