广州市天河区结直肠癌筛查:基于粪便免疫化学检测和危险因素初步筛选出需要行结肠镜检查者

Screening for colorectal cancer in Tianhe,Guangzhou:results of combining fecal immunochemical tests and risk factors for selecting patients requiring colonoscopy

目的:探讨联合粪便免疫化学检测(FIT)和高危因素问卷调查(HRFQ)初筛出需行结肠镜检查者的结直肠癌(CRC)筛查方案应用于中国的可行性。方法:2015-2016年间,我们对中国广州市天河区45岁以上居民进行了一项CRC筛查项目。所有筛查对象均接受FIT检测和HRFQ调查,作为初筛。对于FIT阳性和/或HRFQ调查结果考虑存在高危风险的受检者,我们推荐其行进一步结肠镜检查。结果:共计10074名居民纳入CRC筛查项目,其中17.5%的受检者FIT阳性,19.4%经HRFQ调查被认为具有高危风险。经推荐,有773名受检者接受了进一步的结肠镜检查。该筛查方案对非腺瘤性息肉、低危腺瘤、高危腺瘤和CRC的总体阳性预测值分别为4.9%、11.4%、15.9%和1.6%。其中,FIT阳性结果对上述四种病变的阳性预测值分别为5.2%、15.9%、22.5%和2.5%,HRFQ阳性结果分别为4.1%、10.2%、14.3%和1.4%,FIT和HRFQ均为阳性结果的阳性预测值分别为4.5%、16.4%、23.7%和2.8%。结论:我们的两步法CRC筛查策略(FIT和HRFQ阳性者行进一步结肠镜检查)可有效发现早期CRC。鉴于对CRC和腺瘤较的高检出率和阳性预测值,该筛查方案可继续用于我们这项大规模CRC筛查项目的后续研究。

Objective:To explore the performance of a protocol combining fecal immunochemical test(FIT)and a high-risk factor questionnaire(HRFQ)for selecting patients requiring colonoscopy as part of a population-based colorectal cancer(CRC)screening program in China.Methods:From 2015 to 2016,we conducted a CRC screening program for all residents aged 45 years or older in Tianhe District,Guangzhou City,China.Participants underwent an FIT and received an HRFQ as part of primary screening.Those with positive FIT and/or HRFQ results were considered to be at high risk and were recommended to undergo colonoscopy.Results:A total of 10074 subjects were recruited and enrolled in the screening program.In the enrolled population,17.5%had positive FIT results and 19.4%had positive HRFQ results.Of those recommended to undergo diagnostic colonoscopy,773 did so.The screening method’s overall positive predictive value(PPV)was 4.9%for non-adenomatous polyps,11.4%for low-risk adenomas(LRAs),15.9%for high-risk adenomas(HRAs)and 1.6%for CRC.The PPVs of positive FIT results for nonadenomatous polyps,LRAs,HRAs and CRC were 5.2%,15.9%,22.5%and 2.5%,respectively.The PPVs of positive HRFQ results for non-adenomatous polyps,LRA,HRA and CRC were 4.1%,10.2%,14.3%and 1.4%,respectively.The PPVs associated with combined positive FIT and HRFQ results for non-adenomatous polyps,LRAs,HRAs and CRC were 4.5%,16.4%,23.7%and 2.8%,respectively.Conclusion:Our results suggest that this two-step CRC screening strategy,involving a combination of FIT and HRFQ followed by colonoscopy,is useful to identify early-stage CRC.The high detection rates and PPVs for CRC and adenomas encourage this strategy’s use in ongoing screening programs.