| 杨金华,贺加贝,费兴林,等.定量粪便免疫化学试验阳性阈值设定对结直肠癌筛查检出结果的影响[J].中国肿瘤,2025,34(1):10-16. |
| 定量粪便免疫化学试验阳性阈值设定对结直肠癌筛查检出结果的影响 |
| Yield of Different Quantitative Fecal Immunochemical Test Cut-Offs in the Colorectal Cancer Screening Program |
| 投稿时间：2024-07-23 |
| DOI：10.11735/j.issn.1004-0242.2025.01.A003 |
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| 中文关键词: 结直肠癌 筛查 定量粪便免疫化学试验 结肠镜 |
| 英文关键词:colorectal cancer screening quantitative fecal immunochemical test colonoscopy |
| 基金项目:国家自然科学基金（81973124） |
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| 中文摘要: |
| 摘 要：［目的］ 比较定量粪便免疫化学试验（fecal immunochemical test，FIT）的不同阳性阈值设定对结直肠癌及癌前病变检出的影响。［方法］ 浙江省嘉善县第三轮结直肠癌早诊早治项目针对当地40~74岁人群进行定量FIT与结直肠癌高危因素问卷联合初筛，并对初筛阳性人群进行结肠镜检查。纳入2021年9月至2023年8月完成定量FIT人群为研究对象，分别计算FIT阳性阈值设定为100、120、140、160、180、200 ng/mL时各类结直肠病变阳性预测值。采用Cochran-Armitage趋势检验分析阳性预测值随FIT阳性阈值设定的变化趋势，并评估不同筛查起始年龄和FIT阳性阈值设定对结肠镜需求和病变检出的影响。［结果］ 共有58 256人完成定量FIT。参与定量FIT筛查的人群中，共有3 106人粪便血红蛋白浓度＞100 ng/mL，其中2 186人接受结肠镜检查，结肠镜检查参与率为70.38%。结肠镜共检出非进展期腺瘤588例、进展期病变355例（包括结直肠癌30例和进展期腺瘤325例）。随着FIT阳性阈值设定的升高，结肠镜受检对象的非进展期病变阳性预测值均显著减少，进展期病变阳性预测值均显著增加。筛查起始年龄为45岁、FIT阳性阈值设定为100 ng/mL时，结肠镜需求减少率与进展期病变漏诊率的比值最小。［结论］ 不同FIT阳性阈值设定下的结直肠癌检出情况存在显著差异，FIT阳性阈值设定升高，进展期病变的阳性预测值增加。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze the diagnostic yield of quantitative fecal immunochemical test (FIT) at different cut-offs in colorectal cancer (CRC) screening. ［Methods］ The sequential screening method was adapted in Jiashan CRC screening program for local residents aged 40~74 years old， which included a quantitative FIT and high-risk factor questionnaire for primary screening and subsequent colonoscopy for the diagnostic screening. Subjects who participated in quantitative FIT were included in this study between September， 2021 and August， 2023. The positive predictive values (PPVs) for colorectal neoplasms were calculated at the cut-offs of 100， 120， 140， 160， 180 and 200 ng/mL of FIT. The Cochran-Armitage trend test was performed to compare the trend of PPVs at different cut-offs. The effects of different starting age and FIT cut-offs on requirement of colonoscopy and advanced neoplasia detection were assessed. ［Results］ A total of 58 256 individuals completed the quantitative FIT， and 3 106 had fecal hemoglobin concentrations > 100 ng/mL， among whom 2 186 underwent colonoscopic examination with a compliance rate of 70.38%. The colonoscopy detected 588 cases of non-advanced adenomas and 355 cases of advanced neoplasms (AN)， including 30 cases of CRC and 325 cases of advanced adenomas. Progressively increasing the cut-off showed a decrease in PPVs of non-advanced adenomas and an increase of AN. The ratio of the rate of reduced requirement of colonoscopy to the missed rate of the progressive lesions was the smallest when the screening start age was 45 years old and the positive FIT threshold was set at 100 ng/mL.［Conclusion］ There were significant differences in the diagnostic yield at different cut-offs of FIT. Increasing the cut-offs of FIT will elevate PPVs for the advanced neoplasms. |
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