优化亚太地区结直肠肿瘤筛查评分系统在结直肠肿瘤筛查中的应用

Application of optimized Asia-Pacific colorectal screening scoring system in the screening of colorectal neoplasms

目的探讨亚太地区结直肠肿瘤筛查(APCS)评分系统在结直肠肿瘤筛查中的优化策略。方法选择2016年2至12月和2018年3至12月在空军军医大学西京医院、西安医学院第一附属医院行结直肠肿瘤伺机性筛查的人群为研究对象。所有入组病例在行结肠镜检查前行APCS评分(低危0~1分,中危2~3分,高危4~7分)、BMI测量、粪便隐血试验(FOBT)和血浆甲基化Septin9基因(mSEPT9)检测,以结肠镜检查和活组织病理诊断为金标准,比较以上方法在结直肠肿瘤筛查中的效能,确定优化APCS评分系统筛查效能的策略。采用卡方检验进行统计学分析。结果共纳入筛查对象494例,其中结直肠息肉133例,包括结直肠腺瘤86例(非进展期腺瘤82例,进展期腺瘤4例)和非腺瘤性结直肠息肉47例。APCS评分高危筛查人群结直肠腺瘤检出率(33.3%,33/99)分别是中危(16.5%,39/237)、低危(8.9%,14/158)人群的2.02和3.76倍,差异均有统计学意义(均Bonferroni校正法,P均<0.016);BMI>23.9 kg/m2筛查人群中结直肠腺瘤的检出率高于BMI≤23.9 kg/m2人群[22.2%(59/266)比11.8%(27/228)],差异有统计学意义(χ2=9.126,P=0.003);而血浆mSEPT9表达阳性筛查人群中结直肠腺瘤的检出率与血浆mSEPT9表达阴性人群比较[22.4%(15/67)比17.3%(47/271)]差异无统计学意义(χ2=0.913,P=0.378)。在同时行BMI测量、FOBT和血浆mSEPT9检测的158例中低危(APCS评分≤3分)人群中,BMI>23.9 kg/m2者结直肠腺瘤再次检出率高于BMI≤23.9 kg/m2者[17.8%(16/90)比5.9%(4/68)],差异有统计学意义(χ2=4.957,P=0.030);BMI>23.9 kg/m2且FOBT阳性者结直肠腺瘤再次检出率高于BMI≤23.9 kg/m2且FOBT阴性者[28.1%(9/32)比8.0%(4/50)],差异有统计学意义(χ2=5.942,P=0.027);FOBT和血浆mSEPT9表达均阳性者结直肠腺瘤再次检出率高于两者均阴性者[5/14比12.9%(12/93)],差异有统计学意义(χ2=4.738,P=0.045)。结论 APCS评分系统应用于结直肠肿瘤序贯筛查时,优化选择BMI替代或联合FOBT可改善患者依从性,提高筛查效能,在结直肠肿瘤早期诊治中有重要的临床意义和推广价值。

Objective To explore the optimization strategy of the Asia-Pacific colorectal screening(APCS)scoring system in the screening of colorectal neoplasms.Methods From February to Decomber in 2016 and March to December in 2018,at Xijing Hospital of Air Force Military Medical University and the First Affiliated Hospital of Xi′an Medical University,patients who received opportunistic screening colonoscopy were enrolled.Before colonoscopy,the APCS score(low-risk zero to one points,medium-risk two to three points and high-risk four to seven points),body mass index(BMI),fecal occult blood test(FOBT)and plasma methylated Septin9 gene(mSEPT9)of all patients were detected and recorded.The results of colonoscopy and biopsy pathology were taken as the gold standard,the efficacies of the above methods in screening colorectal neoplasms were compared to determine and optimize the screening efficiency of APCS scoring system.Chi-square test was used for statistical analysis.Results A total of 494 patients were screened,of whom 133 cases were diagnosed with colorectal polyps,including 86 cases of colorectal adenomatous polyps(82 cases of non-progressive adenoma,and four cases of advanced-adenoma),and 47 cases of non-adenomatous polyps.According to the APCS score,the detection rate of colorectal adenomatous polyps of the high-risk group(33.3%,33/99)was 2.02 and 3.76 times higher than those of the medium-risk group(16.5%,39/237)and low-risk group(8.9%,14/158),respectively(both Bonferroni correction test,both P<0.016).The detection rate of colorectal adenomatous polyps of patients with BMI>23.9 kg/m2 was significantly higher than that of patients with BMI≤23.9 kg/m2(22.2%,59/266 vs.11.8%,27/228),and the difference was statistically significant(χ2=9.126,P=0.003).There was no statistically significant difference in the detection rate of colorectal adenomatous polyps between patients with positive-mSEPT9 expression and patients with negative-mSEPT9 expression(22.4%,15/67 vs.17.3%,47/271)(χ2=0.913,P=0.378).Among 158 low and medium risk patients(APCS score≤three points)who underwent simultaneous BMI measurement,FOBT and plasma mSEPT9 test,the detection rate of colorectal adenomatous polyps in patients with BMI>23.9 kg/m2 was higher than that in patients with BMI≤23.9 kg/m2(17.8%,16/90 vs.5.9%,4/68),and the difference was statistically significant(χ2=4.957,P=0.030).The redetection efficacy of colorectal adenomatous polyps in patients with BMI>23.9 kg/m2 and FOBT-positive was higher than that in patients with BMI≤23.9 kg/m2 and FOBT-negative(28.1%,9/32 vs.8.0%,4/50)and the difference was statistically significant(χ2=5.942,P=0.027).In addition,the redetection rate of colorectal adenomatous polyps of patients with positive expression of FOBT and plasma mSEPT9 was also higher than that of patients with negative expression(5/14 vs.12.9%,12/93),and the difference was statistically significant(χ2=4.738,P=0.045).Conclusions When the APCS scoring system is used for sequential screening of colorectal tumors,the optinal choice of BMI replacement or combined with FOBT can improve the patients′compliance and screening efficiency,which has significant clinical significance and promotion value in the early diagnosis and treatment of colorectal neoplasms.