结直肠癌筛查中粪便免疫化学试验应用进展及展望

Application research progress and prospect of fecal immunochemical test in colorectal cancer screening

结直肠癌(CRC)是一种常见的消化道肿瘤,早期诊断可以降低患者的经济负担和死亡率。粪便免疫化学试验(FIT)作为CRC筛查中方便可行的无创检测,可提高结肠镜检查依从性,降低漏诊率,逐渐被广泛应用。本研究概述FIT的原理、分类及操作方法,与结肠镜检查对CRC的诊断效能对比,分析其影响因素、局限性及应用展望。应用PubMed及中国知网(CNKI)、万方数据等检索系统,以“fecal immunochemical test、colorectal cancer screening、粪便免疫化学试验、结直肠癌筛查”等为关键词,检索日期设置为2013-01-01-2023-05-31。纳入标准:(1)有关CRC筛查及FIT的研究;(2)近10年发表的图书文献、临床试验、随机对照研究;(3)研究设计合理、统计学方法选择得当。剔除标准:(1)研究内容相似或重复;(2)文章质量差,或存在设计缺陷;(3)研究结果、结论不明确;(4)数据不明确或统计学方法错误。共检索到相关英文文献264条,中文文献85条。根据剔除标准剔除英文文献227条,中文文献80条,最后纳入分析42篇文献。结果分析显示,不同阈值FIT筛查CRC的诊断效能不同,10μg/g的阈值设定是比较合理的。不同结肠部位和肿瘤分期FIT的诊断效能不同。高风险分组可以通过降低阈值提高诊断效能。增加检测次数可以提高诊断效能。FIT检测结果受温度与季节、仪器品牌与系统、药物、采样操作、阈值设定及质量控制等影响。提示,FIT可用于CRC筛查,可以通过加强宣传、提高依从性、技术改进及个性化筛查策略的制定等进一步提高诊断效能。

Colorectal cancer(CRC)is a common digestive tract tumor.Early diagnosis can significantly reduce the economic burden and mortality of patients.Fecal immunochemical tests(FIT)have gradually become widely used as a convenient and feasible non-invasive test in CRC screening.This article overviewed the principles,classification and operating methods of FIT,compared the diagnostic efficacy with colonoscopy for CRC and analyzed influencing factors,limitations and application prospects.Multiple databases such as PubMed,CNKI and Wanfang data were used to search for relevant research on FIT.The keywords were fecal immunochemical test,colorectal cancer screening,tool immunochemical test,colorectal cancer screening.The retrieval date was set from January 1,2013 to May 31,2023.Inclusion criteria:(1)Studies on CRC screening and FIT.(2)Published books,clinical trials and randomized controlled studies in the past10 years.(3)Reasonable study design and appropriate statistical methods.Exclusion criteria:(1)Studies with similar or repetitive content.(2)Poor article quality or design defects.(3)The research results and conclusions were unclear.(4)Unclear data or incorrect statistical methods.A total of 264 relevant English literature and 85 Chinese literature were retrieved.According to the exclusion criteria,227 English literature and 80 Chinese literature were excluded,and finally55 articles were included in the analysis.The results of the analysis showed that the diagnostic efficacy of FIT screening for CRC varied with different threshold values,and the threshold setting of 10μg/g was considered relatively reasonable.The diagnostic efficacy of FIT varied with different colon segments and tumor stages.The diagnostic efficacy could be improved by lowering the threshold in high risk group.Increasing the number of tests could improve the diagnostic efficiency,FIT results were affected by temperature and season,instrument brand and system,drugs,threshold setting,quality control.It suggests that FIT can be used for CRC screening.The diagnostic efficacy can be further improved by strengthening the publicity,improving the adherence,technical improvement and the formulation of personalized screening strategies.