| 余 微,尹 利,王娇丽,等.定量粪便免疫化学试验在四川省结直肠癌机会性筛查中的应用效果分析[J].中国肿瘤,2025,34(7):539-545. |
| 定量粪便免疫化学试验在四川省结直肠癌机会性筛查中的应用效果分析 |
| Analysis of the Application Effect of Quantitative Fecal Immunochemical Test in Colorectal Cancer Opportunistic Screening in Sichuan |
| 投稿时间：2025-01-03 |
| DOI：10.11735/j.issn.1004-0242.2025.07.A006 |
|
 |
| 中文关键词: 结直肠癌 定量粪便免疫化学试验 结肠镜 机会性筛查 |
| 英文关键词:colorectal cancer quantitative fecal immunochemical test colonoscopy opportunistic screening |
| 基金项目:四川省保健科研课题（川干研2024-801） |
|
| 摘要点击次数: 227 |
| 全文下载次数: 131 |
| 中文摘要: |
| 摘 要：［目的］ 分析定量粪便免疫化学试验（fecal immunochemical test，FIT）在健康体检人群结直肠癌（colorectal cancer，CRC）机会性筛查中的应用效果。［方法］ 纳入2021年1月1日至2023年12月31日在四川省肿瘤医院健康管理中心完成定量FIT的10 025名健康体检者作为研究对象，对 FIT 阳性者建议行诊断性结肠镜检查。分析人群定量FIT阳性率、结肠镜筛查顺应率以及各级结直肠病变检出率，比较定量FIT阳性和阴性组行结肠镜筛查各级结直肠病变检出差异和结肠镜资源负载，评估定量FIT 对非进展期病变和进展期病变的诊断效能。［结果］ 定量FIT阳性率为6.24%（95%CI：5.77%~6.71%）。结肠镜筛查顺应率为20.93%（95%CI：17.74%~24.12%）。共284名结肠镜受检者中，检出CRC 7例，进展期腺瘤21例，非进展期腺瘤52例，非腺瘤性息肉40例，其他良性病变51例，无异常113人。定量FIT阳性组人群的非进展期腺瘤、进展期腺瘤、CRC以及非进展期病变和进展期病变的检出率均明显高于定量FIT阴性人群，无异常者病变检出率则明显低于定量FIT阴性组，差异均有统计学意义（P均<0.05）。定量FIT阳性与阴性组结肠镜资源负载分别为5.46（95%CI：1.56~9.34）、38.25（95%CI：30.55~45.95）。FIT测定值水平随着病变严重程度的增高而逐渐上升，组间差异有统计学意义（H=48.308，P<0.001）。定量FIT对非进展期病变和进展期病变有较高的灵敏度和阴性预测价值，分别为71.15%、85.71%和90.20%、97.39%。定量FIT筛查非进展期病变和进展期病变的曲线下面积（area under curve，AUC）分别为0.653（95%CI：0.572~0.734，P=0.001）、0.720（95%CI：0.631~0.808，P<0.001）。［结论］ 定量 FIT 适用于无症状健康体检人群的 CRC 机会性筛查，对非进展期病变和进展期病变具有良好诊断效能，对 FIT 阳性者行结肠镜检查可提高病变检出率并减少结肠镜资源消耗，契合我国卫生资源现状。 |
| 英文摘要: |
| Abstract：［Purpose］ To analyze and evaluate the application effect of quantitative fecal immunochemical test (FIT) in the opportunistic screening of colorectal cancer (CRC) in health examination population. ［Methods］ 10 025 healthy individuals who completed quantitative FIT at the Health Management Cancer of Sichuan Cancer Hospital from January 1， 2021 to December 31， 2023 were included. Participants with positive FIT results were recommended for diagnostic colonoscopy. Quantitative FIT positivity rate， colonoscopy screening compliance rate， and colorectal lesion detection rate in the queue population were analyzed， the detection rate of colorectal lesions and colonoscopy resource load between quantitative FIT positive and negative colonoscopy screening groups at all levels were compared and the diagnostic efficacy of quantitative FIT for non progressive lesions and progressive lesions were explored. ［Results］ The positive rate of quantitative FIT was 6.24% (95%CI： 5.77%~6.71%). The compliance rate of colonoscopy screening was 20.93% (95%CI： 17.74%~24.12%). Among 284 colonoscopy patients， 7 cases were detected with CRC， 21 cases with advanced adenomas， 52 cases with non advanced adenomas， 40 cases with non adenomatous polyps， 51 cases with other benign lesions， and 113 cases without abnormalities. The detection rates of non advanced adenomas， advanced adenomas， colorectal cancer， non progressive lesions and progressive lesions in the quantitative FIT positive group were significantly higher than those in the quantitative FIT negative group. The detection rates of those without obvious abnormalities were significantly lower than those in the quantitative FIT negative group， and the differences were statistically significant(all P<0.05). The resource burden of colonoscopy in the quantitative FIT positive and negative groups was 5.46 (95%CI： 1.56~9.34) and 38.25 (95%CI： 30.55~45.95)， respectively. The level of FIT measurement gradually increases with the severity of the lesion， and the difference between groups is statistically significant (H=48.308， P<0.001). Quantitative FIT has high sensitivity and negative predictive value for non progressive lesions and progressive lesions， with values of 71.15%， 85.71% and 90.20%， 97.39%， respectively. The AUC values for quantitative FIT screening of non progressive lesions and progressive lesions were 0.653 (95%CI： 0.572~0.734， P=0.001) and 0.720 (95%CI： 0.631~0.808， P<0.001)， respectively. ［Conclusion］ Quantitative FIT， as a suitable technique for CRC opportunistic screening in health check-up population， has good diagnostic efficacy for non progressive lesions and progressive lesions. Performing colonoscopy on FIT positive individuals can improve lesion detection rates while reducing colonoscopy resource consumption， aligning with China’s healthcare resource landscape. |
|
在线阅读
查看全文 查看/发表评论 下载PDF阅读器 |