三种粪隐血试验在结直肠癌筛检中的效率与费用分析

Comparison of three FOBT protocols for colorectal cancer screening in Chinese-a multicenter study

目的评价3种粪隐血试验筛检结直肠癌的效率与费用。方法5个医院按统一方案,对324例患者连续进行3次化学法粪隐血试验(CFOBT)、免疫法粪隐血试验(IFOBT)和结肠镜检查。计算CFOBT、IFOBT和序贯粪隐血试验[CFOBT阳性者进行IFOBT,再阳性者,行结肠镜检查,称序贯粪隐血试验(SFOBT)]的筛检效率和费用。结果323例合格病例中,49例结直肠癌;60例结肠腺瘤;60例结肠炎;15例痔疮和139例正常结肠。(1)连续3次粪隐血检查CFOBT、IFOBT和SFOBT的敏感性分别为95.9%、95.9%和93.9%,三种隐血试验间差异无统计学意义。IFOBT和SFOBT的特异性分别为89.2%和94.2%均显著高于CFOBT(75.5%),SFOBT又显著高于IFOBT。调整癌检出例数到同一水平后,在3个粪隐血方案中,每检出1例癌的花费SFOBT最低。(2)连续2次粪隐血检查CFOBT、IFOBT和SFOBT的敏感性分别为77.8%、87.8%和75.5%,IFOBT的敏感性明显高于CFOBT和SFOBT。特异性分别为88.5%、96.4%和98.6%,SFOBT与IFOBT的特异性显著高于CFOBT,但SFOBT与IFOBT间差异无统计学意义。调整癌检出例数后,每检出1例癌的费用IFOBT最低。(3)3种粪隐血试验筛检方案的早期癌检出率均为60%。(4)结直肠腺瘤的检出率为41.6%～48.3%;随腺瘤直径的增大检出率亦有所增加,>2cm的腺瘤检出率可达到87.5%。结论依从性?

Objective To evaluate three FOBT protocols of colorectal cancer screening.~Methods A multycenter study was conducted based on a consulted program.The effectiveness/cost of each protocole(CFOBT,IFOBT,SFOBT) were evaluated by the identifying patients who underwent CFOBT and IFOBT for 3 times consecutively as well as colonoscopy .Results 323 eligible patients including 49 colorectal cancers,60 colon adenomas,60 chronic colitis,15 hemorrhoids and 139 normal colon were observed. The effect/cost of CRC screening protocols was following:1). For 3 times of FOBT consecutively:There was no significant difference for their sensitivity among CFOBT,IFOBT and SFOBT(95.9%,95.9%&93.9%) but the specificity of IFOBT and SFOBT(89.21% and 94.24%) were higher significantly than CFOBT(75.54%).The specificity of SFOBT was higher than IFOBT.After adjusting their detecting number of cancer to same level the cost of SFOBT was the lowest. among these FOBTs.2). For 2 times of FOBT consecutively: The sensitivity of CFOBT,IFOBT and SFOBT were 77.8%,87.8% and 75.5% respectively.The sensitivity of IFOBT was higher than SFOBT and CFOBT significantly.Their specificity were 88.5%,96.4% and 98.6% respectively. The specificity of IFOBT and SFOBT were higher significantly than CFOBT. However, there was no significant difference for the specificity between IFOBT and SFOBT. After adjusting their detecting number of cancer to same level the cost of IFOBT was the lowest. among these FOBTs.3).The detected rate of early colorectal cancer was 60% for all of 3 protocols. 4).41.6%~48.3% of adenomas was found by the 3 protocols, and 87.5% of adenomas over 2cm in diameter were detected by any one of FOBT.Conclusions For the population with nice compliance 3 times of SFOBT will be recommended as a screening protocol of colorectal cancer. For that with poor compliance 2 times of IFOBT was recommended 3.The majority of adenomas in that advanced lesion existed might be detected by FOBT.