Long-term effectiveness of endoscopic and stool-based colorectal cancer screening strategies: a systematic review and network meta-analysis.

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Therapeutic Advances in Gastroenterology Pub Date : 2026-06-04 eCollection Date: 2026-01-01 DOI:10.1177/17562848261454186

Motoki Kaneko, Atsushi Sakuraba

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引用次数: 0

Abstract

Background: The population impact of colorectal cancer (CRC) screening depends on test performance and uptake, yet the comparative effectiveness of colonoscopy (CS), flexible sigmoidoscopy (FS), fecal immunochemical test (FIT), and guaiac-based fecal occult blood test (gFOBT) remains uncertain.

Objectives: To compare the 10-year effects of CS, FS, FIT, and gFOBT on CRC incidence, CRC mortality, and all-cause mortality.

Design: A systematic review and network meta-analysis.

Data sources and methods: We searched PubMed, EMBASE, and Cochrane CENTRAL from inception to June 13, 2025, for randomized controlled trials enrolling average-risk adults comparing CS, FS, FIT, or gFOBT with no screening (NS) or each other. Risk ratios (RRs) with 95% confidence intervals (CI) were synthesized using a frequentist random-effects model. Intention-to-treat (ITT) analyses estimated invitation-based population effectiveness, with exploratory per-protocol (PP) analyses serving as a complementary assessment for screening completers (high risk of bias and very low certainty). The sparse network lacked closed loops, precluding formal inconsistency assessment.

Results: In ITT analyses, CS (RR 0.83, 95% CI 0.72-0.96) and FS (0.78, 0.74-0.83), but not FIT (limited evidence) or gFOBT, reduced CRC incidence versus NS. For CRC mortality, FS (0.74, 0.67-0.83) and gFOBT (0.87, 0.79-0.95), but not CS or FIT, reduced risk. No strategy reduced all-cause mortality. In exploratory PP analyses, CS (0.78, 0.62-0.99) and FS (0.72, 0.66-0.79) reduced CRC incidence. For CRC mortality, CS (0.52, 0.31-0.85), FS (0.58, 0.49-0.70), and gFOBT (0.71, 0.61-0.82) reduced risk.

Conclusion: CS reduced CRC incidence in ITT analyses but showed limited population-level effectiveness when uptake was low. FS reduced CRC incidence and mortality in ITT analyses, and gFOBT reduced CRC mortality. Screening strategies should be selected based on test characteristics, real-world participation, and healthcare capacity. PP findings were exploratory and should not be used in isolation to guide recommendations.

Trial registration: PROSPERO registration number CRD420251127511.

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内镜和粪便为基础的结直肠癌筛查策略的长期有效性：系统回顾和网络荟萃分析。

背景：结直肠癌（CRC）筛查对人群的影响取决于检查的表现和接受情况，但结肠镜检查（CS）、乙状结肠镜检查（FS）、粪便免疫化学检查（FIT）和愈疮木粪便潜血检查（ggft）的比较效果仍不确定。目的：比较CS、FS、FIT和gobt对CRC发病率、CRC死亡率和全因死亡率的10年影响。设计：系统回顾和网络荟萃分析。数据来源和方法：我们检索了PubMed、EMBASE和Cochrane CENTRAL，从一开始到2025年6月13日，纳入平均风险成人的随机对照试验，比较CS、FS、FIT或gobt与无筛查（NS）或彼此之间的差异。采用频率随机效应模型合成95%置信区间的风险比（rr）。意向治疗（ITT）分析估计了基于邀请的人群有效性，探索性方案分析（PP）作为筛选完成者的补充评估（高偏倚风险和极低确定性）。稀疏网络缺乏闭环，排除了正式的不一致性评估。结果：在ITT分析中，CS （RR 0.83, 95% CI 0.72-0.96）和FS（0.78, 0.74-0.83）比NS降低了CRC发病率，但FIT（证据有限）或ggfbt没有降低。对于结直肠癌死亡率，FS（0.74, 0.67-0.83）和gobt（0.87, 0.79-0.95）降低了风险，但CS或FIT没有降低风险。没有策略降低全因死亡率。在探索性PP分析中，CS（0.78, 0.62-0.99）和FS（0.72, 0.66-0.79）降低了CRC的发病率。对于结直肠癌死亡率，CS (0.52, 0.31-0.85)， FS（0.58, 0.49-0.70）和gobt（0.71, 0.61-0.82）降低了风险。结论：在ITT分析中，CS降低了CRC的发病率，但当摄取较低时，其人群水平的有效性有限。在ITT分析中，FS降低了CRC的发病率和死亡率，gobt降低了CRC的死亡率。筛查策略的选择应基于测试特征、实际参与情况和医疗保健能力。PP研究结果是探索性的，不应单独用于指导建议。试验注册：普洛斯彼罗注册号CRD420251127511。

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

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.