定性和定量粪便免疫化学试验筛查结直肠癌效果评价  

Evaluation of the effectiveness of qualitative and quantitative fecal immunochemical tests in colorectal cancer screening

作　　者：和金金 朱陈[1,2] 潘婷婷[2] 黄文雯 蒋秉洁 余炜燕 王乐 吴维妙 杭栋 杜灵彬[1,2] HE Jinjin;ZHU Chen;PAN Tingting;HUANG Wenwen;JIANG Bingjie;YU Weiyan;WANG Le;WU Weimiao;HANG Dong;DU Lingbin(School of Public Health,Nanjing Medical University,Nanjing,Jiangsu 211166,China;Zhejiang Cancer Hospital,Hangzhou,Zhejiang 310022,China)

机构地区：[1]南京医科大学公共卫生学院,江苏南京211166 [2]浙江省肿瘤医院,浙江杭州310022

出　　处：《预防医学》2024年第4期317-321,共5页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：浙江省自然科学基金项目(LTGY23H260004)。

摘　　要：目的比较定性和定量粪便免疫化学试验(FIT)筛查结直肠癌的效果,为完善结直肠癌筛查策略提供依据。方法以2020年5月—2021年12月参加浙江省重点人群结直肠癌筛查项目的人群为研究对象,通过问卷收集基本信息、生活方式和疾病信息。采用问卷风险评估、定性或定量FIT进行初筛;风险评估结果显示高风险或FIT结果为阳性者进行结肠镜检查。比较定性和定量FIT筛查阳性率、结直肠癌检出率、阳性预测值和需镜检次数等指标的差异,并根据性别和年龄进行分层分析。结果纳入4099769人,定性FIT组3574917人,FIT筛查阳性率为11.35%,结直肠癌检出率为1.19%,阳性预测值为0.48%,每检出1例结直肠癌需要进行83.84次肠镜检查;定量FIT组524852人,FIT筛查阳性率为6.70%,结直肠癌检出率为2.31%,阳性预测值为1.01%,每检出1例结直肠癌需要进行43.23次肠镜检查。定量FIT组结直肠癌检出率、阳性预测值高于定性FIT组,需镜检次数少于定性FIT组(均P<0.05)。性别和年龄分层后结果稳定。结论与定性FIT相比,定量FIT提高了结直肠癌检出率,降低了结肠镜检查的工作量,更适合大规模人群的结直肠癌筛查。Objective To compare the effectiveness of qualitative and quantitative fecal immunochemical tests(FIT)in identifying colorectal cancer,so as to provide insights into perfecting screening strategies for colorectal cancer.Methods Participants in the Colorectal Cancer Screening Program for Key Populations in Zhejiang Province from May 2020 to De-cember 2021 were recruited,and their demographic information,lifestyle and disease history were collected through a questionnaire survey.Qualitative or quantitative FIT along with a questionnaire-based risk assessment were employed as the initial screening tests.Individuals who were positive in any FIT or had high-risk assessment results were required to attend a subsequent colonoscopy examination.The positive rate,detection rate of colorectal cancer,positive predictive value and number of colonoscopies required were compared between qualitative and quantitative FITs,and stratified anal-yses by gender and age were conducted.Results Totally 4099769 participants were included.The qualitative FIT group included 3574917 individuals,yielding a positive rate of 11.35%,a detection rate of 1.19%,a positive predic-tive value of 0.48%and 83.84 colonoscopies required to detect one cancer case.The quantitative FIT group involved 524852 individuals,yielding a positive rate of 6.70%,a detection rate of 2.31%,a positive predictive value of 1.01%and 43.23 colonoscopies required to detect one cancer case.The quantitative FIT group showed significantly higher de-tection rate of colorectal cancer,higher positive predictive value and less number of colonoscopies required compared to the qualitative FIT group(all P<0.05).The same results were obtained after stratification by gender and age.Conclu-sion Compared to qualitative FIT,quantitative FIT improves the detection of colorectal cancer and reduces the work-load of colonoscopy examinations,making it more suitable for colorectal cancer screening in large-scale populations.

关 键 词：结直肠癌筛查 定性粪便免疫化学试验 定量粪便免疫化学试验 

分 类 号：R735[医药卫生—肿瘤]