自然人群序贯粪隐血试验连续性结直肠癌普查的队列研究:19年结果分析

A Cohort Study of Consecutive Colorectal Cancer Screening Using Sequential Fecal Occult Blood Test in a Natural Population: Results of 19 Years Study

背景:筛查是早期发现结直肠癌(CRC)的重要手段。目的:评价自然人群序贯粪隐血试验(SFOBT)连续性CRC普查在提高早期CRC检出率、患者长期生存率和降低CRC发生率方面的作用。方法:于1987～2005年,应用SFOBT对一组基本固定的中老年人群(初次普查人群3002例)行连续性CRC普查。每1～2年接受一次普查者计入普查组,连续3年或3年以上未接受普查者计入未普查组。FOBT阳性者行结肠镜检查。于北京军区总医院行手术治疗的1033例CRC患者作为对照组。结果:19年中普查人群共发生CRC52例,总CRC发生率为90.4/10万人·年。普查组共检出CRC25例,漏诊7例,CRC检出率为57.6/10万人·年,发生率为73.8/10万人·年;未普查组发生CRC20例,发生率为141.4/10万人·年。普查组DukesA/B期患者比例(95.5%对31.2%和43.9%,P<0.05)和5年生存率(77.8%对33.3%和39.8%,P<0.05)显著高于未普查组和对照组。SFOBT筛查CRC的19年总敏感性为90.6%,特异性为98.0%,阳性预测值为3.2%,阴性预测值为99.99%。结论:SFOBT应用于自然人群连续性普查可提高早期CRC检出率和患者5年生存率。切除普查中发现的腺瘤可明显降低CRC发生率。该筛查方案具有较高的敏感性和特异性,但仍需高度关注其结肠镜检查的依从性。

Screening is an important approach to early detection of colorectal cancer （CRC）. Aims： To evaluate the effectiveness of sequential fecal occult blood test （SFOBT）, a consecutive screening method for CRC, in raising early detection rate, long-term survival rate and lowering of the incidence of CRC in natural population. Methods： From 1987 to 2005, a consecutive screening for CRC with SFOBT was performed in a relatively fixed middle-aged and aged population. The initial screening subjects included 3002 individuals. Subjects who had undergone SFOBT every one or two years were identified as the screening group, while those who had not taken the test for at least 3 years were identified as the non- screening group. Colonoscopy was offered if the test was positive. The control group included 1033 CRC patients underwent surgery in the General Hospital of Beijing Military Command of Chinese PLA. Results： Fifty-two cases were found to have CRC during the 19 years, the annual incidence of CRC in this population was 90.4/los. In the screening group, 25 cases of CRC were detected and 7 cases were missed in the screening, the annual detection rate and incidence of CRC were 57.6/ 10s and 73.8/los, respectively. In the non-screening group, 20 cases of CRC were found and the annual incidence of CRC was 141.4/10^5. Number of cases of CRC in relatively early stages （Dukes A/B） in the screening group was more than that in the non-screening group and controls （95.5% vs. 31.2% and 43.9%, P〈0.05）. The 5-year survival rate in the screening group was also higher （77.8% vs. 33.3% and 39.8%, P〈0.05）. The sensitivity, specificity, positive predictive value and negative predictive value of this 19-year SFOBT screening for CRC were 90.6%, 98.0%, 3.2% and 99.99%, respectively. Conclusions： Most of the CRC cases detected by consecutive screening using SFOBT are in the relatively early stages and can lead to a higher 5-year survival rate. Removal of adenomas followed by colonoscopy surveillance significantly reduces the incidence of CRC. The sensitivity and specificity of SFOBT are satisfactory, but more concern should be paid on the compliance of subsequent colonoscopy.